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VETERINARY  OBSTETRICS 


INCLUDING    THE 


DISEASES  OF   BREEDING  ANIMALS 


THE  NEW-BORN 


By  W.  L.  WILLIAMS 

Professor  of  Surgery  and  Obstetrics  iu  the  New  York  State  Veterinary 
College  at  Cornell  University 


PUBLISHED    BV   THE   AUTHOR 

AT    ITHACA,    N.   Y. 

1909 


COPYRIGHT   BY 

W.    I,.    WILLIAMS 

1909 


PRESS  OF 

ANDRUS  &  CHURCH 

ITHACA,    N.  Y. 


PREFACE. 


Whatever  apology  may  be  due  the  American  veteriuar}-  pro- 
fession for  the  imperfections  of  this  volume,  the  author  does  not 
deem  it  necessary  to  apologize  for  considering  desirable  a  treat- 
ise upon  Veterinary  Obstetrics,  and  the  diseases  and  accidents 
intimately  associated  therewith. 

In  American  veterinary  colleges,  and  largely  in  the  veterinary 
colleges  of  the  world,  obstetrics  is  the  most  poorly  and  ineffi- 
ciently taught  of  all  the  major  subjects  in  the  veterinary  curri- 
culum. The  available  obstetric  literature  in  the  English  language 
is  very  unsatisfactory.  The  author  believes  that  the  chief  ques- 
tion affecting  this  treatise  is  not  the  need  for  a  comprehensive 
volume  upon  veterinary  obstetrics  and  the  closelj^  related  sub- 
jects, but  the  efficiency  of  the  volume  to  partly  supply  that  need. 

We  have  felt  warranted  in  introducing  features  which  are  not 
usually  included  in  treatises  upon  obstetrics.  We  have  devoted 
a  chapter  to  the  "  Accidents  and  Injuries  of  Coition."  A  yet 
greater  space  has  been  devoted  to  the  "  Infections  of  Coition", 
especially  to  the  specific  venereal  infections.  Still  more  em- 
phasis has  been  placed  upon  the  subject  of  sterility. 

The  writer  desires  to  heartily  express  his  sense  of  profound 
obligation  to  the  various  authors  and  publishers  upon  whose 
publications,  with  their  kind  permission,  free  draft  has  been 
made  for  illustrations  and  material  for  the  text.  It  has  been 
aimed,  at  the  proper  places,  to  give  due  credit  for  the  source  of 
the  material  used. 

Special  mention  is  due  to  the  authors  and  publishers  of  the 
treatises  on  Embryology  by  Bonnet,  Heisler  and  Marshall ;  the 
Obstetrics  of  St.  Cyr  and  Violet,  Harms,  Franck,  DeBruin,  and 
Fleming  ;  the  Teratology  of  Gurlt ;  and  the  Handbook  of  Surgery 
and  Obstetrics  by  Bayer  and  Frohner. 

The  author  is  under  specially  deep  obligations  to  Professor 
Doctor  E.  Hess,  of  the  Berne  Veterinary  School,  for  his  courtesy 


^v  Preface 

in  permitting  the  insertion  in  our  text  of  his  extensive   and  ad- 
mirable contribution  relating  to  sterility  in  cows. 

With  a  keen  sense  of  the  many  and  serious  imperfections,  this 
volume  is  submitted  to  the  veterinary  profession  of  America, 
hoping  that  it  may  awaken  new  interest  in  the  practice  of 
obstetrics,  and  extend  some  aid  to  those  veterinarians  engaged 
in  obstetric  work. 

W.  L.  Williams. 
Cornell  University, 

June  I,    1909. 


CONTENTS. 

PAGE 

INTRODUCTORY  i 

OBvSTETRIC  ANATOMY 3 

A.  The  Accessory  Organs  OF  Reproduction 3 

The    Pelvis 3 

B.  The  Generative  Organs 11 

The  Ovaries 11 

The  Miillerian  Ducts  ;  the  Oviducts,  Uterus  and  Vagina 19 

OBSTETRIC   PHYSIOLOGY 40 

Reproduction 40 

Ovulation 44 

Estrum 48 

Copulation 49 

THE  DANGERS  AND  INFECTIONS  OF  COITION 50 

Physical    Injuries 50 

Generai.  Infections  of  Coition 64 

Contagious  Cellulitis 68 

Specific  Infections  of  Coition 73 

Dourine 73 

Genital  Horse  Pox_ 92 

Venereal  Diseases  of  Cattle 95 

Vesicular  Exanthem 95 

Granular  Venereal  Disease  (See  also  Appendix  I  page  1075 )__  97 

Venereal  Disease  of  the  Dog 104 

Venereal  Disease  of  vSheep  (See  also  Appendix  II  page  iii4")_  108 

Venereal  Disease  of  Rabbits no 

Venereal  Diseases  of  Swine  and  Goats no 

Other  Infections  of  Genitaiv  Organs in 

Bursattee  of  the  Penis  and  Prepuce in 

Actinomycosis  of  the  Genital  Organs  113 

MENSTRUATION 114 

FERTILIZATION 115 

The  Relation  between  Estrum,  Ovulation,  Fertilization  and 

Mf:nstruation 116 

vSTERILITY 119 

Sterility  of  the  Male  Animal 121 

Sterility  of  the  Female 153 

Nostrums  and  Panace^^  against  Sterility 272 

Artificial  Impregnation 278 

EMBRYOLOGY 281 

Germinal  Layers 284 

The  Primitive  Streak 285 

Formation  of  the  Embryo_ 286 

TheCoelom  or  Body  Cavity 287 

The  Nervous  System 288 


VI 


C 071  tents 


Development  OF  the  Organs  of  Special  Sense 296 

The  Olfactory  Organs 296 

The   Eye 298 

The  Ear 300 

Formation  OF  the  Digestive  Apparatus 304 

The  Lungs 310 

The  Teeth 311 

The  Liver 318 

The  Pancreas 318 

The  Circulatory  System 319 

The  Development  of  the  Urino-Genital  System 332 

The  Wolffian  Ducts 332 

The  Kidneys,  Ureters  and  Bladder 334 

The  Reproductive  Organs 335 

The  Limbs 341 

The  Fetal  Membranes 347 

The  Vitelline,  or  Yolk   Sac 347 

The  Amnion 347 

The  Allantois 353 

The  Chorion 355 

The  Placenta 358 

The  Umbilic  Cord 364 

TERATOLGY 367 

PREGNANCY  OR  GESTATION 369 

The  Form  of  the  Pregnant  Uterus 375 

The  Position  of  the  F'etus  in  Uterus 379 

Signs  of  Pregnancy 384 

The  Duration  of   Pregnancy 395 

HYGIENE  OF  THE  PREGNANT  ANIMAL 404 

ANOMALIES  IN  FECUNDATION  AND  GESTATION 413 

Superfecundation 413 

Extra-Uterine  Pregnancy 415 

DISEASES  OF  THE  PREGNANT  ANIMAL 421 

Osteomalacic 423 

Dropsy  of  the  Amnion  and  Allantois 424 

Dropsy  of  the  Uterus 430 

Paraplegia 431 

Amaurosis 435 

Rupture  of  Prepubian  Tendon 436 

Hernia  of  the  Uterus 445 

Rupture  of  the  Gravid  Uterus 447 

Ante-Partum  Prolapse  of  the  Vagina 449 

Metrorrhagia 457 

DISEAvSES  OF  THE  FETUS  AND  ITS  MEMBRANES 460 

Death  of  the  Fetus 460 

Maceration  or  Putrid  Decomposition  of  the  Fetus 463 

ABORTION 466 

Sporadic  or  Accidental  Abortion 467 


Co7itents  vii 

Enzootic  Abortion 473 

Infectious  Abortion 474 

NORMAL  PARTURITION 509 

ExPuivSiON  OF  Fetal  Membranes,  and  Involution  of  the  Uterus     529 

Presentations  and  Positions  of  the  Fetus 530 

Management  of  Normal  Parturition 538 

The  Care  of  the  Parturient  Animal  and  of  the  New-Born 550 

DYSTOKIA 568 

EQUIPMENT  FOR  OBSTETRIC  WORK 576 

Cords  and   Bands ,',76 

Halters 577 

Forceps 582 

Traction 586 

Repellers  and  Repulsion 595 

Instruments  for  Section 599 

General  Observations  upon  the   Construction   of   Obstetric 

Instruments 608 

Obstetric  Outfits 611 

The  Dress  of  the  Operator 613 

Position  and  Control  OF  the  Patient 615 

The  Prevention  of  Infection  During  Obstetric  Operations___  620 

The  Examination  of  the  Patient 623 

The  General  Handling  of  Dystokia 927 

OBSTETRIC  OPERATIONS 631 

Mutations : 631 

Forced  Extraction 640 

Embryotomy 641 

Exercises  in  Mutations  and  Embryotomy 661 

Caesarian  Section 663 

MATERNAL  DYSTOKIA 673 

Inadequate  Expulsive   Powers 673 

Pelvic  Constriction 674 

Rigidity  or  Spasm  of  Cervix   Uteri 682 

Induration  of  Cervix  Uteri 685 

Malignant  and  Other  New-Gro^s-ths  of  Genital  Passages 690 

DYSTOKIA  DUE  TO  DISPLACEMENTS  OF  UTERUS 692 

Hernia  of  Uterus 692 

Deviation  of  Uterus 692 

Torsion  of  Uterus 693 

FETAL    DYSTOKIA 714 

Development  of  the  Fetus  in  an  Abnormal  Position  in  the  Uterus  7 1 6 

Bicornual  Pregnancy  or  Transverse  Development  of  the  Fetus  716 

Abnormalities  in  the  Development,  or  Diseases  of  the  Fetus.  _  727 

Excess  of  Volume  of  the  Fetus 727 

Hj'drocephalus 736 

Ascites  and  Hydrothorax 739 

Anasarca 740 

Cysts  and  Cystic  Degeneration  of  Fetal  Organs 740 


viii  Confoifs 

Tumors  OF  the  Fetus 741 

Anomalies  and  Diseases  of  the  Fetal  Membranes 742 

Aberrations  and  Anomalies  in  the  Development  of  the  Fetus.  744 

Cainpylorrhachis 744 

Schistocormus  Reflexus 744 

Contractions  of  Extremities 746 

Double  aurlTriple  Monstrosities 748 

The  Dvstokia  of  Twins 752 

ABNORMAL  PRESENTATIONS  AND  POSITIONS  OF  THE  FETUS  753 

Dystokia  IN  the  Longitudinal  Presentations 753 

Dvstokia  in  the  Tranverse  Presentations : 786 

PATHOLOGY  OF  THE  PARTURIENT  OR  PUERPERAL  .STATE--  791 

Pathology  of  the  Placenta 791 

Retention  of  Fetal  Envelops 791 

Wounds  and  Injuries  to  the  Genital  and  Neighboring  Organs.  812 

Post-Partum  Hemorrhage 812 

Rupture  of  the  Uterus  and  Vagina 814 

Rupture  of  the  Bladder S20 

Rupture  of  the  Intestines 820 

Rupture  of  the  Diaphragm 821 

Rupture  of  the  vSacro-vSciatic  Ligaments 821 

Prolapse  of  the  Intestines  through  the  Ruptured  Walls  of   the 

Uterus  or  Vagina 821 

Prolapse  of  the  Bladder  through  a  Rupture  in  the  Vagina. 822 

Uterine  Prolapse 823 

Eversion  of  Vagina 848 

Prolapse  of  the  Rectum 854 

Eversion  of  the  Bladder 855 

Rupture  of  the  Perineum 857 

Vesico-Vaginal  Fistula 863 

Hematoma  of  the  Vulva 864 

Relaxation  of  the  Pelvic  vSymphj^sis . 1  866 

Contusion  of  the  Lumbo -Sacral  Nerves 866 

Contusion  of  the  Gluteal  Nerves 867 

Contusion  of  the  Obturator  Nerves 868 

PUERPERAL  INFECTIONS 871 

Acute  Metritis 872 

Acute  Endometritis  in  the  Mare 874 

Acute  Metro-Peritonitis  in  the  Mare 877 

Acute  Metritis  and  Metro  Peritonitis  in  the  Cow 878 

Acute  Metritis  in  the  Smaller  Animals 884 

Chronic  Metritis,  Pyometra 885 

Chronic  Metritis  in  the  Mare 885 

Chronic  Metritis  in  the  Cow 894 

Pyometra  in  the  Bitch  and  Cat 895 

Uterine   Abscess 896 

Vaginitis  and  Vulvitis 898 


Contents  ix 

Cystitis 9oo 

Peri- Vaginal  Abscesses 901 

Pyemic  Infection 902 

Puerperal  Septicemia 905 

Puerperal  Laminitis 907 

Puerperal  Tetanus 909 

PUERPERAL  ECLAMPTIC  DISEASES- 9" 

Parturient  Eclampsia  in  the  Mare 9^4 

Parturient  Paresis  in  the  Cow  ..   920 

Puerperal  Eclampsia  in  the  Sow 93^ 

The  Milk  Disease  of  Sheep 937 

Puerperal  Eclampsia  in  the  Bitch 93^ 

DISEASES  OF  THE  MAMMARY  GLANDS 939 

Mammitis  in  the  Cow 94° 

Acute  Mammitis 94 1 

Infectious  Mammitis  of  Cows 9^5 

Exanthema  of  the  Udder 960 

Tuberculosis  of  the  Udder 968 

Actinomycosis  of  the  Udder 972 

Mastitis  in  the  Mare 973 

Mammary  Strangles  in  the  Mare 973 

Botryomycosis  of  the  Udder 974 

Infectious  Gangrenous  Mammitis  of  Ewes 97^ 

Infectious  Agalactia  in  Goats  and  Sheep 977 

Mastitis  in  Swine 97^ 

Mammitis  in  the  Bitch 97^ 

Edema  of  the  Udder 979 

Tumors  of  the  Mammae 9^1 

Hemorrhages  in  the  Udder 9^3 

Milk  Fistulae 9^5 

Milk  Calculi 9^7 

Pendulous  Udder 9^8 

Dermatitis  of  the  Udder 9^8 

Furunculosis  of  the  Udder 990 

Wounds  of  the  Teats  and  Udder 99^ 

Wartsonthe  Teats 992 

Stricture  or  Atresia  of  the  Teats 993 

DISEASES  OF  THE  NEW-BORN 1003 

Infections  of  the  New-Born 1003 

Omphalo- Phlebitis 1005 

Tetanus   Neonatorum 1021 

Dysentery  of  the  New-Born 1022 

Sporadic  Dysentery  of  the  New-Born 1022 

Infectious  Diarrhea  of  Calves 1028 

Septic  Pleuro-Pneumonia  of  Calves 1032 

Calf  Septicaemia 1033 

Bacterisemia io33 


X  Contents 

Non-Infectious  Diseases  and  Defects  of  the  New-Born 1035 

Asphyxia 1035 

Umbilic    Hemorrhage 1037 

Persistent  Urachus 1039 

Retention  of  the  Meconium 1041 

Anatomical  Defects  of  the  New-Born 1046 

I'mbilic  Hernia 1046 

Scrotal  Hernia 1059 

Imperforate  Anus 1064 

Imperforate  Vulva , 1064 

Atresia  of  Posterior  Nares 1065 

Atresia  of  other  Body  Openings 1066 

Fissure  of  the  Palate 1067 

Persistent  Foramen  Ovale 1068 

Tongue  Tie .' 1069 

Hernia  Cerebrii   1069 

Odontomes 1069 

Rupture  of  the  Extensor  Pedis  Tendons  in  the  Anterior  Limbs 

OF  THE  New-Born 1070 

APPENDIX  I  The  Granular  Venereal  Disease  of  Cows 1075 

APPENDIX  II  The  Venereal  Disease   of  Sheep 1114 

Errata 1114 

Alphabetic  Index 1115 


VETERINARY  OBSTETRICS 


INTRODUCTORY 

Veterinary  obstetrics,  in  its  most  restricted  sense,  is  a  consid- 
eration of  the  necessary  or  advisable  oversight  or  aid  during  the 
act  of  parturition  in  domestic  animals.  Birth  constitutes  one  of 
the  most  prominent  epochs  in  mammalian  existence,  marking  the 
boundary  between  intra-uterine  or  fetal  development,  in  which 
the  young  animal  is  nourished  and  protected  within  the  maternal 
body  by  the  mother,  and  the  extra-uterine  life,  when  the  young 
animal  must  assume  more  or  less  independence  and  responsibility, 
partly  or  wholly  secure  its  own  food  and  provide  for  its  safety. 

The  giving  of  birth  to  young  is  the  culminating  act  of  a  series 
of  complex  and  interesting  phenomena,  the  perversion  or  inter- 
ruption of  any  one  of  which  may  lead  to  the  defeat  of  reproduc- 
tion, and  when  the  act  has  been  completed  and  living  offspring 
produced,  there  are  still  incidents  innnediately  following,  which 
are  essentially  dependent  upon  parturition  and  which  may  jeop- 
ardize the  life  or  usefulness  of  either  the  mother  or  her  young. 

The  subject  is  one  of  intense  scientific  and  economic  impor- 
tance as  it  lies  at  the  very  foundation  of  livestock  husbandrj-  and 
largely  determines  the  ultimate  success  or  failure  of  this  great 
industry. 

It  is  necessary  to  have  a  full  comprehension  of  each  corollary 
process  in  order  that  we  may  effectively  grasp  the  significance  of 
the  phenomenon  itself.  Successful  parturition  occurs  only  when 
the  prospective  mother  is  normal  in  the  structure  and  ph3\siologic 
development  of  all  her  organs  of  reproduction  and  of  others 
which  may  have  an  essential  relation  thereto  ;  and  the  fetus  must 
undergo  a  normal  development  ere  it  can  be  born  in  a  viable 
state. 

We  consequently  habitually  include  under  veterinary  obstet- 
rics all  factors  which  necessarily  precede  and  lead  directly  to  par- 
turition and  all  immediate  consequences  of  birth  which  affect  the 
health  of  either  the  mother  or  the  young.  In  this  wider  signifi- 
cance veterinary  obstetrics  may  be  defined  as  the  study  of  the 
I 


2  Veterinary  Obstcirics 

dangers  and  diseases  occurring  in  the  process  of  reproduction  in 
domestic  animals  and  our  means  for  avoiding  or  overcoming  them. 
Under  this  conception  we  necessarily  include  : 

1 .  A  study  of  the  anatomy  of  all  those  organs  having  a  vitnl 
relation  to  the  act  of  reproduction  either  directly  or  indirectly  : 
Obstetric  Anatoniv. 

2.  A  study  of  the  2hvsiologic  functions  of  the  reproductive 
orgao^.  including  such  phenomena  as  sexual  desire  or  estrum, 
ovulation,  menstruation,  copulation,  fecundation,  the  origin  and 
development  of  the  fetus  and  the  birth  of  the  young  :  Obstetric 
Physioloiiy. 

3.  The  pathology  of  breeding,  including  the  accidents  and  dis- 
eases dependent  upon  coition  or  interfering  with  fecundation. 

4.  Aberrations  in  the  development  of  the  embryo  :  Teratolop-j. 

5.  Accidents  and  diseases  of  the  mother  and  fetus  during 
pregnancy  ;  Pathology  of  Pregnancy . 

6.  Difficult  birth  :  Dystocia. 

7.  Accidents  and  diseases  of  the  mother  occurring  as  a  sequence 
to  parturition  :  Pathology  of  the  Puerperal  State. 

8.  Diseases  and  accidents  of  the  new-born  acquired  during 
intra-uterine  life  or  referable  to  the  exigencies  of  birth. 


OBSTETRIC  ANATOMY 

Each  organ  or  part  of  the  body  contributes  directly  or  indi- 
rectl3'  toward  the  function  of  reproduction,  but.  in  many  of  them, 
the  influence  is  so  remote  that  their  relationship  to  breeding  does 
not  require  special  consideration,  while  some  organs  or  parts,  de- 
signed primarily  to  serve  other  ends,  incidentally  perform  impor- 
tant accessor}^  offices  in  the  act  of  birth,  as  in  the  case  of  the  pel- 
vis, while  other  organs,  like  the  ovaries,  uterus,  vagina,  vulva  and 
mammae  are  devoted  exclusively  to  the  procreation  of  the  spe- 
cies and  are  designated  reproductory  or  generative  organs. 

A.  The  Accessory  Organs  of  Reproduction. 
The  Pelvis. 

The  pelvis  constitutes  an  accessory  organ  of  generation  of 
fundamental  importance  because  the  fetus  must  traverse  its  canal 
in  the  process  of  birth,  and  success  or  failure  may  be  decided  by 
the  amplitude  of  the  pelvic  channel  in  relation  to  the  size  of  the 
fetal  body. 

It  consists  of  a  bony  girdle  forming  the  posterior  bod}^  wall, 
into  which  extends  the  posterior  prolongation  of  the  peritoneal 
cavity,  and  the  terminal  portions  of  the  digestive,  urinary  and 
generative  systems.  Our  chief  obstetric  interest  in  the  pelvis  is 
in  its  internal  face,  constituting  the  walls  of  its  cavity. 

The  pelvis  is  composed  of  the  sacrum  and  coxae  or  ossa  inno- 
minata,  with  their  ligaments,  and  the  first  two  or  three  coccy- 
geal vertebrae  may  be  regarded  as  participating  somewhat  in  its 
formation  as  they  constitute  a  part  of  the  pelvic  roof. 

The  sacrum  consists  of  a  series  of  anchylosed  .sacral  yerte^ 
brae,  varying  in  number  in  the  different  species  of  domestic  ani- 
mals ;  in  the  horse  and  ruminants  five,  in  the  pig  four,  and  in 
carnivora  three. 

In  sagitttal  .section  it  presents  the  form  of  a  truncated  cone 
with  its  base  articulating  anteriorly  with  the  last  lumbar  verte- 
bra and  its  apex  posteriorly  with  the  first  coccygeal  bone, 

In  cross  section  it  is  triangular,  with  its  base  inferior.  The 
lateral  surfaces  offer  roughened  facets  for  articulation  with  the 
3 


4  Vetcnnary  Obstetrics 

coxae.  The  inferior  surface  contributes  to  the  formation  of  the 
pelvic  roof,  is  concave  from  before  to  behind,  essentially  plane 
from  side  to  side  and  shows  transverse  lines  of  demarcation  be- 
tween the  individual  vertebrae  in  the  form  of  ridges  varying  in 
prominence  with  species,  age,  breed  and  individual.  It  is  alleged 
that  the  sacrum  varies  according  to  sex,  the  articular  elevations 
being,  it  is  claimed,  less  prominent  in  the  female.  We  have  not 
been  able  to  verify  this  claim  by  the  study  of  specimens. 


Fig.  I.  Sagittal  Section  of  the  Pelvis  ok  the  Mare, 

SHOWING    H'MHO-SaCRAL    NERVES. 

S,  First  sacral  vertebra.  L,  Last  lumbar  vertebra.  A,  Last  lumbar 
nerve,  passing  passing  over  lumbo-sacral  eminence.  E,  Gluteal  nerves. 
O,  Obturator  nerve  entering  foramen. 


The  spinal  canal  extends  through  the  .sacrum  and  is  occu- 
pied by  the  terminal  nerves  of  the  spinal  cord.  The  inferior  sur- 
face of  the  bone  shows  a  series  of  paired  openings,  through  which 
the  sacral  nerves  emerge  to  take  a  prominent  part  in  the  forma- 
tion of  the  lumbo-.sacral  plexus.      Most  of  these  emerge  in  sucli  a 


The  Pelvis  5 

manner  as  to  render  mechanical  injur}'  to  them  during  parturi- 
tion very  improbable,  while  others,  especially  the  anterior  gluteal 
and  obturator  nerves  from  the  last  lumbar  pair.  Fig.  i,  have  to 
pass  over  a  promontory  marking  the  lumbo-sacral  articulation  at 
A,  in  such  a  manner  that  they  may  be,  and  not  .rarely  are, 
crushed  between*  the  bony  ridge  and  some  unyielding  part  of  the 
fetus  during  its  passage  through  the  pelvic  canal.  The  ob- 
turator nerve  may  also  be  injured  in  a  somewhat  similar  manner 
as  it  enters  the  obturator  foramen,  as  shown  in  Fig.  140.  (See 
Contusions  of  Lumbo-sacral  Nerves. ) 

The  two  coxae  or  ossa  innominata  are  elongated,  flattened 
bones,  widely  expanded  at  each  extremity,  where  they  are  com- 
posed chiefly  of  cancellated  tissue,  and  constricted  in  the  center, 
where  they  partake  more  of  the  structure  of  long  bones.  Above 
and  anteriorly  they  are  briefly  separated  from  each  other  by  the 
intervening  .sacrum,  with  which  they  articulate  by  means  of  an 
almost  immovable  joint  ;  behind  or  below  the}'  converge  to  form 
the  pelvic  floor,  in  which,  on  either  side  of  the  median  line  and 
about  midway  from  behind  to  before,  occur  two  large  oval  open- 
ings, the  foramina  ovale.  They  unite  on  the  median  line  to  con- 
stitute the  ischio-pubic  symphysis  and,  becoming  anchylosed  early, 
serve,  with  the  aid  of  the  well-nigh  immovable  sacro-iliac  articu- 
lation, to  complete  the  pelvic  girdle.  Near  the  middle  of  each 
coxa,  on  the  infero-external  face,  occurs  the  acetabulum  or  coty- 
loid cavity  for  articulation  with  the  femur. 

Each  coxa  is  composed  of  an  ilium,  ischium  and  pubis,  which 
constitute  separate  bones  during  early  fetal  life,  but  become  fused 
together  prior  to  birth  to  constitute  a  single  bone. 

The  general  direction  of  the  ossa  innominata  is  obliquely  back- 
wards and  downwards  from  the  sacrum,  the  two  coxae  curving 
at  first  outwards  and  later  inwards  to  unite  on  the  median  line 
and,  with  the  sacrum,  to  complete  the  oval  pelvic  inlet. 

The  ilium,  the  jargesJ.  of  the  three,  is  flat_and  triangular  in 
outline,  its  supero-external  face  being  concave  and  occupied  by 
the  gluteal  muscles,  the  infero-internal  face  being  occupied  largely 
by  the  articulation  with  the  .sacrum  inwardly  and  by  muscular 
insertions  laterally.  The  postero-inferior  angle  of  the  bone  is 
contracted  and  rounded  to  form  the  iliac  shaft  and  ends  by  con- 
curring with  the  ischium  and  pubis  in  the  formation  of  the  ace- 
tabulum.    The  two  ilia  extend  obliquely  downwards  and  back- 


6  Veterinary  Obstetrics 

wards  from  their  sacral  articulation,  their  inner  borders  being 
concave.  They  attain  their  greatest  distance  from  each  other 
soon  after  leaving  the  sacrum,  near  the  great  sciatic  notch,  at 
the  point  where  the  flattened  anterior  portion  merges  into  the 
shaft,  from  whence  they  converge  slightly  as  they  approach  the 
cotyloid  cavities.  ^The  ilia  form  the  major  portion  of  the  lateral 
walls  of  the  pelvic  inlet. 

The  ischium  is  an  irregular  triangular,  flattened  bone,  consti- 
tuting the  most  posterior  portion  of  the  pelvis  and  concurring 
with  the  pubis  in  the  formation  of  the  pelvic  floor.  It  occupies 
an  almost  horizontal  position  in  the  horse  and  most  domestic  ani- 
mals, but,  in  the  cow,  its  posterior  portion  is  directed  upwards  and 
backwards  and  compels  the  fetus,  during  its  expulsion,  to  pa.ss 
obliquely  upwards  and  backwards,  instead  of  horizontally  back- 
wards. Anteriorly,  it  constitutes  internally  the  posterior J)ouud- 
ary  of  the  foramen  ovale  and,  externall}',  concurs  in  the  formation 
of  the  acetabulum,  where  it  articulates  with  the  ilium  and  pubis  ; 
on  the  median  line  it  unites  throughout  its  anterior  part  with  the 
corresponding  bone  of  the  opposite  side,  constituting  the  pos- 
terior portion  of  the  pelvic  symphysis. 

The  postero-external  angles  of  the  ischia  are  tuberous,  con.sti- 
tuting  the  i.schial  tuberosities  and  between  these  is  the  receding 
angle  known  as  the  ischiatic  notch,  which  depends  largely  upon 
the  extent  of  the  tuberosities  for  its  depth  while  its  width  is  fixed 
by  the  degree  of  divergence  of  the  two  bones. 

This  triangular  notch  varies  greatly  with  species  and  individ- 
uals and  .some  authors  contend  that  it  is  wider  and  more  ample 
in  the  mare  than  in  the  horse.  The  latter  contention  is  not  well 
established  and,  if  it  exists,  is  not  sufficiently  marked  to  consti- 
tute a  means  for  differentiation  between  the  .sexes. 

The  ischium  is  of  little  obstetric  significance  in  domestic  ani- 
mals, except  possibl}'  in  the  cow,  where  the  notch  may  be  very 
deep  and  narrow  and  the  tuberosities,  being  very  prominent  and 
directed  sharply  upward  toward  the  coccyx,  tend  to  limit  the  di- 
mensions of  the  pelvic  outlet  and  constitute  a  barrier  to  the  pa.s- 
sage  of  the  fetus. 

The  pubis  is  a  flattened  bone  placed  transversely  at  the  anter- 
ior border  of  the  pelvis,  articulating  on  the  median  line  with  the 
corresponding  bone  of  the  opposite  side  to  constitute  the  floor  of 
the  pelvic  inlet.      It  articulates  posteriorly  with  the  ischium  and 


The  Pelvis  7 

concurs  with  the  ilium  and  ischium  in  the  formation  of  the  ace- 
tabuhim. 

In  the  mare  there  frequently  appears  a  sharp  elevation  on  the 
median  hne  at  the  anterior  end  of  the  symphisis  pubis,  surmount- 
ing the  pubic  brim  and  projecting  upwards  into  the  pelvic  cavity 
in  a  manner  to  endanger  the  integrity  of  the  vaginal  or  uterine 
walls  when  impinged  between  this  sharp  elevation  while  the  body 
of  the  fetus  is  passing  over  it  under  great  pressure.  See  Fig.  w^a. 
The  relations  between  the  pelvis  and  the  spinal  column  are 
maintained  by  a  series  of  ligaments  and  muscles.  The  sacro-iliac 
articulation  is  very  rigid,  the  two  bones  being  closely  applied  to 
each  other  by  means  of  roughened  surfaces  and  maintained  by 
short  and  very  strong  inter-osseous  ligaments. 

The  integrity  of  the  sacro-iliac  articulation  is  further  preserved 
behind  by  the  sacro-sciatic  ligament  and  in  front  by  the  pre- 
pubian  tendon  and  the  muscles  contributing  thereto. 

The  great  sacro-sciatic  ligament  arises  from  the  transversa 
spinous  ridge  of  the  sacrum  and, commencing  immediately  behind 
the  sacro-iUac  ajrticulatioii,  extends  to  the  posterior  extremity  of 
that  bone  ;  passing  downwards,  it  is  attached  along  the  supero; 
external  border  of  the  ijimn  and  ischium^ from  the  sacro-ihac 
^nk^tion,  backwards  to  the  ischial  tuberosity.  The  two  liga- 
ments thus  form  wide  aponeurotic  sheets,  which  constitute  the 
greater  portions  of  the  lateral  pelvic  walls  and  occupy  all  that 
area  comprised  between  those  portions  of  the  sacrum  and  ilium 
posterior  to  the  sacro-iliac  articulation  and  the  external  bor- 
der of  the  ischium  to  the  summit  of  the  ischial  tuberosity. 
This  broad  and  powerful  ligament  serves  to  prevent  the  posterior 
portion  of  the  pelvis  or  ischia  from  receding  downwards  from  the 
sacrum  and  affords  a  strong  and  somewhat  flexible  and  yielding 
wall  to  the  pelvic  cavity.  It  is  sufficiently  extensible  that,  under 
the  pressure  of  parturition,  it  yields  enough  to  permit  the  con- 
stricted outlet  to  equal  in  dimensions  the  larger  bony  inlet  to  the 
pelvis. 

The  powerful  pre^ubian  tendoii  arises  from  the  pubic  bnm 
and,  through  the  linea  alba  and  the  contributory  muscles,  finds 
attachment  in  front  to  the  ensiform  cartilage  of  the  sternum  and 
prevents  the  pubis  and  ischium  from  passing  upwards  and  back- 
wards toward  the  sacral  termination  when  the  body  weight  is 
thrown  upon  the  coxo-femoral  articulation,  which  lies  behind  the 


8  Veterinary  Obstetrics 

iliosacral  joint.  It  plays  a  very  important  part  in  the  large  herb- 
ivora,  especially  in  the  mare,  where  it  sometimes  ruptures  during 
advanced  pregnancy,  resulting  in  a  hernia  of  the  gravid  uterus 
and  destroying  the  normal  relation  of  the  pelvis  to  the  spinal 
column.  (See  Rupture  of  Prepubian  Tendon,  and  Figs.  82,  "i^)' 
84  and  85.)  In  addition  to  these  ligaments,  the  great  dorsal  and 
psoas  muscles  serve  an  important  function  in  maintaining  the  re- 
lations between  the  pelvis  and  spine. 

The  peh-ic  cavity  is  somewhat  conical  in  fprm  in  its  antero- 
posterior diameter, with  the  base  of  the  cone  presenting  forwards 
so  that  the  pelvic  inlet  is  somewhat  larger  than  its  outlet,  a  dif- 
ference which  is  counter-balanced  fully  by  the  fact  that  the  inlet 
is  really  the  only  non-extensible  portion  of  the  pelvis  so  that,  in 
practice,  other  things  being  normal,  if  a  fetus  can  enter  this  por- 
tion it  can  pass  through  the  outlet  by  causing  its  dilation.  This 
disten.sibility  is  dependent  upon  the  yielding  character  of  the 
sacro-sciatic  ligament,  as  mentioned  above.  In  woman,  the  rela- 
tions between  the  .sacro-pubic  and  bisiliac  diameters  of  the  pelvis 
are  inconstant,  resulting  in  a  tortuous  passage,  which  leads  to  a 
rotation  of  the  fetus  on  its  long  axis  during  parturition  in  order 
to  keep  the  greater  dimen.sions  of  the  fetal  body  in  harmony 
with  those  of  the  bony  girdle  through  which  it  is  passing,  while, 
in  our  domestic  animals,  the  cavity  is  rectilinear  and  the  fetus  is 
expelled  in  a  direct,  instead  of  a  spiral  line. 

In  cross  section,  the  pelvic  cavjtv  is  oval  in  outline,  departing 
but  little  from  circular,  its  perpendicular  usually  being  slightly 
greater  than  the  transverse  diameter,  though  these  relations  may 
be  reversed.  The  relations  between  the  perpendicular  and 
tran.sver.se  diameters  do  not  vary  materially  between  the  inlet  and 
outlet,  the  former  being  usually  the  greater  for  the  entire  length 
of  the  pa.ssage.  The  pelvic  channel  is  direct  and  almost  horizontal 
but  usually  directed  more  or  le.ss  obliquely  upwards  and  back- 
wards from  the  inlet  to  the  outlet.  This  is  especially  nota- 
ble in  the  cow,  where  the  pelvic  floor  is  quite  oblique  and  concave 
from  before  to  behind  and  is  further  empha.sized  by  the  promi- 
nent i.schial  tuberosities,  placed  so  closely  together  that,  for  prac- 
tical obstetric  purposes,  the  summits  of  these  may,  in  some  cases, 
virtually  mark  the  floor  of  the  pelvic  outlet  because  they  are  too 
close  to  each  other  to  permit  of  the  ready  passage  of  the  fetus 
between  them.     In  the  mare  the  pelvic  floor  is  almost  level  and 


The  Pelvis  9 

the  ischial  tuberosities  so  small  and  wide  apart  as  to  be   of  little 
significance. 

The  measurements  of  the  pelvic  cavitj'  vary  wideh^  in  different 
species,  breeds  and  individuals  so  that  it  is  virtually  impossible 
to  make  any  general  statements  as  to  the  dimensions  of  the 
pelves  of  our  domestic  animals.  The  variations  in  size  among 
domestic  animals  are  extreme,  owing  to  artificial  selection  for 
the  production  of  giant  and  dwarf  animals, which  are  widely  sep- 
arated in  stature.  In  the  horse  it  is  not  rare  to  find  animals 
weighing  250  lbs.  or  2500  lbs.,  or  a  ratio  of  1:10,  and  there  is 
naturally  a  corresponding  variation  in  the  measurements  of  the 
pelvic  passages.  In  the  dog  the  variations  are  even  greater  in 
size,  the  ratio  in  weight  being  at  times  as  great  as  1:100.  It  is, 
therefore,  quite  impossible  to  give  a  rea.sonably  approximate 
measurement  of  the  pelves  of  the  different  species  of  domestic 
animals.  The  most  important  diameters  of  the  pelvis  of  the 
mare  to  be  considered  by  the  veterinarian  are  the  supero-inferior, 
extending  from  the  lumbo-sacral  articulation  to  the  anterior 
point  of  the  pubic  symphysis  ;  a  vertical  diameter  of  the  inlet 
from  the  symph)'sis  pubis  to  the  middle  of  the  sacrum  ;  and  a 
transverse  from  the  most  concave  point  of  one  ilium  to  the  corre- 
sponding point  on  the  opposite  side.  For  the  outlet,  usually  but 
two  diameters  are  considered  ;  a  vertical,  from  the  ischio-pubic 
symphysis  to  the  sacro-coccygeal  articulation  and  a  transverse, 
from  one  ischial  tuberosity  to  the  other.  The  measurements 
vary  considerably  in  the  experiences  of  different  authors,  the 
supero-inferior  for  an  average  horse  being  9  to  10  inches  accord- 
ing to  Baumeister  &  Rueff  ;  9.5  by  Carsten- Harms  ;  9  by  Ar- 
loing  and  8.75  by  Saint-Cyr.  The  same  authors  make  the  trans- 
verse diameters  1 1  to  12.5;  9.2;  9.2  and  8.1  in.  respectively. 
These  authors  have  evidently  secured  their  measurements  from 
different  classes  of  mares. 

In  the  cow,  the  average  diameters  of  the  pelvic  inlet  as  given 
by  various  authors  range  between  8^  and  10^2  inches  trans- 
versely and  6^  to  7^  perpendicularly,  with  an  outlet  somewhat 
smaller  in  each  of  its  measurements. 

The  ewe  and  she-goat  show  a  perpendicular  diameter  of  the 
pelvis  averaging  about  4,7  in.  and  a  transverse  measurement  of 
approximately  3.1  in.  The  bitch  shows  a  very  wide  variation  in 
pelvic  measurements,  ranging  from   2   to   2    1-3  in.  in  the  sacro- 


lo  Veterinary  Obstetrics 

pubic  and  1.2  to  2  in.  in  the  transverse  diameter.  Similar  varia- 
tions occur  in  the  measurements  taken  by  the  various  observers 
of  the  other  diameters  of  the  pelvis  of  the  mare  and  of  other  ani- 
mals, the  differences  being  .so  wide  as  to  render  the  measurements 
of  questionable  value.  Some  investigators  have  attempted  to 
establish  rules  for  determining  approximately  the  diameters  of 
the  pelves  of  living  animals,  but,  thus  far,  have  been  unable  to 
turn  pelvimetr}'  to  practical  account  in  veterinary  obstetrics,  in 
contrast  with  human  practice,  where  it  acquires  fundamental  im- 
portance on  account  of  the  frequency  of  pelvic  deformities,  which 
often  render  normal  parturition  impossible.  The.se  deformities- 
rarely  occur  in  our  domestic  animals,  partly  because  the  o.sseous 
system  is  far  more  mature  at  birth  than  is  observed  in  man  and 
still  more  because  a  pelvis  weakened  by  disea.se  is  subjected  to 
no  such  strain  in  quadrupeds.  The  horse  bears  only  45  "/f  of  his 
total  weight  upon  his  posterior  feet  and  this  is  largely  made  up 
by  the  weight  of  the  limbs  them.selves  and  the  muscles  connect- 
ing them  with  the  trunk  .so  that  the  actual  weight  resting  upon 
the  pelvis  in  domestic  animals  is  inconsequential  and  represents 
probably  less  than  25  %  of  the  total  body  weight,  while,  in  man. 
it  needs  endure  the  entire  body  weight,  except  the  legs  themselves. 

The  pelves  of  domesticated  animals  are  .sometimes  seriously 
deformed  as  a  result  of  fractures,  tumors  and  dislocations,  which 
may  render  parturition  difficult  or  impossible. 

Pelvimetry  in  domestic  animals  is  impracticable  usually  in  the 
two  chief  groups  of  cases  where  the  size  of  the  pelvis  has  to  do 
with  dystocia.  When  the  pelvis  is  deformed  as  a  result  of  tu- 
mors, fractures,  dislocations  or  rickets,  the  constriction  is  rarely 
recognized  until  the  veterinarian  is  called  because  of  dystocia 
and  he  faces  the  question  of  overcoming  it  and  must  determine 
his  method  of  procedure  by  a  rough  comparison  of  the  size  of  the 
fetus  as  related  to  the  capacity  of  the  pelvis,  as  estimated  by  man- 
ual exploration.  He  is  then  in  a  position  to  advise  the  owner  in 
reference  to  the  future  of  the  patient,  whether  she  should  be 
again  used  for  breeding  purposes,  turned  to  some  other  available 
use,  or  destroyed.  When  dealing  with  such  injuries  in  non-preg- 
nant animals,  it  is  clearlj^  the  duty  of  the  attending  veterinarian 
to  warn  the  owner  against  breeding  the  animal  unless  careful 
examination  makes  it  clear  that  the  patient  may  normally  give 
birth  to  young. 


The  Generative  Orgaiis  ii 

In  a  second  group  of  cases,  excessive  volume  of  the  fetus, 
pelvimitr}-  fails  the  veterinarian  as  he  can  not  recognize,  even  if 
called  to  do  so,  this  over  size,  until  he  is  brought  face  to  face 
with  the  consequent  dystocia,  and  that  fact  alone  demonstrates 
the  disparity  in  size  between  the  pelvic  canal  and  the  fetus,  which 
is  to  traverse  it.  Nor  does  this  occurrence,  even  when  safely 
overcome  by  the  obstetrist,  furnish  any  safe  criterion  for  future 
action  except  possibly  suggesting  a  change  of  mating.  Subse- 
quent fetuses  may  be  of  normal  size. 

It  has  moreover  been  asserted  that  sexual  differences  exist  in  the 
pelves  of  domesticated  animals,  especially  in  the  horse.  This  we 
have  been  wholly  unable  to  verify.  It  is  claimed  that  the  pelvis 
of  the  mare  is  more  ample  than  that  of  the  stallion  or  gelding, 
that  its  foramen  ovale  is  larger,  that  the  ischiatic  notch  is 
broader  and  shallower,  that  the  sacrum  has  less  prominent  articu- 
lar ridges  ;  in  other  words,  that  the  pelvis  of  the  mare  is  specially 
constructed  as  an  organ  of  reproduction  in  a  manner  to  facilitate 
the  passage  of  the  fetus  at  the  time  of  parturition.  We  have 
critically  examined  a  number  of  equine  pelves  and  find  among 
them  those  of  stallions  or  geldings  fulfilling  the  description  given 
as  tj'pical  of  the  mare  in  every  regard  and,  vice  versa,  a  mare 
pelvis  fully  meeting  all  the  alleged  characters  of  the  male.  So 
far  as  we  have  been  able  to  determine,  it  is  impossible  to  differen- 
tiate the  sex  of  any  species  of  domestic  mammals  by  the  form  or 
size  of  the  pelvis. 

B.  The  Generative  Organs. 

The  genital_systeiii  of  the  mammalian  female  consists  of  the 
ovaries,  oviducts,  uterus,  va^rina.  vulva  and  mammae.  Writers 
variously  divide  them  into  internal  and  external,  essential  and 
subsidiary,  genital  or  copulatory  ;  each,  however,  is  influenced  by 
the  other  and  each  is  essential  to  normal  reproduction. 

I.  The  Ovaries. 

In  the  protozoa,  reproduction  is  effected  by  the  division  of  a 
single  nucleated  cell  into  two  parts,  alike  in  form  and  size,  the 
completion  of  the  division  establishing  two  individuals  which 
supplant  the  parent. 

Reproduction  in  the  higher  forms  of  animal  life  proceeds  in  a 
somewhat  similar  manner  from  a  single  specialized  cell,  the  ovum. 


1 2  I  'eterinary  Obstetrics 

which,  however,  only  divides  after  conjugation  and  fusion  with 
the  male  cell,  the  spermatozoon,  while  the  parental  body  remains 
unchanged  after  the  separation  and  casting  off  of  the  male  or 
female  reproductive  cell. 

The  ova-producing  bodies,  the  ovaries,  appear  early  during 
embryonic  life,  varying  in  date  according  to  species — usually  at 
about  one  month  in  those  of  long  gestation  periods.  The  first 
traces  of  the  ovaries  are  the  genital  ridges,  which  arise  as  longitud- 
inal eminences  along  the  median  borders  of  the  Wolffian  bodies 
and  consist  of  a  proliferation  of  the  peritoneal  epithelium  at  this 
point,  by  which  several  layers  of  cells  are  formed.  The  ridges 
appear  in  the  human  embryo  at  about  35  days  or  one-eighth 
term,  in  the  rabbit  at  1 1  days  or  a  trifle  after  the  first  one-third, 
and  in  the  sheep  at  42  days  or  nearly  one-half  term. 

Connective  tissue  grows  up  into  the  genital  ridges  from  the 
underlying  mesoblastic  cells  to  form  the  skeletal  frame-work  and 
tubules  from  the  Wolffian  bodies  grow  into  the  ridges  to  consti- 
tute the  tubular  tissue  of  the  ovary,  but  they  play  no  known 
es.sential  part  and  are  said  to  have  nothing  to  do  with  the  forma- 
tion of  the  ova.  For  a  time  the  genital  ridges  are  alike  in  both 
sexes,  so  far  as  can  be  determined,  forming  the  indifferent  stage, 
during  which  the  male  and  female  organs  cannot  be  differentiated. 

As  the  genital  ridges  develop,  the  differentiation  in  sex  becomes 
established  and,  in  the  female,  the  ovary  soon  assumes  the  charac- 
teristic form  of  the  adult,  varying  with  the  species. 

While  it  is  held  that  all  ovarian  tissues  are  of  nie.soblastic  ori- 
gin, the  genital  epithelium,  arising  from  the  peritoneum,  the 
skeletal  connective  tissue  from  the  sub-peritoneal  mcsoblast  and 
the  tubular  portion  from  the  mesoblastic  Wolffian  bodies,  we  meet 
with  in  various  animals,  especially  in  the  horse  and  human  fam- 
ily, dermoid  cysts  and  well  defined  tooth  tissues  in  the  ovaries 
and  testicles.  These  abnormalities  are  variously  explained  by 
pathologists  and  teratologists.  Since  dermal  structures  and  teeth 
are  derived  normall}'  from  the  epiderm,  it  may  be  well  to  recall 
in  this  connection  that  the  gubernaculum  testis  of  the  male  and 
corresponding  round  ligament  of  the  female  extends  from  the  ex- 
ternal skin  in  the  scrotal  region  of  the  male  and  the  correspond- 
ing parts  in  the  female  through  the  inguinal  canal  and  ring  into 
the  peritoneal  cavity,  where  it  proceeds  to  a  point  contiguous  to, 
if  not  continuous  with,  the  testicle  or  ovary.     Embryologists  do 


The  Ovaries  13 

not  make  it  clear  whether  epidermal  cells  may  thus  reach  this 
region  or  not,  nor  whether  the  presence  of  this  gubernaculum 
accounts  for  the  occasional  inclusion  and  development  within  the 
genital  glands,  of  epidermal  structures. 

It  is  also  alleged  by  some  embryologists  that  the  Wolffian  ducts 
are  of  epiblastic  origin  and  are  formed  from  a  longitudinal  in- 
vagination of  epiblast. 

In  the  outermost  layer  of  genital  epithelium,  the  cells  are 
columnar  while,  deeper,  they  are  cuboidal  in  form.  In  the  deeper 
parts,  the  skeletal  stroma  divides  the  cuboidal  or  spherical  cells 
into  clumps  or  groups  known  as  egg  columns,  among  which  are 
to  be  seen,  usually  one  or  more  in  each  nest,  cells  of  large  size 
with  prominent  nuclei,  the  primitive  ova,  which  continue  to 
form  until  near  the  clo.se  df  intra-uterine  life.  Primitive  ova  are 
present  as  soon  as  the  genital  ridges  are  well  formed  and  Nagel 
claims  that  these  are  not  confined  strictly  to  the  genital  ridges, 
but  occur  here  and  there  in  the  region  of  the  ducts  of  Mueller  in 
the  thickened  epithelium. 

This  observation  of  Nagel  is  highly  suggestive  in  reference  to 
the  operation  of  ovariotomy  in  females.  We  frequently  find 
reports  of  cases  where  females  have  been  castrated  and  later  have 
shown  signs  of  estrum,  and  it  has  been  held  by  many  practitioners 
that  certain  of  our  domestic  animals  continue  to  show  signs  of 
estrum  after  they  have  been  properly  castrated.  In  our  own 
experience,  we  have  seen  estrum  recur  in  an  aggravated  form — 
nymphomania — in  the  case  of  cows,  where  we  were  sure  that  we 
had  removed  the  ovaries  completely.  Operating  a  second  time, 
we  have  found  cystic  Graafian  follicles  at  the  point  of  removal  of 
the  ovary.  It  would  consequentl}-  seem  that  not  only  may 
these  ova  exist  in  the  tissues  somewhat  outside  the  ovary,  but, 
when  the  gland  itself  has  been  surgically  removed,  they  are 
capable  of  developing  ovisacs,  especiall}'  in  a  cystic  form  which 
will  later  produce  all  the  symptoms  of  estrum,  but  probably 
have  no  living  ova  in  them.  The.se  facts  suggest  to  us  that,  in 
performing  ovariotomy,  the  operation  should  not  be  confined  to 
removing  the  ovary,  but  should  include  a  large  part,  if  not  all, 
of  the  oviducts,  with  the  contiguous  tissues,  so  as  to  be  sure  that 
the  ova  and  ovisacs  are  all  removed. 

It  is  contended  hy  Nagel  that  there  are  differences  in  the  geni- 
tal ridges  of  the  .sexes  in  the  human  embryo  at  as  early  a  period 


14  Veteri7iary  Obstetrics 

as  32  or  33  days,  those  of  the  female  containing  primitive  ova, 
while  in  the  male  there  appear  the  tortuous  cords,  which  are  to 
become  the  tubuli  semeniferi  and,  in  these  columns  are  found 
primitive  sperm  cells.  Nagel  doubts  if  there  is  any  truly  indif- 
ferent stage  in  the  development  of  the  sexual  organs,  but  be- 
lieves that  they  can  be  distinguished  at  a  very  early  date  and  that 
probably  they  are  at  no  time  exactly  alike. 

The  primitive  ova  pass  inwards  toward  the  center  of  the  gland 
and,  as  they  do  so,  undergo  a  progressive  development,  at  first 
having  grannlar  nnrlei  of  indistinct  outline,  which  soon  enlarge. 
becoming  very  distinct,  and  of  a  regular  .sph^iicaLform,  having  a 
double-contoured  wall,  fluid  contents  and  a  nuclear  reticulum  with 
one  or  several  nucleolar  enlargements  at  the  nodes.  The  whole 
egg  also  increases  greatly  in  size,  its  protoplasm  becomes  granular 
and,  between  the  ovum  and  the  follicle  or  capsule,  there  is  formed 
an  elastic  investing  homogeneous  layer  known  as  the  zona  radiata. 
Having  undergone  this  development,  they  are  known  as  ^er^ 
inaiifnt  nva^ 

The  smaller  germinal  cells  arrange  themselves  in  enveloping 
layers  about  the  permanent  ova  in  the  form  of  a  hollow  sphere, 
from  the  walls  of  which,  usually  near  the  bottom,  a  discoid 
eminence  of  small  granular  cells,  the  discus  pr-olifenc^,  appears 
and,  resting  in  this,  is  the  ovum,  while,  between  the  discus  prolitr-^ 
f.rrix  and  the  follicular  wall,  is  the  follicular  liquid.  Outside  the 
cellular  wall  the  follicle  is  furnished  with  a  fibrous,  investing  tu- 
nic from  the  stroma  of  the  gland  and,  when  contiguous  to  the  sur- 
face, has,  in  addition,  a  covering  of  ordinary  peritoneum.  To- 
gether these  structures  constitute  Graafian  follicles  or  ovisacs. 

Of  all  animal  cells,  the  duration  of  life  of  \.\\^  per tn anient  ova  is 
best  known.  Unless  they  mature  and  are  discharged  into  the 
oviducts  upon  the  rupture  of  the  Graafian  follicles,  they  remain 
permanent  from  the  date  of  birth,  or  soon  thereafter,  until  the  re- 
productive powers  of  the  animal  have  ceased  as  a  consequence  of 
age.  They  remain  in  an  unchanged  state  in  the  mare,  for 
example,  for  20  to  25  years,  capable  at  any  time  during  that 
period  of  becoming  discharged  into  the  oviducts,  and.  when  im- 
pregnated, of  developing  into  a  fetus.  In  all  our  domestic  ani- 
mals, so  far  as  known,  all  permanent  ova  are  developed  at,  or 
very  soon  after,  birth  and  hence,  whenever  such  of  these  as  are 


The  Ovaries  15 

capable  of  impregnation  have  all  perished  through  ovulation  or 
other  means,  the  fertility  of  the  animal  is  at  an  end.. 

Since  the  ova  are  formed  from  specialized  peritoneal  cells 
Icnown  as  the  genital  epithelium,  while  the  vessels  and  skeletal 
tissues  are  derived  from  the  sub-peritoneal  mesoblast  we  are  pre- 
pared to  anticipate  the  occurrence  in  the  ovary  of  two  somewhat 
definitely  marked  zones,  the  cortex  and  medulla.  The  peri- 
pheral cortex  contains  the  essential  ovarian  cells,  the  ova,  em- 
bedded in  prolongations  from  the  central  or  medullary  portion, 
composed  of  skeletal  connective  tissue,  vessels,  nerves  and  pale 
muscles.  The  multiplication  of  the  ova  and  ovisacs  in  the  cortex 
causes  it  to  outgrow  the  medulla  and  results  generally  in  the 
formation  of  a  well  marked  hilus,  where  the  vessels  and  nerves 
enter,  at  which  point  ova  are  usually  absent. 

The  skeletal  tissues  present  an  area  of  increased  density  at  the 
periphery,  where  they  constitute  a  firm,  dense  envelop,  the 
tunica  albiishiea,  over  which  the  peritoneum  extends.  As  the 
ovisacs  develop,  they  tend  to  pass  centralwards  toward  the  me- 
dulla, and,  continuing  to  grow  as  the  amount  of  follicular  liquid 
within  them  increases,  finally  occupy  the  entire  thickness  of 
the  cortex  and,  in  some  species  of  animals,  bulge  out  beyond  the 
surface  as  more  or  less  prominent,  hemispherical  masses  or  even 
protrude  quite  beyond  the  tunica  albuginea  as  spherical  out- 
growths. As  they  mature,  the  external  wall  of  the  ovisac  atro- 
phies and  finally  ruptures  at  the  time  of  estrum  and  the  ovum  is 
discharged  into  the  pavillion  of  the  oviduct  or  fimbriated  end  of 
the  Fallopian  tube.  (It  is  claimed  that  in  rare  instances  in  mam- 
malia the  ova  are  accidently  discharged  into  the  peritoneal 
cavity.)  Usually  a  Graafiaii_£Qllicl£  contains  but  one  ovum 'but 
in  some  cases  two  have  been  recognized.  The  total  number  of 
ova  in  the  ovaries  of  our  domestic  animals  has  not  been  deter- 
mined. In  woman,  the  number  has  been  estimated  at  about 
70,000,  nearly  all  of  which  must  undergo  retrograde  changes  and 
not  mature.  The  ova  mature  in  cycles,  varying  according  to 
species,  climate  and  degree  of  domestication.  In  some  well 
housed  and  fed  domestic  animals  which  are  not  pregnant,  ovula- 
tion occurs  every  three  or  four  weeks  throughout  the  year. 

During  oestrum  the  ova  are  discharged  either  singly,  as  in  the 
mare  and  cow  ;  two  or  three,    as   is    frequently  observed  in    the 


1 6  Veterinary  Obstetries 

sheep  and  goat ;  or  in  varying  numbers,  as  in  the  carnivora  and 
rodentia. 

It  is  estimated  that  the  ovaries  of  a  child  two  years  of  age 
are  fully  developed  so  far  as. the  new  formation  of  ova  is  con-, 
cerned.  Ovogenesis  must  cease  much  earlier  in  our  domestic  ani- 
mals, all  of  which  may  reach  sexual  maturity  within  one  3'ear 
from  birth  and  are  in  most  ways  more  mature  when  born  than  is 
the  child  when  two  years  old. 

In  old  animals  which  have  ceased  to  breed  or  to  show  sexual 
desire,  the  ovaries  are  much  atrophied  and  contain  degenerate  ova 
incapable  of  fecundation,  signifying  that  the  supply  of  fecunda- 
ble  ova  has  become  exhausted  during  the  span  of  sexual  life. 
This  suggests  that  any  estoppel  of  ovulation,  like  pregnancy, 
where  the  cycle  is  longer  than  that  of  ovulation,  as  in  all  our 
larger  animals,  will  tend  in  some  degree  to  conserve  the  num- 
ber of  ova  capable  of  further  development.  In  harmony  with 
this  thought,  we  find  that  mares  which  are  regularly  bred  tend  to 
retain  their  reproductive  powers  to  a  later  period  in  life  than 
those  which  are  not  permitted  to  breed  until  aged,  but  here 
other  factors,  probably  of  greater  importance,  are  at  work. 

The  rupture  of  the  ovisac  leaves  a  lesion  which  usually  be- 
haves differently  according  to  whether  the  discharged  ovum  be- 
comes impregnated  and  undergoes  development  into  a  fetus  or, 
failing  of  fecundation,  perishes.  The  ruptured  .sac  becomes  filled 
with  lymph,  blood  or  other  products  of  the  disturbances  of  the 
ti.ssues.  Should  the  ovum  perish,  the  ruptured  ovisac  tends  to 
heal  rapidly,  with  a  faintly  yellowish  cicatrix,  which  soon  disap- 
pears entirely  so  that  no  visible  trace  exists  of  the  ruptured  sac. 
The  temporarv  scar  is  known  as  a  false  cori)us  In  team.  The  per- 
sistence of  a  corpus  luteum,  especially  if  over  size,  in  a  non- 
pregnant animal,  inhibits  ovulation  and  induces  sterlity.  (See 
under  "  Sterility."      "  Persistent  Corpus  Luteum  "). 

Should  the  ovum  become  fecundated  and  undergo  normal  de- 
velopment, the  scar  resulting  from  the  ruptured  ovisac  normally 
attains  greater  dimensions,  is  markedly  yellow  in  color,  projects 
beyond  the  ovarian  surface  and  persists  nearly  or  up  to  the  time 
of  parturition,  and  is  known  as  a  true  corpn<<  liifemn^  We  thus 
note  a  bond  of  functional  sympathy  between  the  ovary  and  the 
fate  of  a  discharged  ovum,  a  harmony  shown  constantly  between 
the  various  organs  of  the  reproductive  system.     An  important 


The  Generative  Organs  17 

fact  in  relation  to  the  persistence  of  the  true  corpus  luteum 
during  pregnancy  is  a  well  marked  tendency  to  abortion  when 
the  ovaries  are  removed  from  a  pregnant  female,  or  the  corpus 
luteum  is  forced  out  of  the  ovary  by  crushing  or  otherwise. 

The  size  and  form  of  the  ovaries  differ  greatly  according  to 
species,  age  and  individual  and  even  the  two  glands  in  the  same 
animal  are  not  ordinarily'  alike  and  may  varj'  greatly  in  size. 

The  ovary  of  the  mare  is  much  the  largest  seen  in  the  domes- 
tic animals,  reniform,  very  dense  owing  to  its  thick  tunica  albu- 
ginea,  with  a  smooth  surface  which  is  elevated  here  and  there  in 
many  cases  by  the  presence  near  the  surface  of  cystic  Graafian 
follicles.  It  attains  its  maximum  size  at  the  age  of  two  or  three 
years  and  begins  to  atrophy  at  ten  to  fifteen  years,  to  finallj^ 
become  very  small  as  age  advances.  The  ovary  of  the  young 
mare  is  usually  3^  to  4  inches  in  its  greatest  diameter  and  weighs 
about  4  ounces,  while,  in  the  aged,  it  may  shrink  to  1^2  inches 
in  its  greatest  diameter  and  its  weight  to  Yo  ounce. 

The  ovary  of  the  cow  is  much  smaller,  being  about  one  inch 
in  its  greatest  diameter,  weighing  but  ^  to  ^  ounce  ;  it  is  ob- 
long in  form,  more  regular  in  outline  and  its  tunica  albuginea  is 
less  dense. 

The  ovary  of  the  sow  is  very  large  comparatively  and  the 
numerous  ovisacs  appear  prominently  on  its  surface  to  such  an 
extent  that  the  most  superficial  of  them  stand  out  entirely  be- 
yond the  general  ovarian  line  in  such  a  manner  that  they  are 
attached  to  the  body  of  the  organ  b}'  a  somewhat  constricted 
neck. 

The  ovar}^  of  the  cat  is  very  small,  oblong,  with  pointed  ex- 
tremities and  of  a  bright  scarlet  color  with  the  ovisacs  standing 
out  thickly  over  the  surface  in  a  way  to  suggest  a  mulberry. 

The  ovary  of  the  bitch  is  very  small,  dark  livid  in  color,  even 
in  outline,  and,  unlike  that  of  other  domestic  animals,  is  com- 
pletely enveloped  in  the  pavillion  of  the  oviduct,  except  for  a 
minute  oblong  opening  of  so  small  size  that  the  ovary  cannot  be 
exposed  to  plain  view  through  it. 

Forming  in  the  fetus,  beneath  and  on  either  side  of  the 
notochord  just  posterior  to  the  kidney,  and  above  the  perito- 
neum, the  ovary  descends  into  the  peritoneal  cavity,  carrying 
with  it  the  peritoneum,  which  thus  forms  a  double  layer  behind 
2 


1 8  Veterhiaty  Obstetrics 

it  which  serves  to  preserve  its  attachment  to  the  sub-lumbar 
region,  and,  between  the  two  folds,  the  vessels  and  nerves  pass  to 
the  gland. 

The  location  of  the  ovary  in  the  adult  varies  much  with 
species  but,  apparentl3%  the  size  of  the  gland  has  little  or  no  in- 
fluence upon  its  position.  It  rests  upon  the  superior  ^nj-fnre  of 
the  aulmauborder  of  the  broad  ligament,  naked  in  most  animals 
but  closely  invested  in  the  bitch  by  the  pavillion  of  the  oviduct. 
The  pavillion  of  the  oviduct  is  attached  at  one  point  of  its 
margin  to  the  ovary  near  its  hilus  and  its  connection  with  the 
uterus  is  further  maintained  by  the  utero-ovarian  ligament,  com- 
posed largely  of  connective  tissue  and  pale  muscle  fibers.  The 
ovary  is  further  influenced  in  its  position  by  the  round  ligament, 
which  is  analogous  to  the  gubernaculum  testis  of  the  male. 
Arising  like  the  latter  from  the  skin  and  dartos  at  the  point 
where  the  fundus  of  the  scrotum  of  the  male  normally  appears 
in  the  given  species,  it  passes  up  through  the  inguinal  ring  and 
above  the  peritoneum  to  became  attached  to  the  uterine  cornua 
or  oviduct  not  far  from  the  ovary.  The  latter  tends  with  these 
attachments  to  follow  a  line  of  descent  comparable  to  the  testicle 
but  normally  becomes  arrested  in  its  movement  at  some  point 
between  its  place  of  origin  and  the  internal  inguinal  ring.  In 
the  bitch,  it  remains  closely  applied  to  the  sub-lumbar  region 
immediately  behind  the  kidney  ;  in  the  mare,  its  movement  is 
arrested  early  and  it  remains  rather  firmly  suspended  not  far  be- 
hind the  kidney  and  above  the  middle  of  the  posterior  part  of  the 
aJ->rlnnijtin|  cavity,  while  that  of  the  cow  lies  loosely  alongside  the 
vagina  just  by  the  internal  inguinal  ring. 

In  the  .sow,  the  ovary  floats  quite  freely  in  the  peritoneal  cavity 
and  at  times  passes  out  through  the  inguinal  ring  and  conies  to 
rest  in  the  perineal  region  corresponding  to  the  scrotum  of  the 
male.  The  same  displacement  is  said  to  occur  rarely  in  bitches 
and  it  is  possible  in  any  species. 

In  general  we  might  say  that  in  the  elongated  uteri  of  multi- 
parous  animals  the  ovaries  are  situated  further  forward  than  in 
the  uniparous  or  biparous  species.  The  location  of  the  ovary  is 
further  modified  by  the  pregnant  state,  the  gravid  uterus 
dragging  it  downwards  and  forwards  in  its  own  descent. 


The  Muelleriaii  Ducts  19 

The  Muellerian  Ducts ;  the  Oviducts,  Uterus  and  Vagina. 
I.  The  Muellerian  Ducts. 

Early  in  embryonic  life,  before  the  genital  ridges  have  become 
well  marked,  about  the  second  month  in  animals  with  extended 
durations  of  pregnancy,  the  ducts  of  Mueller  develop  as  two 
ridges  beneath  the  peritoneum  near  to,  but  outwardly  from,  the 
Wolffian  ducts,  from  which  they  are  said  to  arise  as  outgrowths, 
and  extend  forwards  from  near  the  cloaca  to  or  beyond  the 
Wolffian  glands.  Appearing  first  as  solid  rods,  they  later  become 
excavated  to  constitute  tubes,  which  end  blindly  at  their  posterior 
extremity  for  a  time  but  later  open  into  the  cloaca  or  common 
vent  of  the  digestive  and  urino-genital  sy.stems.  As  soon  as 
hollowed  out,  each  vessel  opens  anteriorly  into  the  peritoneal 
cavity  through  a  large  funnel-shaped  mouth,  the  future  pavillion 
of  the  oviduct  of  fimbriated  end  of , the  Fallopian  tube.  At  this 
time  there  are  in  this  region,  lying  parallel  and  near  to  each 
other,  three  separate  ducts  :  the  ureter,  the  ^Wolffian  dm:L  to 
become  the  excretory  duct  of  the  male  genital  gland  and  the 
Muellerian  duct  to  become  the  genital  tract  of  the  female.  The 
■'posterior  ends  of  the  Muellerian  ducts  are  in  close  contact  at 
first  and  later,  at  about  the  time  of  their  opening  into  the  cloaca, 
they  fu.se  together  for  a  variable  distance  forward,  their  median 
walls  disappearing,  resulting  in  the  formation  of  a  single  tube  as 
far  as  the  fusion  extends. 

The  Muellerian  ducts  later  become  differentiated  into  three 
essentially  separate  segments  through  specialization  of  their 
development,  each  having  its  distinctive  function.  The  anterior 
.segment  constitutes  the  ovidnct  or  Fallopian  tube  with  its 
ampulla,  or  pavillion,  which  serves  to  receive  the  ovum  from  the 
ovary  and  bear  it,  fetilized  or  unfecundated,  into  the  uterine 
cornu,  or  uterus  ;  the  second  or  middle  portion  of  the  genital 
tube  constitutes  the  uterine  cavity- .  in  which  the  fetus  may  find 
lodgement,  attachment,  nutrition  and  protection  during  its  devel- 
opment ;  the  third  or  posterior  segment,  the  vagina,  extending 
from  the  uterus  to  the  vulva,  serves  first  as  an  essential  copula- 
tive organ  and  later  as  a  passage  for  the  fetus  at  the  time  of  birth. 

The  distance  to  which  the  fusion  of  the  Muellerian  duct  ex- 
tends forwards  and  the  extent  of  the  specialization  of  the  different 


20  Veterinary  Obste fries 

areas,  modifies  greatly  the  form  and  relations  of  the  various 
segments. 

Arrests  in  the  development  of  the  genital  tube  may  occur  at 
any  point,  which  may  interfere  more  or  less  with  its  form  and 
functions.  The  f u.sion  in  the  utero-vaginial  region  may  be  partly 
or  wholly  arrested,  resulting  in  a  more  or  less  completely  double 
uterus  or  vagina  or  the  Meullerian  ducts  may  fail  to  develop  as 
such  but  remain  as  two  dense  solid  cords,  as  is  .seen  in  Fig.  51 
where  no  uterus  or  vagina  exists. 

A  study  of  Fig.  51  shows  that  the  uterine  cornua  and  ovaries 
were  apparently  well  developed,  the  cornua  contained  consider- 
able cavities  which  were  distended  with  fluid,  the  ovaries  showed 
Graafian  follicles  and  a  corpeus  luteum.  The  anterior,  or  oviduct 
segments  of  the  genital  tubes  are  widely  .separated  from  each  other 
and  are  not  commonly  the  .seat  of  arrest  of  development. 

The  Muellerian  ducts  in  the  male  commence  to  disappear  at 
about  the  middle  third  of  pregnancy,  but  small  vestiges  may  re- 
main in  the  adult  male  as  the  hydatids  of  Morgagni,  which,  in  some 
species  of  animals  constitute  small  pedunculated  bodies  between 
the  testis  and  the  head  of  the  epididymis.  They  are  supposed  to 
come  from  the  anterior  end  of  the  ducts  and  are  more  prominent 
in  man  than  in  our  domesticated  animals.  At  the  posterior  end  of 
these  ducts,  where  they  unite  together,  they  are  by  some  supposed 
to  form  the  so-called  uterus  ma.sculinus,  a  small  sinus  which  ex- 
ists in  the  superior  wall  of  the  urethra  between  the  .seminal  vesi- 
cles, at  the  point  of  emergence  of  the  vasa  deferentia. 

The  entire  genital  tract,  having  a  common  origin,  has  a  gen- 
eral type  of  construction,  characterized  chiefly  by  each  having 
three  separate  coats  ;  peritoneal,  muscular  and  mucous. 

The  peritoneal  layer,  which  invests  the  genital  tract  almost 
completely,  is  derived  from  that  of  the  body  wall,  behind  which 
the  ducts  of  Mueller  originate.  At  the  anterior  extremity  the 
genital  tract  opens,  through  the  pavillion  of  the  oviduct,  into 
the  peritoneal  cavity,  the  continuity  of  the  peritoneum  being 
interrupted  at  this  point  to  be  succeeded  by  the  mucous  mem- 
brane of  the  oviducts. 

As  the  broad  ligament  consists  of  two  peritoneal  layers,  re- 
sulting from  the  departure  of  the  genital  tube  from  its  seat  of 
origin  behind  the  peritoneum,  it  follows  that,  along  the  line  of  its 
attachment  to  the  genital  tube,  the  investment  is  interrupted  to 


The  Broad  Ligaments  21 

the  extent  of  the  area  between  the  two  folds,  occupied  by  the 
vessels  and  nerves.  At  the  posterior  extremity  of  the  genital 
tract,  where  it  opens  into  the  cloaca  of  the  embryo,  the  peritoneal 
investment  is  interrupted  and  its  place  taken  by  the  intrapelvic 
connective  tissue  so  that,  eventually,  the  peritoneum  covers,  in 
addition  to  the  oviducts  and  uterus,  only  the  more  anterior  por- 
tion of  the  vagina  ;  the  fusion  of  the  two  Muellerian  ducts  more- 
over, to  form  the  vagina  and  uterus,  eliminates  the  peritoneal 
covering  on  the  median  plane  of  each  separate  tube  as  far  as  they 
coalesce,  and,  following  this,  occurs  the  atrophy  and  disappear- 
ance of  the  muscular  and  mucous  walls  connecting  the  two,  and 
the  adjacent  tubes  become  a  single  canal. 

The  muscular  portion  is  composed  of  transverse  and  longitu- 
dinal layers  of  pale  fibers,  varying  greatly  in  the  different  sections 
of  the  tract  and  also  according  to  whether  the  animal  be  pregnant 
or  not. 

The  mucous  coat  of  the  genital  tract  offers  the  greatest  possi- 
ble variations  and  assumes  widely  differing  and  highly  import- 
ant functions,  according  to  the  particular  area  occupied. 

2.  The  Broad  Ligaments. 

Since  the  Muellerian  ducts  have  their  origin  outside  the  peri- 
toneum, it  follows  that  in  moving  away  from  the  abdominal  walls 
they  must  carry  with  them  their  peritoneal  covering.  As  soon 
as  they  drop  away  from  their  point  of  origin  the  investing  folds 
of  peritoneum  tend  to  meet  behind  to  constitute  a  double  perito- 
neal fold,  between  which  the  vessels  and  nerves,  along  with  pale 
muscle  fibres  pass  to  and  from  the  ovaries  and  genital  tube. 

These  expanses  of  peritoneum,  with  invested  vessels,  nerves  and 
muscles,  constitute  the  broad  ligaments  of  the  uterus,  or  more  cor- 
rectly speaking,  of  the  genital  canal.  The  ligaments  act  as  a  sus- 
pensorium  for  the  genital  tract,  maintaining  its  connection  with 
the  abdominal  walls  and  also  furni.shing  a  support  for  the  ovaries, 
thereby  fixing  the.se  organs,  under  certain  limitations,  in  a  defi- 
nite location.  The  broad  ligament  varies  greatly  in  its  form 
and  amplitude  according  to  species  and  the  functional  activity  of 
the  genital  tract.  In  the  bitch,  cat  and  sow,  in  which  the  anterior 
extremities  of  the  uterine  cornua  remain  throughout  the  life  of 
the  animal,  as  far  forward  as  or  anterior  to,  the  po.sterior  border  of 
the  kidney,  the  broad  ligament  maintains  its  anterior  attachment 


22  Veterinary  Obstetrics 

to  the  abdominal  wall  at  or  near  the  point  of  origin  of  the  ovary 
just  behind  the  kidnej'  ;  in  the  cow,  where  the  ovar}'  and  the  an- 
terior end  of  the  uterine  cornua  are  turned  backwards  to  the  im- 
mediate vicinity  of  the  internal  inguinal  ring,  the 'attachment  of 
the  anterior  border  of  the  ligament  likewise  moves  backwards  for 
a  considerable  distance  so  that  the  middle  of  the  recurved  cornu 
tends  to  project  anteriorly  beyond  the  anterior  margin  of  the 
ligamentous  attachment  even  when  non-gravid.  When  the 
uterus  of  a  quadrupedal  mammal  becomes  gravid  the  weight  of 
the  fetus  drags  the  occupied  portion  downwards  and  forwards 
until  the  organ  comes  to  rest  upon  the  abdominal  floor,  in  front 
of  the  anterior  point  of  fixation  of  the  ligament  to  the  abdominal 
wall.  Since  the  anterior  attachment  of  the  broad  ligament  is 
more  posteriorly  situated  in  ruminants  than  in  other  domestic 
animals,  it  tends  to  favor  the  revolving  of  the  gravid  uterus  on  its 
long  axis  in  front  of  the  anterior  attachment.  This  disposition 
attains  an  important  clinical  significance  in  the  study  of  uterine 
torsion  (which  see)  in  which  it  is  observed  that  the  tendency  to 
torsion  increases  as  the  anterior  extension  of  the  attachments  of 
the  broad  ligaments  to  the  abdominal  walls  recedes. 

The  genital  tube  is  further  maintained  in  its  position  by  its  at- 
tachment posteriorly  to  the  vulva  and  also  by  the  round  ligament 
of  the  uterus,  which  we  have  already  described  on  page  i8. 

3.  The  Oviducts. 

The  oviducts,  formed  from  the  anterior  or  ovarian  extremities 
of  the  Muellerian  ducts,  are  two  long,  tortuous  tubes,  varying  in 
length  and  other  characters  according  to  species.  Their  length 
is  .several  times  the  distance  from  the  anterior  extremity  of  the 
uterine  cornu  to  the  ovary,  thus  throwing  it  into  folds.  The 
distance  between  the  anterior  extremity  of  the  cornu  and  the 
ovary  is  fixed  by  the  utero-ovarian  ligament  and  not  by  the  ovi- 
duct. In  some  animals  the  oviducts  are  naked  and  clearly  visible 
while,  in  the  bitch,  they  are  hidden  in  the  fat  of  the  broad  liga- 
ment and  the  utero-ovarian  ligament  is  very  short  .so  that  the 
anterior  end  of  the  uterine  cornu  is  virtually  in  contact  with 
the  ovary  while  the  oviduct,  some  3  to  4  inches  in  length,  is 
thrown  into  numerous  folds  to  terminate  about  ^  inch  from  its 
uterine  end,  so  that  casual  ob.servation,  without  dissection,  might 
lead  to  the  assumption   that   the   Fallopian   tube  was  well-nigh 


The  Oviducts 


23 


absent  in  this  animal,  whereas  it  is  verj^  similar  in  actual  length 
to  that  seen  in  other  species.  When  divested  of  any  concealing 
coverings  of  peritoneum,  fat  or  other  tissues,  the  oviduct  appears 
as  a  very  tortuous,  firm  white  cord  about  .  i  inch  in  diameter,  of 
variable  length  in  different  species  of  animals.  It  is  very  firm  to 
the  touch  and  gives  a  sensation  much  like  its  analogue  in  the 
male,  the  vas  deferens.  After  dissecting  it  out  from  the  sur- 
rounding tissues  and  carefully  eliminating  its  numerous  abrupt 
curves,  a  very  fine  sound,  like  one  of  the  tail  hairs  of  a  horse,  may 
be  inserted  at  one  opening  and  passed  through  its  entire  length. 
The  opening  is  therefore  very  narrow  and  being  remarkably  tor- 
tuous in  its  disposition  it  becomes  difficult  to  pass  either  a  solid 
object  like  a  sound  or  even  a  liquid  through  it.  While,  techni- 
cally, the  oviducts  complete  a  communication  between  the  peri- 
toneal cavity  and  the  exterior,  it  seems  virtually  impassable  except 
to  ova  and  spermatozoa  and  does  not,  under  usual  conditions, 
permit  even  the  forcing  of  liquids  through  them  when  intra- 
uterine injections  are  made  under  comparatively  high  pressure. 
Clinically,  they  are  also  well-nigh  proof  against  the  passage  of 
bacteria  unless  we  except  some  special  organisms  like  those  of 
gonorrhea  in  woman.  Occasional!)',  however,  after  abortion, 
retained  placenta,  nodular  venereal  disease,  etc.,  in  cows  and 
other  animals,  infection  extends  along  the  oviducts,  causing  dis- 
ease of  them  or,  reaching  the  ovary,  induces  abscess  or  other  disea.se 
causing  sterlity. 

The  intimac}-  of  contact  between  the  peritoneum  and  oviduct 
varies  according  to  species,  the  investment  being  very  close  in 
ruminants  and  the  sow  so  that  they  are  readily  seen  without  dis- 
section, while,  in  the  mare,  it  is  surrounded  by  much  connective 
tissue,  which  serves  to  conceal  it  from  view  until  the  peritoneal 
and  fibrous  coverings  are  di.ssected  away  ;  and  in  the  bitch  the 
concealment  is  further  accentuated  b}'  large  amounts  of  adipose 
tissue. 

The  oviduct  opens  anteriorly  through  the  ostium  abdominale 
into  the  pavillion^of  the  tube  and  posteriorly  into  the  uterine 
cornu  through  the  ostium  uterinum,  which  usually  projects 
somewhat  as  a  small  eminence  into  the  cavity  of  the  cornu. 

The  muscular  coat  of  the  oviducts  is  characterized  chiefly  by 
its  density,  which  gives  to  it  an  almost  cartilaginous  consistency, 
and  its  paleness,  which  amounts  almost  to  translucency. 


24  Veteri7iary  Obstetrics 

The  superficial  layer  of  the  mucosa  of  the  oviducts  consists  of 
ciliated  columnar  epithelium,  with  the  cilia  vibrating  toward  the 
uterus.  The  oviduct  is  the  most  rigid  and  undilatable  portion  of 
the  genital  tube  and  has  for  its  office  the  conveyance  of  the  ovum^ 
fecundated  or  otherwise,  from  the  ovary  to  the  uterus,  in  which 
function  the  cilia  apparently  play  an  essential  part.  The  duct 
also  provides  passage  for  the  migration  of  the  .spermatozoa  of  the 
male,  which,  advancing  from  the  uterus  toward  the  ovary,  meet 
the  ovum  within  this  narrow  pas.sage  and  fecundate  it.  In  rare 
cases  the  fecundated  ovum  lodges  in  this  duct  and  undergoes  par- 
tial development,  to  con.stitute  tubal  pregnancy  (which  .see),  but 
its  undilatability  serves  as  a  rule  to  cause  a  rupture  of  its  walls 
and  leads  to  the  escape  of  the  fetus  from  the  duct  into  the  ab- 
dominal cavity  to  either  cause  sudden  death  of  the  animal  from 
hemorrhage  or  constitute  extra-uterine  or  abdominal  pregnancy 
(which  .see). 

4.  The  Uterus. 

The  uterus  is  a  musculo-membranous  sac  designed  for  the  re- 
ception, attachment,  nutrition  and  protection  of  the  ovum  and 
finally  aids  in  the  expulsion  of  the  fetus  at  the  time  of  birth. 

Derived  from  the  ducts  of  Mueller,  it  varies  greatly  in  form  and 
disposition,  partly  dependent  upon  the  degree  of  fusion  between 
those  two  structures.  There  are  generally  recognized  a  uterine 
body  and  two  cornua,  each  having  essentially  like  functions  in 
varying  degrees. 

In  the  rabbit,  there  exists  no  uterine  body,  but  two  distinct  tub- 
ular uteri  opening  .separately  into  the  vagina.  In  the  bitch,  cat 
and  sow  the  uterine  body  is  limited  in  extent  and  physiologically 
unimportant,  rarely  containing  even  a  portion  of  a  fetus  except 
in  tran.sit  at  the  time  of  birth,  while  the  two  cornua  are  exten- 
.sive  and  in  them  develop  virtually  all  the  fetuses  .so  that,  physio- 
logically, they  represent  the  two  separate  uteri  of  the  rabbit. 

In  ruminants,  the  uterine  body  becomes  markedly  greater  in 
size  and  assumes  far  higher  importance  physiologically,  while  the 
cornua  remain  relatively  large. 

In  these  animals  the  one,  two,  or  more  fetu.ses  habitually  rest 
almost  equally  in  the  body  and  cornua  .so  that  they  represent  a 
middle  point  in  the  transition  between  the  double  uterus  of  the 
rabbit  and  the  single  uterus  of  woman,  physiologically  devoid  of 


The   Uterus  25 

cornua.     In  the  iparp  the  uteriii£__hQri.y  becomes  relatively  more 
ijTiportant  than  in  the  ruminant. 

The  relative  importance  of  the  cauiua  to  the  uterine  body  sus- 
tains a  close  relation  to  the  m^mbar  of  young  brought  forth  at  a 
given  birth.  In  multiparous  animals,  there  are  two  uteri,  as  in  the 
rabbit,  or  the  two  extensive  corntia  with  functionally  unimportant 
uterine  body,  as  in  the  bitch,  cat  and  sow.  In  ruminants,  which 
are  largely  bi-parous,  the  uterine  body  and  cornua  become  ap- 
proximately equal  in  extent  and  function. 

In  the  normally  uniparous  mare,  the  cornua  are  smaller  than 
the  body,  while,  in  woman,  the  uterus  is  virtually  without  cornua 
in  size  or  function. 

The  uterus  and  its  cornua,  within  the  above  limitations,  are 
iiniformin  their  plan  of  structure  and  function.  They  consist  of 
three  coats  ;  mucous,  muscular  and  peritoneal. 

The  mucous  coat  constitutes  the  essential  physiologic  basis  of 
the  organ.  The  mucous  epithelium  is  very  elaborate,  consisting 
superficially  of  columnar  cells,  while,  embedded  deeply  within  it, 
are  numerous  tubular  structures  of  a  glandular  character,  the 
utricular  glands,  believed  to  secrete  the  so-called  lUerine  milk, 
which  is  presumed  to  play  an  important  role  in  the  nutrition  of 
the  ovum  pending  the  formation  of  the  embryo  and  the  establish- 
ment of  its  intricate  connection  with  the  mucous  membrane 
through  the  chorion.  Yet  more  important,  it  is  through  a 
.special  elaboration  of  the  uterine  mucosa  that  the  highly  intricate 
and  essential  maternal  placenta  is  formed,  to  constitute  a  phys- 
ical and  physiologic  bond  between  the  mother  and  fetus  during 
the  span  of  pregnancy.  The  uterine  mucosa  apparently  exerts  a 
distinct  bactericidal  power  and  ordinarily  prevents  the  gaining  of 
a  habitat  by  bacteria  in  the  uterine  cavity. 

In  the  non-gravid  uterus,  as  is  common  with  distensible  hollow 
organs,  the  mucous  membrane  is  thrown  into  numerous  longi- 
tudinal folds,  which  permit  of  prompt  and  extensive  dilation  of 
the  cavity  without  violence  to  this  membrane. 

The  muscular  coat  consists  of  two  somewhat  differentiable 
groups  of  longitudinal  and  circular  pale  mu.scle  fibers  which  in- 
crease in  size,. number  and  activity  during  pregnancy.  The 
proportion  of  the  longitudinal  to  the  circular  fibers  varies,  the 
latter  being  much  more  prominent  in  the  region  of  the  cervix. 


*26  Vetcn'}iary  Obstetrics 

where  they  serve  specialh'  as  occlusive  agents  to  establish  a  sep- 
aration of  the  uterine  from  the  vaginal  cavity. 

The  peritoneal  layer  of  the  uterus  is  derived  from  that  of  the 
abdominal  walls  and  completely  envelops  the  organ  except  at  the 
points  of  continuity  with  the  oviducts  and  vagina  and  the  inter- 
stice between  the  two  peritonea?  sheets  of  the  broad  ligament  at 
their  points  of  uterine  attachment.  The  broad  ligaments  have 
already  been  described  on  page  21. 

Those  portions  of  the  Muellerian  ducts  from  which  the  uterus 
is  later  developed  are  formed  early  in  embryonic  life  behind  the 
peritoneum  and  later  leave  the  abdominal  walls,  to  float  freely 
within  the  abdominal  cavity,  suspended  by  the  broad  ligaments 
or,  in  the  gravid  state,  to  rest  upon  the  abdominal  floor. 

The  uterus  is  further  retained  in  position  by  its  continuity 
anteriorly  with  the  oviducts  and  posteriorly  with  the  vagina. 
The  round  ligainent  of  the  uterus,  arising  from  the  skin  ordartos 
in  the  region  normally  constituting  the  fundus  of  the  scrotum  in 
the  male  and  passing  up  through  the  inguinal  canal  and  abdom- 
inal ring  and  thence  to  the  cornu  or  oviduct  is  functionally  of 
little  or  no  interest. 

The  uterus  of  the  mare,  with  its  cornua,  constitutes  a  some- 
what crucial-shaped  organ,  the  horns  leaving  the  body  laterally 
at  right  angles  or  somewhat  recurved.  It  is  located  immediately 
beneath  the  rectum  with  its  two  cornua  passing  obliquely  out- 
ward and  upward  on  either  side.  The  uterine  body  is  oblong, 
flattened  somewhat  from  above  to  below,  varying  from  5  to  & 
inches  in  length  and  i^  to  2)^  inches  wide.  In  the  non-gravid 
organ,  the  mucous  surfaces  of  its  walls  are  normally  in  contact 
with  each  other.  Posteriorly,  its  cavity  is  continuous  with  that 
of  the  vagina  through  the  medium  of  the  cervical  canaL  a  con- 
stricted portion  of  the  genital  tube  which  serves  to  fix  a  bound- 
ary between  the  two  cavities  and  to,  in  a  measure,  close  the 
uterine  cavity  to  the  exterior.  This  canal  is  a  somewhat 
elongated  and  tortuous  channel,  dependable  for  its  length  upon 
that  of  the  cervix  ///<;';7.  which  it  traverses,  and  for  its  width  upon 
the  development  and  degree  of  contraction  of  the  circular  muscle 
fibers  of  the  latter. 

The  cervix  uteri  consists  of  a  constricted  area  of  the  uterus  in 
which  the  circular  muscle  fibers  are  comparatively  much  more 
numerous  than  in  other  portions  of   the   organ.      Posteriorly   the 


The   Uterus 


27 


cervix  projects  into  the  anterior  end  of  the  vagina  for  a  distance 
of  I  to  2  inches  in  the  form  of  an  obtuse  cone  varying  in  its 
transverse  diameter,  but  approximating  its  longitudinal  dimen- 
sions. At  the  summit  of  this  conical  projection  is  the  os  uteri 
or  OS  externum,  with  its  mucous  membrane  thrown  into  conver- 
gent longitudinal  folds,  suggesting  the  appearance  of  a  radiating 
flower,  y7(?«r  epanouie. 


Fig. 


2.     NoN-GRAviD  Uterus  of  Mare  viewed  from  abovi 
WITH  Right  Corni'  Laid  Open. 


O,  O,  Ovaries.  Ov,  Oviduct.  U,  Uterus.  UC,  Uterine  cornu. 
BL,  Broad  ligament.  V,  Vagina.  Vu,  Vulva.  CI,  Clitoris. 
H,  Hymen. 


28  I  'eicn'uary  Obstetrics 

The  origin  of  this  projection  of  the  cervix  into  the  vagina 
seems  somewhat  analogous  to  intestinal  intussusception,  a  partial 
invagination  of  the  anterior  portion  of  the  genital  tube  into  the 
vaginal  cavity.  At  the  time  of  parturition  this  projection  and 
the  cervix  as  a  whole  becomes  obliterated  and  the  uterus  and 
vagina  temporarily  indistinguishable  except  in  the  character  of 
their  mucosa. 

The  dimensions  and  dilatability  of  the  os  uteri  and  cervical 
canal  vary  widely  in  individuals  and  at  different  times.  Nor- 
mally, the  mucosa  of  the  circumference  of  the  os  7cteri  sho\\\6.  be 
in  contact.  In  the  mare  it  should  permit  of  the  ready  intro- 
duction of  one  or  two  fingers  through  it  and  along  the  canal  of 
the  cervix  into  the  uterine  cavity. 

At  the  time  of  estrum  the  os  becomes  more  dilated  and,  fre- 
quently, readily  admits  three  or  four  fingers  or  the  entire  hand. 
It  is  not  unusual  to  find  cases  where  the  os  iiteri  of  the  mare  is 
abnormally  dilated  and  flaccid  to  such  a  degree  as  to  interfere 
with  fecundation.  More  rarely  in  the  mare  the  os  iiteri  may  be 
closed  or  the  cervix  very  much  constricted  in  a  manner  to  render 
the  passage  of  spermatozoa  into  the  uterine  body  uncertain  and 
thus  tend  to  induce  sterility. 

Anteriorly,  the  cavity  of  the  uterine  body  of  the  mare  is  con- 
tinuous with  that  of  the  two  cornua,  without  a  distinct  line  of 
demarcation  beyond  an  abrupt  turn  at  right  angles  or  a  slight 
recurvation  to  its  long  axis.  This  peculiar  relation  of  the  cornua 
to  the  uterine  body  and  to  each  other  renders  bi-cornual  preg- 
nancy (which  see)  possible  in  the  mare  (see  Figs.  2,  120,  121). 
Each  cornu  is  much  like  the  body  and  the  combined  length  of 
the  two  surpasses  the  latter  in  extent.  They  end  obtusely,  not 
far  from  the  ovary,  and  present,  on  their  interior,  conical  pro- 
jections in  which  there  is  an  opening,  the  os  uterinum,  or  uterine 
orifice  of  the  oviducts. 

In  the  cow,  and  other  ruminants,  the  uterine  body  is  less  pro- 
nounced in  size  when  viewed  exteriorly  and  yet  more  so  upon 
section,  while  the  cornua  are  much  longer,  tapering  and  more 
ample  than  in  the  mare.  The  two  cornua  separate  at  a  very  acute 
angle  and  for  a  time  extend  forwards  almost  parallel  to  each 
other  and  then,  becoming  .somewhat  more  divergent,  curve  down- 
wards, outwards,  backwards  and  then  upwards  to  end  above  the 


The   Uterus  29 

broad  ligament  against  the  brim  of  the  pubis  and  the  infero- 
lateral  wall  of  the  vagina. 

The  uterine  bod}'  and  cornua  of  ruminants  are  much  more 
dense,  narrower  and  more  cylindrical  than  in  the  mare,  the  cer- 
vix is  longer,  intensely  rigid,  almost  cartilaginous  to  the  touch, 
while  the  cervical  canal  is  longer,  narrower,  more  tortuous  and 
interrupted  by  transverse,  as  well  as  longitudinal  rugae.  It  is 
very  difficult  and  sometimes  well  nigh  impractical  to  insert  one 
finger  through  the  cervical  canal  into  the  uterus.  During  estrum 
the  OS  uteri  and  cervical  canal  become  more  dilatable. 

The  broad  ligamenl  of  the  uterus  of  the  mare  arises  anteriorly 
from  the  abdominal  wall  in  the  sublumbar  region  not  far  poster- 
ior to  the  kidney  and  its  parietal  attachment  passes  from  this 
point  obliquely  downwards,  backwards  and  medianwards,  along 
the  median  side  of  the  inguinal  ring  and  thence  into  the  pelvic 
cavity  where  its  two  layers  of  peritoneum  become  reflected  from 
the  vagina  upon  the  bladder,  rectum  and  pelvic  walls.  As  com- 
pared with  the  broad  ligament  of  other  domestic  animals  it  is  re- 
stricted in  extent  in  the  mare,  especially  transversely,  resulting  in 
a  comparatively  rigid  fixation  of  the  uterus  and,  since  its  anterior 
attachment  is  approximately  in  a  direct  line  with  the  long  axis  of 
the  cornua,  the  entire  organ  is  held  well  forward  in  the  abdo- 
minal cavity  in  the  form  of  a  cross,  in  marked  contrast  to  the 
disposition  of  the  organ  in  ruminants. 

As  compared  with  the  mare,  the  broad  ligament  of  ruminants 
is  much  more  ample  transversely,  while,  in  an  antero-posterior 
direction,  it  is  much  less  extensive.  Its  anterior  point  of  attach- 
ment to  the  abdominal  parieties  is  much  farther  back  than  in  the 
mare.  This  variation  in  disposition  and  relations  of  the  broad 
ligament  produces  two  well  marked  clinical  differences  obstetric- 
ally. 

In  the  non-gravid  uterus  of  the  cow  the  anterior  parietal  at- 
tachment of  its  broad  ligament  is  alread}-  posterior  to  the  ante- 
rior curvature  of  the  uterine  cornua,  which,  in  the  gravid  uterus, 
becomes  sharply  accentuated,  almost  the  entire  organ  resting  an- 
terior to  its  ligamentous  attachments  to  the  abdominal  parieties. 
Thus  the  broad  ligaments  become  largely  powerless  in  prevent- 
ing the  pregnant  organ  from  revolving  upon  its  long  axis,  so  that 
torsion  of  the  uterus  (which  see),  becomes  quite  common  in  the 
cow  and  ewe,  while  in  the  mare,  the  more  rigidh-  fixed  organ, 


30 


l^eterhiary  Obstetrics 


1- 

RUC- 

U 

Bll- 

A- 

B- 


Fig.  3.     Generative  Organs  of  Bitch  in  situ. 

TT,  Two  posterior  teats.  B,  Bladder.  V,  Vagina.  U,  Uterus. 
IvUC,  LUC,  Left  uterine  cornu  with  a  portion  of  its  broad  ligament, 
BL,  lying  across  it.  RUC,  Right  uterina  cornu  with  its  broad  liga- 
ment, BI/,  turned  outwards  exposing  the  full  length  of  the  cornu. 
00,  Ovaries.  R,  Rectum.  K,  Left  kidney.  AA,  Dotted  lines  in- 
dicating level  of  the  external  ilial  tuberosities. 


The    Vagina  31 

■u'ith  the  anterior  parietal  attachment  of  the  ligament  much 
farther  forward,  renders  the  accident  comparatively  rare. 

The  comparative  amplitude  of  the  ligament  in  the  cow,  with 
its  most  anterior  point  of  parietal  attachment  but  little  forward 
of  the  pelvis,  permits  more  readily  of  inversion  and  prolapse  of 
the  uterus  and  vagina  (which  see)  than  obtains  in  other  animals. 

In  multiparous  animals  the  broad  ligaments  are  necessarily 
verj'  extensive  and  uniformly  have  their  anterior  point  of  attach- 
ment to  the  abdominal  walls  far  forward  in  the  post-renal 
region.  In  the  bitch,  the  ligament  at  its  anterior  border  is  \^xy 
short  so  that  the  ovary  and  ovarian  end  of  the  cornu  is  closely 
fixed  in  the  sublumbar  region  just  posterior  to  the  kidney  and 
tends  to  stretch  the  cornu  between  this  anterior,  sublumbar  at- 
tachment and  the  vagina. 

The  ligament  being  exceedingly  ample  except  at  the  anterior 
border,  it  is  much  longer  than  the  distance  from  its  parietal 
attachments  to  the  position  of  the  cornu,  resulting  in  a  large 
antero-posterior  fold  which  drops  down  on  the  median  side  of 
the  cornu  and  covers  it  in  this  double   fold   of  broad   ligament. 

<Fig.  3).  _ 

Unlike  in  other  domesticated  animals,  the  broad  ligaments  of 
the  bitch  are  uniformly  the  seat  of  extensive  deposits  of  fat, 
which  causes  them  to  strongly  resemble  the  gastric  omentum  in 
general  appearance. 

5.  The  Vagina. 

The  vagina  is  a  musculo-membranous  canal,  formed  from  the 
fusion  of  the  posterior  ends  of  Mueller's  ducts  and  extending 
from  the  uterus  to  the  vulva.  Limited  anteriorly  by  the  os  uteri 
£xter?ium,  it  ends  posteriorly  at  the  position  of  the  hymen,  just 
anterior  to  the  meatus  urinarius,  where  the  vulva  succeeds  it. 

In  the  mare  it  is  8  to  12  inches  in  length  and  capable  of  lateral 
distension  to  the  full  size  of  the  pelvic  cavity.  Lined  with 
squamous  epithelium,  its  muco.sa  is  thrown  into  longitudinal 
folds,  which,  when  at  rest,  lie  in  contact  with  each  other. 

The  mucous  membrane  of  the  vagina  has  in  its  deeper  portions 
numerous  mucous  glands  which  serve  to  keep  the  surfaces  at  all 
times  moist  and  which  become  especially  active  during  sexual 
excitement  and  at  the  close  of  pregnancy.  The  muscular  coat 
does  not  differ  fundamentally  in  arrangement  from  that  of  the 
uterus  though  less  in  volume. 


32  Veterinary  Obstetrics 

The  peritoneal  covering  extends  backwards  from  the  anterior 
extremity  three  to  five  inches  in  the  mare,  where  it  becomes  re- 
flected upon  the  rectum,  bladder  and  pelvic  walls.  In  the  poste- 
rior portion  of  its  course  the  vagina  is  surrounded  by  the  loose 
pelvic  connective  tissue,  which  permits  comparatively  free  move- 
ment. 

The  function  of  the  vagina  is  chiefly  copulative,  receiving  the 
penis  of  the  male  during  coition  ;  and  during  parturition  it 
affords  a  passage  for  the  fetus  from  the  uterus  to  the  vulva. 

In  the  mare,  the  organ  has  the  power  of  "  ballooning  "  or  in- 
flating under  sexual  excitement  or  physical  excitation.  In  this 
state  it  expands  to  such  a  degree  that  it  fills  the  pelvic  cavity 
completely  from  side  to  side  and  from  floor  to  roof,  presenting  a 
vast  cavity  with  smooth,  rigid  walls,  which  laterally  are  in  clo.se 
contact  with  the  bony  or  ligamentous  pelvic  walls,  while,  superi- 
orly they  lie  against  the  sacrum  except  in  the  area  where  the 
rectum  intervenes  and  inferiorly  with  the  pubis  except  for  the 
urinary  bladder. 

The  phy.siological  nature  of  this  "  ballooning  "  has  not  been 
determined  ;  apparentlj^  it  is  of  an  erectile  character.  It  prob- 
ably increases  the  .safety  of  copulation  by  rendering  it  impos.sible 
for  folds  of  the  vagina  to  become  caught  by  the  penis  and 
injured.  This  power  of  ballooning  differs  largely  from  other 
hollow  organs  of  the  body. 

The  vagina  of  the  cow  has  a  .similar  ballooning  power  but  of  a 
less  degree  and  it  is  po.ssibly  a  general  function,  though  less 
marked,  in  the  vaginae  of  other  animals. 

The  ballooning  of  the  vagina  of  the  mare  is  easily  induced  by 
intravaginal  manipulation,  by  the  injection  into  the  organ  of 
bland,  tepid  fluids  or  by  various  other  means.  The  phenomenon 
is  especially  marked  and  easily  induced  by  introducing  the  moist 
hand  into  the  organ  at  the  time  of  estrum  when  the  inflation  at 
once  occurs. 

The  hymen  is  a  transverse  membranous  expanse  stretching 
across  the  genital  canal  marking  the  boundary  between  the 
vagina  and  vulva.  It  represents  the  partition  between  the  term- 
ination of  the  hiind  gut  and  the  proctodeum  of  the  embryo,  which 
has  failed  to  disappear  in  the  lower  or  genito-urinary  division  of 
the  cloaca.  Generally  it  atrophies  and  completely  disappears  in 
our  domesticated  animals  before  their  birth  but  at  times   it  per- 


The    J  ^ulva  33 

sists, either  as  perpendicular  shreds  or  in  a  broad  expanse  closing 
one-half  or  more  of  the  genital  canal.  We  have  met  an  instance 
in  a  filly  where  it  prevented  copulation  until  after  surgical  inter- 
vention occurred,  and  cases  are  recorded  of  imperforate  hymen 
which  caused  an  accumulation  of  utero-vaginal  secretions. 

6.  The  Vulva. 

The  vulva,  located  immediately  beneath  the  anus,  constitutes 
the  posterior  termination  of  the  genital  canal  and, instead  of  being 
derived  from  the  mesodermic  Muellerian  ducts,  as  in  case  of  the 
preceding  organs,  its  epithelial  covering  originates  from  the  epi- 
derm  of  the  embrj'O.  It  opens  externally  b}'^  means  of  a  verti- 
cally elongated  slit,  bounded  upon  either  side  by  the  labise  vulvae, 
which  meet  above  and  below  to  form  the  superior  and  inferior 
vulvar  commissures. 

The  vulvar  labiae  are  covered  by  a  very  fine  skin,  in  which  the 
growth  of  hairs  ma}^  be  inconspicuous,  as  in  the  mare,  while  in 
others,  like  the  cow,  there  is  a  prominent  tuft  of  hairs  about  the 
inferior  commissure.  Since  the  parts  are  so  scantily  haired, 
their  color,  which,  as  a  rule,  is  simply  that  of  the  adjacent  .skin, 
becomes  very  conspicuous.  In  mares  with  white  faces,  eyes  and 
feet,  the  cutaneous  covering  of  the  vulva  tends  also  to  be  devoid 
of  pigment. 

The  prominence  of  the  pigmentation  of  the  skin  of  this  part 
serves  as  an  aid  in  the  clinical  diagnosis  of  the  venereal  diseases 
of  honses  (which  see),  in  which  important  discolorations  occur. 

The  muscles  of  the  vulva  are  chiefly  circular  and  are  divided 
into  two  groups,  the  posterior  and  anterior  con.strictors.  The 
posterior  constrictor  is  situated  within  the  vulvar  lips  and  con- 
stitutes a  true  sphincter,  analogous  to  those  about  other  body 
openings.  Above,  its  fibers  become  lost  in  the  perineum  and  the 
sphincter  ani  ;  below  some  go  to  the  base  of  the  clitoris 
and  .some  pass  downwards  to  become  lost  in  the  skin  and 
other  tissues  on  the  inside  of  the  thighs.  The  office  of  this 
group  compri.ses  the  usual  function  of  a  sphincter,  their  contrac- 
tion bringing  about  the  closure  of  the  vulvar  opening.  The  an- 
terior group  of  muscle  fibers  invests  the  vulva  in  the  region  of 
the  hymen,  just  anterior  to  the  meatus  urinarius,  where,  by  their 

3 


34  \'eterinary   Obstetrics 

contraction,  they  produce  a  constriction  on  the  vulvo-vagjinal 
border  line. 

The  mucous  membrane,  continuous  with  that  of  the  urinarv 
bladder  and  the  vagina,  is  covered  with  squamous  epithelium 
and  contains  numerous  mucous  glands,  which  are  largeh-  dis- 
placed near  the  labial  margins  and  about  the  clitoris  bj-  sebace- 
ous follicles,  the  secretions  from  which  are  odoriferous,  especially 
during  estrual  periods,  when  the  odor  becomes  very  marked  in  a 
manner  characteristic  of  the  species. 

Within  the  vulvar  cavity  are  to  be  noted  the  meatus  urinariiis, 
clitoris  and  vaginal  bulb.  The  tneatus  uri7iarius,  or  terminal 
opening  of  the  urethra,  is  located  along  the  floor  of  the  vulva  at 
a  distance  of  three  to  four  inches  from  the  external  opening  in 
the  mare.  The  urethral  canal  passes  obliquely  downwards  and 
forwards  through  the  vaginal  floor  to  the  urinary  bladder.  In 
most  animals,  the  meatus  urinaritis  is  comparatively  small  and 
inextensible  while,  in  the  mare,  in  general  harmony  with  the 
large  and  freely  dilatable  os  uteri  and  genital  passage,  it  is  quite 
ample.  One,  two  or  more  fingers  are  readily  passed  through  it 
into  the  bladder  and  it  is  not  rare  to  find  the  opening,  in  heavy, 
lymphatic  animals,  sufficiently  large  to  admit,  without  great  diffi- 
culty, the  entire  hand.  The  dimensions  of  the  meatus  urinarius 
in  the  mare  are  of  special  significance  clinically  as  they  favor 
ever-sion  and  prolapse  of  the  bladder,  an  accident  not  particularly 
rare  in  this  animal,  while  extremely  so  in  others.  In  the  cow 
the  narrow  meatus  urinarius  is  further  guarded  by  a  valvular 
membranous  fold  directed  from  the  posterior  border  forward  in  a 
manner,  it  is  claimed,  to  prevent  the  penis  of  the  bull  from  acci- 
dentally entering  it  and  wounding  the  bladder  as  a  result  of  the 
violent  copulative  thrust  of  that  animal.  Nevertheless  we  have 
one  instance  recorded  (.see  under  "  Accidents  of  Coition  ")  in 
which  a  fatal  rupture  of  the  bladder  was  caused  in  copulation. 

The  clitoris  is  an  erectile  organ,  analogous  to  the  male  penis 
and  having  in  general  the  same  ti.ssues,  form  and  attachments. 
It  is  two  or  three  inches  in  length  and  arises,  like  the  penis,  by 
two  crura  from  the  ischial  arch  and  passes  upwards  and  back- 
wards to  protrude  from  the  vulvar  floor  just  inside  the  inferior 
commissure  and  is  the  principal  element  in  maintaining  the  form 
of  this  part. 


The  MaynmcB  or  Udder 


35 


Its  free  end  is  lodged  within  a  depression  in  the  vulvar  floor 
and  over  it  extends  a  mucous  fold,  the  prepuce  of  the  clitoris. 
The  clitoris  and  its  prepuce  are  covered  by  a  pigmented  mucous 
membrane  in  which  the  mucous  glands  are  displaced  by  sebaceous 
follicles,  and  the  characters  of  the  surrounding  mucosa  are  absent. 

The  clitoris  is  composed  chiefly  of  erectile  tissue  like  that  of 
the  corpus  cavernosum  of  the  penis.  The  clitoris  of  the  bitch, 
like  the  penis  of  the  dog,  contains  a  small  bone. 

The  functions  of  the  clitoris  are  not  important,  although  it  is 
alleged  to  exert  an  influence  upon  sexual  excitement.  In  our 
observation  upon  a  large  number  of  sows  from  which  the  clitoris 
had  been  removed  by  an  empiric,  it  had  no  influence  upon  oes- 
trum or  fecundation  and  all  bred  normally.  In  the  mare  it  is 
frequently  removed  for  the  relief  of  nymphomaniac  vice,  but 
the  results  are  in  controversy. 

7.  The  Mamm.^x  or  Udder. 

The  mammae  are  essential  organs  of  generation  ;  they  are  nor- 
mally excited  to  activity  only  by  parturition  and  constitute  a 
necessary  source  of  nutritive  supply  to  the  new-born  animal. 
Under  domestication,  the  activity  of  the  milk  glands  has  been 
highly  developed  in  the  cow  and  goat  to  provide  the  important 
food  supply  to  man  of  milk  and  its  derivatives  :  cream,  butter 
and  cheese. 

The  milk  glands  originate  from  the  epiblast  by  an  invagination 
into  the  subjacent  parts  from  which  is  finally  elaborated  the  es- 
.sential  secretory  structure  and  the  excretory  apparatus. 

They  are  located  symetrically  on  either  side  of  the  median  line 
of  the  ventral  surface  of  the  body,  varying  in  numbers  approx- 
imately in  accordance  with  the  number  of  young  usually  pro- 
duced at  a  birth.  Usually  the  number  of  mammae  is  in  excess 
of  that  of  the  young  born  at  one  time,  but  rarely  the  relation- 
ship is  reversed. 

Each  mamma  consists  of  a  glandular  parenchyma  with  excre- 
tory ducts  traversing  a  conical  nipple  or  teat,  from  which  the 
young  may  obtain  the  secreted  milk  by  sucking.  The  glands  are 
covered  with  a  very  soft,  almost  hairless  skin, containing  numer- 
ous sebaceous  follicles  and  are  closely  invested  by  a  firm,  fibro- 
elastic  capsule  derived  from  the  abdominal  tunic. 


36 


[  '^eterin arv  Obstetrics 


The'mammae  belong  to  the  acinous  type  of  glands  and  con- 
sist fundamental!)'  of  the  milk  cells  or  acini,  where  the  polyhe- 
dral or  spherical  epithelial  cells  form  the  active  secretory  units, 
and,  from  these,  the  milk  is  poured  out  through  the  small  execre- 
tory  ducts  into  more  extensive  canals  which  serve  as  a  common 
outlet  for  a  group  of  acini,  constituting  a  lobule. 

These  ducts  continue  to  unite  and  form  yet  larger  canals,  which 
are  few  in  number  and,  according  to  species,  empty  either  into 
one,  two  or  more  milk  cisterns  or  reservoirs  in  the  teat,  or,  in 
the  absence  of  these,  traverse  the  length  of  the  teat  to  open  by 
separate  orifices  at  the  apex.  Through  these  excretory  ducts 
the  milk  is  drawn  normally  by  the  new-born  animal  by  sucking  ; 
artificially,  in  dairying,  it  is  forced  out  by  compression  with  the 
hand  or  other  means  in  a  manner  clo.sely  analogous  to  the  suck- 
ing by  the  young. 

^^li^;^?^.,^?-::^^..  Ma, 


Areolar  Zone . 


.^^ly 


..*s-l 


-H^ 


■:r^ 


•■^5%; 


Glandular  Area 


Primary 
Lacteal  Bud 


,  7 VV/j' 


Secondary 

Lacteal 

Bud 


Fig.  4.     Section  through  the  mammary  pit  of  a   20  cm.  long  fe- 
male swine  embryo  after  Prof^.     Magnified  about  200.     (Bonnet). 


The  secretion  of  milk  and  its  discharge  from  the  udder  bears 
.some  analogy  to  the  behavior  of  erectile  organs.  It  has  been  as- 
sumed by  some  that  the  milk  is  largely  secreted  and  stored  in  the 
galactophorous  sinu.ses  and  cisterns  during  the  intervals  between 
milking,  but  this  is  for  the  most  part  erroneous.  The  milk  is  chiefly 
stored  in  the  epithelial  cells  of  the  milk  acini  until,  under  excita- 


The  Mam  nice  or  Udder  -yi 

tion  of  sucking  or  milking,  it  is  poured  out  into  the  milk  cisterns 
and  teats  and  thence  is  readily  extracted  by  the  sucking  of  the 
young  or  by  the  various  milking  processes.  In  some  cows,  mares 
and  other  females  the  sight  of  their  young  causes  an  involuntary 


Teat  Pit 
Glandular  Area 


Muscles  of  the 
A  reola 


Glandular 
Outgrowths 


Fig.  5.     A  and  B.     Two  schematic  illustrations  of  the  mammary 
pit,  showing  the  different  forms  of  teats. 

A,  Primary  teat  of  the  cow. 

B,  Secondary  teat  of  woman.  (Bonnet.) 


38  I'cten'nary  Obstetrics 

discharge  of  milk  from  the  udder,  or,  when  the  young  is  sucking 
one  teat,  milk  flows  freely  from  the  others  or,  even,  when  a  milk- 
man is  drawing  milk  from  one  cow,  a  neighboring  one  has  an  in- 
voluntary discharge  of  milk. 

Under  the  influence  of  anger,  fear  or  other  disturbances,  the 
flow  of  milk,  in  the  process  of  milking,  abruptly  ceases,  the  ani- 
mal "  holds  up"  her  milk  and  it  cannot  be  withdrawn. 

One  milker  can  abstract  from  an  udder  a  greater  amount  of 
milk  than  another,  yet  each  will  withdraw  with  equal  care  all 
the  milk  which  reaches  the  teat.  The  flow  of  milk  is  not  directly 
subject  to  the  control  of  the  lactating  animal,  but  involuntary  on 
her  part,  subject  to  external  influences  over  which  she  exerts 
but  very  imperfect  power. 

In  the  mare,  there  are  two  hemispherical  mammae,  flattened 
from  side  to  side,  situated  in  the  inguinal  region  and  each  closely 
attached  in  the  region  of  the  external  abdominal  ring,  through 
which  their  chief  vessels  and  nerves  pass. 

There  are  two  or  more  milk  cisterns  in  each  gland,  from  which 
corresponding  excretory  ducts  pa.ss  to  the  apex  of  the  teats  to 
escape  by  separate  orifices  ranged  one  behind  the  other  in  the 
broad,  antero-posteriorly  flattened  nipple. 

In  ruminants,  the  mammae  are  also  inguinal.  In  the  cow,  the 
right  and  left  halves  of  the  udder  are  quite  distinct  from  each 
other  although  lying  in  contact,  their  fibro-elastic  envelopes  being 
completely  separated  by  areolar  tissue.  Each  lateral  half  is 
divided  into  two  intimately  connected  "quarters,"  an  anterior 
and  posterior,  with  .separate  excretory  ducts  and  teats. 

Each  quarter  has  but  one  milk  cistern,  and  this  is  of  great  size, 
into  which  all  lacteal  sinuses  lead  and  from  which  a  .single  excre- 
tory duct   opens  through  the  apex  of  the  teat  to  the  exterior. 

There  are  generally  one  or  two  rudimentary  glands  with  teats 
behind  the  posterior  quarter,  which  frequently  function  very 
slightly  immediately  after  calving,  while,  in  .some  cases,  they 
secrete  a  noticeable  amount  of  milk.  In  one  cow  observed  by  the 
author  each  lateral  half  of  the  udder  consisted  of  a  single  gland 
or  "  quarter  "  with  but  one  teat  like  that  of  the  ewe  or  goat. 

In  the  bitch  and  cat  there  are  eight  to  ten  mammae  and,  in  the 
sow,  ten  to  twelve.  In  the  mammae  of  the  sow  there  are  two  or 
more  small  milk  cisterns  to  each  gland,  each  of  which  opens  at 
the  apex  of  the  teat  by  a  separate  orifice.     The  mammae  of  car- 


The  Mammae  or   Udder 


39 


nivora  possess  no  milk  cisterns,  each  of  several  large  milk  canals 
opening  separately  at  the  apex  of  the  teat. 

Rudimentary  mammary  glands  occur  in  male  animals  in  har- 
mony with  the  general  rule  that  the  sexual  organs  of  each  sex 
tend  to  be  repeated  or  to  possess  an  analogy  in  the  other.  In 
rare  cases,  the  mammae  of  males  become  functional  and  he-goats 
and  bulls  have  been  known  to  yield  milk. 

In  the  female  the  secretion  of  milk  normally  becomes  estab- 
lished only  as  a  result  of  pregnancy  and  the  milk  appears  ordi- 
narily only  near  its  termination,  within  a  few  days  of  the  birth 
of  the  young,  and  reaches  its  greatest  activity  generally  shortly 
after  giving  birth.  This  is  not  constant.  If  abortion  is  threat- 
ened in  a  pregnant  animal,  especially  a  mare,  when  the  normal 
period  of  pregnancy  is  not  nearing  its  close,  the  secretion  of  milk 
is  liable  to  become  suddenly  established.  In  some  animals  the 
mammae  become  excited,  swollen  and  even  function  during 
estrum.  Such  was  the  case  with  a  mule  observed  by  the  author, 
from  which  there  was  a  very  profuse  and  annoying  flow  of  milk, 
keeping  the  legs  constantly  wet  during  the  spring  of  the  year, 
when  she  was  in  estrum  much  of  the  time. 

If  a  fetus  perishes  within  the  uterus  of  a  uniparous  animal 
without  decomposition,  its  continued  presence  in  the  uterus  fails 
to  excite  lactation  and  tends  to  prevent  by  its  presence  the  occur- 
rence of  estrum. 


OBSTETRICAL  PHYSIOLOGY 
Reproduction. 

The  specific  function  of  the  generative  organs  is  the  pro- 
creation of  the  species,  including  conception,  the  intra-uterine 
nutrition  and  development  of  the  fetus,  its  expulsion  after  a  cer- 
tain degree  of  development  and  its  further  nutrition  for  a  time 
after  birth  by  milk  from  the  mammae,  until  the  young  has  ac- 
quired sufficient  development  to  enable  it  to  lead  a  wholh'  inde- 
pendent existence.  The  two  sexes  in  mammalia  are  normally 
wholly  distinct  so  that,  before  conception  can  take  place,  a  con- 
jugation of  the  male  and  female,  coition  or  copulation,  must  oc- 
cur. In.  all  mammalia  there  are  more  or  less  apparent  vestiges 
of  each  part  of  the  genital  apparatus  of  the  opposite  sex  in  each 
individual,  but  they  naturally  become  arrested  in  their  develop- 
ment in  the  embryonic  stage  and  remain  wholly  functionle.ss  ; 
rarel}-  do  we  meet  with  anomalies  (hermaphrodites)  in  which  the 
analogous  organs  of  both  sexes  develop  more  or  le.ss  completely  ; 
less  rarely  we  ob.serve  the  development  of  .some  of  the  male  or- 
gans (testes)  and  others  of  the  female  (uterus  and  vagina)  in  one 
individual.  These  animals  partaking  of  a  bi.sexual  nature  are,  .so 
far  as  we  have  observed,  uniformly  sterile.  In  other  instances 
ffreemartins),  all  genital  organ.s-may  be  arrested  in  the  embry- 
onic stage  and  the  animal  remain  virtually  a.sexual. 

Before  reproduction  becomes  po.ssible  the  breeding  animal  nuist 
have  reached  the  period  of  puberty  or  .sexual  maturity,  the  period 
when  ova  and  spermatozoa  mature  and  are  di.scharged  and  .sexual 
desire  is  established,  up  to  which  time  the  reproductive  organs 
are  dormant  in  so  far  as  their  specific  functions  are  concerned. 
Puberty  or  .sexual  maturity  occurs  at  varying  ages  in  different 
.species,  breeds  and  individuals.  Much  depends  upon  the  food 
supply  and  rapidity  of  growth.  It  quite  uniformly  occurs  in  both 
sexes  prior  to  the  completion  of  growth.  There  seems  to  be  a 
tendency  towards  early  puberty  in  short  lived  species  and  late  in 
tho.se  which  normally  have  a  long  .span  of  life,  but  the  rule  is  in- 
con.stant.  The  normal  duration  of  life  in  the  cow  is  approxi- 
mately twice  that  of  the  bitch,  but  the  former  tends  to  become 
.sexually  mature  at  an  earlier  age  than  the  latter. 
40 


Reproduction  4 1 

The  rate  of  reproduction  varies  greatly  in  different  species  and 
is  dependent  chiefly  upon  three  factors  ;  the  age  of  puberty  and 
duration  of  sexual  competency,  the  number  of  young  brought 
forth  at  a  given  birth  and  the  -frequency  of  parturition.  Uni- 
parity,  or  single  births,  is  the  rule  in  the  larger  animals  ;  the 
smaller  ruminants  are  to  a  great  extent  bi-parous,  while  the 
smaller  classes  of  animals  are  quite  uniformly  multiparous  and 
bring  forth  from  three  or  four  to  twelve  or  more  young  at  a  given 
time. 

The  frequency  of  parturition  varies  greatly  and  the  minimum 
between  two  births  is  fixed  by  the  duration  of  pregnancy,  which, 
among  our  domestic  animals,  finds  its  extremes  between  the  four 
weeks  of  the  rabbit  and  the  21  months  of  the  elephant.  The  fre- 
quency of  partuition  is  further  influenced  by  a  dormant  period 
in  reproductive  activity  between  the  giving  of  birth  to  young  and 
readiness  to  again  conceive.  In  .some  species  the  nursing  of 
young  tends  to  inhibit  the  power  of  breeding,  as  is  sometimes 
seen  in  the  mare  and  is  said  to  be  yet  more  marked  in  the  ele- 
phant. In  all  our  larger  animals  there  is  usually  an  interval  be- 
tween the  birth  of  a  fetus  and  the  power  to  conceive,  pending 
the  recurrence  of  estrum  and  ovulation.  In  the  mare  this  inter- 
val is  very  brief,  frequently  but  eight  or  nine  days,  while  in  the 
cow  it  is  longer.  In  the.se  larger  animals  there  is  a  tendency 
toward  one  parturition  each  year  and  in  the  mare  the  resumption 
of  the  power  of  conception  after  foaling  needs  be  very  prompt  or 
annual  breeding  becomes  impossible,  .since  the  duration  of  preg- 
nancy is  about  eleven  and  one  third  months,  exceeding  12  months 
in  some  cases,  leaving  an  average  of  but  about  three  weeks,  in 
which  pregnancy  may  recur,  and  a  second  foal  be  born  within  a 
year.  Under  such  conditions  it  is  natural  that  the  mare  does  not 
usually  produce  a  foal  each  year  over  an  extended  period.  On 
the  other  hand,  in  the  rabbit,  conception  normally  recurs  within  a 
few  hours  after  giving  birth  to  a  litter  of  young,  .so  that  she  maj^ 
breed  each  month.  In  nature,  and  still  more  in  the  domesticated 
state,  conceptions  fall  far  short  of  the  maximum  possibilities  and 
the  births  are  relatively  much  below  the  assumed  number.  Mares 
used  especially  for  breeding  purposes  produce  ordinarilj^  but  two 
foals  in  three  years  or  even  less,  and  elephants  are  said  to  pro- 
duce young  but  once  in  three  to  four   years.      Exceptionally,  we 


42  Vetcri7ia>y  Obstc fries 

meet  with  mares  breeding  annually  for  ten,  twelve  or  more  con- 
secutive years. 

Neither  do  all  animals  born  reach  maturity.  Their  j^rowth 
and  development  afterbirth  is  predicated  upon  the  available  food 
supply  and  their  immunity  from  predatory  animals  and  from 
di.seases  and  accidents.  Speaking  generally  we  might  safely  say 
that  in  the  wild  state  the  probabilities  of  maturity  are  in  inver.se 
ratio  to  the  rapidity  of  reproduction.  In  those  which  reproduce 
slowly,  like  the  mare,  with  less  than  one  young  per  annum,  which, 
in  turn,  needs  live  about  three  years  before  giving  birth  to  young, 
the  new-born  animal  is  born  in  a  well  matured  state  and  is 
quickly  able  to  travel  long  distances  for  food  or  water  and  to 
flee  rapidly  from  pursuing  predatory  animals  and  enjoys,  in  addi- 
tion, highly  efficient  maternal  protection.  On  the  other  hand, 
the  young  of  the  rabbit  are  born  in  a  state  of  utter  helplessness 
against  enemies  or  of  procuring  food  independently,  while  the 
mother  is  not  competent  to  afford  effective  protection  against 
foes.  Thus,  in  a  state  of  nature,  where  there  is  neither  room  nor, 
food  for  all  the  young  which  might  be  born,  agencies  which 
modify  the  birth  rate  and  the  percentage  of  young  which  shall 
successfully  mature  serve  to  maintain  a  balance  in  animal  life. 

The  rapidity  of  the  increase  of  a  species  is  also  modified  by  the 
available  nutritive  surplus  of  the  mother.  Generally  speaking 
the  larger  the  animal  the  lower  the  nutritive  reserve.  The 
greatest  drain  upon  the  nutritive  supply  is  that  upon  the  muscles 
for  locomotion.  Large  animals  need  move  over  a  more  extensive 
area  in  order  to  obtain  sufficient  food  and,  the  greater  the  body, 
weight,  and,  especially,  the  greater  the  height,  the  greater  the 
drain  upon  the  nutritive  supply  within  the  body. 

Among  domesticated  animals,  where  food  and  protection  are 
provided  by  man,  the  control  of  the  numbers  of  animals  is  brought 
about  through  such  agencies  as  slaughtering  the  immature  ani- 
mals for  human  food  (ruminants  and  swine),  the  direct  control 
of  numbers  by  killing  the  surplus  new-born  (carnivora),  castra- 
tion and  the  prohibition  of  breeding  by  sexual  segregation. 

The  maintenance  of  nutrition  of  the  body  of  the  parent  must 
necessarily  take  precedence  over  the  reproduction  of  young,  and 
the  latter  be  limited  constantly  by  the  nutritive  reserve  within 
the  parent  after  the  neces.sities  for  her  own  existence  have  been 
supplied.     The  drain  upon  the  maternal  system  in  the  reproduc- 


Reproduction  43 

tion  of  young  is  very  great  in  all  mammalian  animals  but  differs 
widely  according  to  species.  In  a  mare  weighing  1,500  pounds, 
the  new-born  foal  may  weigh  about  125  pounds,  or  8  %  of  her 
body  weight,  to  which  must  be  added  an  additional  demand  of 
the  young,  in  the  form  of  milk  as  food,  covering  a  period  of  five, 
six  or  even  more  months  after  birth. 

The  nutritive  demands  of  the  fetus  of  the  mare  extend  over  a 
long  period,  comprised  of  eleven  and  one-third  months  of  preg- 
nanc}'  and  five,  six  or  more  months  of  nursing,  or  a  total  period  of 
about  one  and  one-half  ^ears.  And  her  average  rate  of  producing 
young  is  reduced  to  approximately  one  in  two,  or  two  in  three 
years.  In  the  cow  there  is  a  greater  nutritive  excess  or  reserve  and, 
while  the  young  is  .somewhat  larger  as  related  to  the  size  of  the 
mother  than  obtains  in  the  case  of  the  mare,  or  about  ib  %;  the 
intra-uterine  term  of  existence  is  shortened  from  about  eleven  and 
one-third  to  nine  and  one-third  months;  and  the  period  of  sucking 
is  also  reduced  .somewhat,  thus  materially  decreasing  the  demands 
upon  the  maternal  system,  with  a  corresponding  increa.se  in  repro- 
ductive power  and  the  rate  of  increase  of  the  species.  In  the 
natural  state,  fewer  of  the  young  reach  maturity.  In  multipara 
the  young  are  relatively  smaller,  but  parturition  occurs  more 
frequenth'.  In  the  sow,  parturition  occurs  about  twice  annually 
and  the  number  of  young  may  reach  ten  or  more  at  each  birth. 
A  sow  weighing  300  pounds  may  thus  give  birth  to  twenty  pigs 
in  a  year,  each  of  which  may  weigh  two,  or  a  total  of  forty 
pounds,  equal  to  13  %  of  the  maternal  body  weight. 

The  character  and  abundance  of  food  exerts  a  well  defined 
influence  upon  the  number  of  young  produced,  a  highly  nutri- 
tive and  well  balanced  ration  with  other  favorable  environment 
tending  to  greatly  increase  fecundity. 

The  completeness  of  development  of  the  fetus  at  birth  varies 
widely  and  the  demands  upon  the  nutritive  reserve  of  the 
mother  correspond  to  the  degree  of  embryonic  evolution  at- 
tained by  the  young  prior  to  birth.  The  i.ew-born  rabbit,  after 
four  weeks  of  intra-uterine  life,  is  a  very  innnature  animal,  inca- 
pable of  locomotion,  its  eyes  not  open  and  its  body  almost  naked 
of  hair  ;  the  young  Guinea  pig,  after  the  same  duration  of 
intra-uterine  existence,  is  born  with  a  den.se  coat  of  hair,  with 
eyes  open  and  its  locomotor}-  apparatus  .so  completely  developed 
that  it  can  move  about  with  almost  the  same  celerity  as  its  dam. 


44  \'eteriuary  Obstetrics 

The  youngj  of  carnivora  are  born  in  a  very  immature  state,  while 
those  of  ruminants  and  solipeds  are  well  developed  and  early 
ready  to  follow  their  dams  at  will. 

In  each  case,  there  are  probably  advantaj^es  to  the  mother  and 
offspring.  The  rabbit  must  depend  wholly  upon  flight  for  pro- 
tection against  foes  and  would  evidently  suffer  a  serious  disad- 
vantage from  a  greatly  increased  body  weight  due  to  the  presence 
in  the  uterus  of  a  number  of  very  large  fetuses  ;  the  bitch,  in 
the  natural  state,  must  depend  upon  the  cha.se  for  her  food,  and 
she  too  would  be  hampered  by  a  great  weight  due  to  well  devel- 
oped fetuses. 

Reproduction  is  a  complex  physiologic  process,  accompanied  by 
or  associated  with  phenomena  which  bear  an  important  relation 
to  each  other.  In  approximately  the  following  order,  we  observe 
the  maturation  of  the  ovisacs  or  (Graafian  follicles:  estrum, copula- 
tion, rupture  of  the  Graafian  follicles,  fecundation  and  possibly 
menstruation.  The  chain  of  phenomena  is  finally  completed  by 
pregnancy,  parturition  and  the  nutrition  of  the  new-born. 

Maturation  of  the  Graafian  Follicle. — Ovulation. 

Recounting  briefly  our  previous  allusion  on  page  ii  to  the  forma- 
tion of  the  ovaries  and  their  specific  function,  the  formation  of  ova, 
there  is  ob.served  very  earl}'  in  embryonic  life  the  two  genital 
ridges  forming  along  the  median  side  of  the  Wolffian  bodies.  Con- 
sisting at  first  of  a  mere  thickening  of  the  peritoneum,  chiefly  due 
to  an  elaboration  of  its  epithelium,  the  external  cell  layer  be- 
comes columnar  fn  contrast  to  the  surrounding  squamous  cells, 
while  the  deeper  strata  assume  a  more  or  less  cuboidal  form,  to- 
gether constituting  the  germinal  epithelium.  This  continues  to 
thicken  and  certain  of  the  cells  become  distinctly  larger  than 
the  others,  to  constitute  the  priviitivc  ova,  while  the  deeper  epi- 
thelial layers  are  being  broken  into  irregular  columnar  masses, 
or  e^g  columns,  through  the  growth  among  them  from  below  of 
blood  vessels  and  connective  tissue.  Prior  to  birth  in  those 
young  which  are  born  in  a  well  developed  state,  shortly  after 
birth  in  the  immature  young  like  that  of  the  rabbit,  some  of  the 
primitive  ova  become  materially  changed,  to  cow?X\\w\.^  permanent 
ova. 

In  the  process  of  development  the  connective  tissue  stroma 
throws  out  a  thin  layer,  the  tunica  albuginea,  parallel  to  the  sur- 


Maturation  of  the  Graafian  Follicle 


45 


face  of  the  ovary  and  serving  to  divide  the  germinal  epithelium 
into  a  superficial,  columnar  lajer  and  a  deeper  one  broken  up 
into  irregular  columns  or  clumps  of  spherical  or  polygonal  cells. 
lu  these  cell  masses  \.\\q.  perniaiient  ova,  developed  from  the  prim- 
itive ova,  become  much  larger,  while  the  nucleus  or  germinal 
vesicle  enlarges  and  its  enveloping  membrane  becomes  distinct. 
The  contents  of  the  nucleus  become  massed  at  one  point  and 
form  a  distinct  reticulum,  in  which  one  or  more  nodal  points  en- 
large to  constitute  the  nucleoli  or  germinal  spots.  The  neighbor- 
ing germinal  cells  become  arranged  about  the  ovum  in  a  manner 
to  completely  enclose  it  in  a  follicle,  which  has  at  first  a  single 
layer  of  cells.  Later  a  second  layer  of  cells  forms  about  the  ovum 
within  the  first. 


Fig.  6.  Section  through  part  of  the  ovary  of  an  adult  rabbit. 
The  section  is  taken  vertical  to  the  surface  of  the  ovary,  and  shows 
one  fully  formed  Graafian  follicle,  and  others  in  various  stages  of 
development.     X  50- 

GA,  Follicle  cells  surrounding  an  ovum. 

GB,  outer  layer  of  Graafian  follicle,  or  "  tunica  granulosa." 

GC,  inner  layer  of  Graafian  follicle  or  "  discus  proligerus. " 
GK,  Cavity  of  Graafian  follicle. 

OE,  Outer  layer  of  columnar  epithelial  cells,  investing  the  ovary. 
OW,  Ovum.  OY,  Primitive  Ovum. 

OZ,  Nests  of  Epithelial  cells  derived  from  the  deeper  layers  of 
the  genital  epithelium.  (  Marshall. ) 


46  l'etcri7iary  Obstetrics 

The  cells  of  the  follicle  inultipl}'  rapidly  and,  the  growth  of  the 
external  layer  being  more  rapid  than  the  inner,  there  results  a 
separation  between  the  two,  except  at  the  point  of  attachment  of 
the  ovum,  revealing  upon  section,  a  cresent-shaped  cavity  which  is 
filled  with  fluid. 

Fully  developed,  this  constitutes  the  Graafian  follicle,  which 
consists  of  the  outer  layer  of  follicular  cells  or  tunica  granulosa, 
the  inner  mass  of  granular  cells  or  discus  proligerus  and  the  ovum, 
attached  within  or  upon  the  inner  cell  mass.  The  cavity  of  the 
follicle  is  occupied  by  the  follicular  fluid.  The  ripening  egg  sacs 
lie  at  first  deeply  in  the  ovary  ;  as  the  size  of  the  follicle  increases 
they  approach  more  and  more  nearly  to  the  surface  and  even  pro- 
ject beyond  in  varying  degrees  dependent  somewhat  upon  species. 
They  vary  greatly  in  size.  In  the  mare  they  are  not  readily 
ob-served  upon  the  outer  surface  owing  to  the  dense,  heavy  tunica 
albuginea  and  to  the  fact  that  they  ripen  and  rupture  in  the  con- 
cealed hilus  instead  of  upon  the  free  surface  as  in  most  other 
species.  The  exposed  surface  of  the  ovary  is  frequently  occupied 
by  massive  cysts,  or  over-di.stended  follicles. 

In  the  cow,  the  ripe  follicles  are  prominent  upon  the  ovarian 
surface  while,  in  the  sow,  they  project  entirely  beyond  and  main- 
tain their  connection  by  a  constricted  neck.  As  the  follicle  be- 
comes more  and  more  distended  it  ruptures  at  the  weakest  part 
of  its  wall  and  discharges  its  ovum  or  ova,  with  the  follicular 
fluid  and  portions  of  its  inner  cellular  layer,  upon  the  surface  of 
the  ovary,  where  the  ovum  is  normally  taken  up  at  once  by  the 
pavillion  of  the  oviduct  and  conveyed  toward  the  uterus.  In 
some  cases,  the  ovum  is  not  discharged  promptly  or  even  at  all 
from  its  follicle,  but  may  become  fecundated  and  developed  there, 
constituting  ovarian  pregnancy  (which  see),  while  in  other  in- 
stances it  possibly  escapes  free  within  the  peritoneal  cavity. 

During  this  period  of  maturation  and  rupture  of  the  ovisac,  the 
ovum  itself  undergoes  important  changes  and,  prior  to  its  dis- 
charge from  the  follicle,  its  nucleus  leaves  its  center  and  passes 
toward  the  periphery  ;  a  definite  vitelline  membrane  is  formed 
within  the  zona  radiata  immediately  about  the  egg  :  the  nucleus 
becomes  indistinct  and,  while  the  yolk  or  vitellusjretracts  slightly 
from  the  vitelline  membrane  at  one  point,  the  first  polar  body,  a 
small  mass  apparently  derived  from  an  unequal  division  of  the 
nucleus,    is     assumed    to    be    extruded,    soon    after    which    the 


Ovulation  47 

rupture  of  the  ovisac  occurs  with  the  escape  of  the  ovum  into 
the  pavillion  of  the  tube  and,  following  this,  while  the  egg  is 
moving  along  the  oviduct,  before  impregnation  has  taken  place, 
the  second  polar  body  is  supposed  to  be  cast  off. 

The  exact  relation  of  ovulation  to  estrum  and  menstruation 
has  not  been  determined  with  complete  satisfaction,  and  conflic- 
ting views  are  held.  In  my  personal  experience  in  spaying 
cows,  it  has  been  constantly  found  that  one  in  estrum  has, in  one 
ovary,  a  ripe  Graafian  follicle  which  is  ready  to  rupture  and  usu- 
ally does  so  on  being  removed,  while,  if  estrum  has  occurred  on  the 
previous  day,  a  fresh  corpus  luteum  is  present.  This  indicates 
that,  for  the  cow,  estrum  normally  signifies  the  presence  in  the 
ovary  of  a  mature  Graafian  follicle,  about  to  rupture,  and  that 
copulation  with  the  male  usually  takes  place  prior  to  the  dis- 
charge of  the  ovum  from  its  ovisac.  Later,  menstruation  may 
occur  if  impregnation  has  not  taken  place. 

Observations  on  rabbits  are  similar.  When  young  are  born, 
there  alreadj^  exists,  in  the  ovaries  of  the  doe,  a  crop  of  ovisacs, 
fully  matured  and  ready  to  rupture.  Estrum  follows  at  once 
upon  the  birth,  copulation  occurs,  and  it  is  not  until  after  eight 
to  twelve  hours  have  elapsed  that  the  ovisacs  rupture  and  dis- 
charge their  contents  into  the  pavillion  of  the  oviduct,  there  to 
become  fertilized  by  the  male  cells  already  present.  Such  is 
probably  in  a  large  measure  the  rule  with  other  animals.  There 
are  reasons  for  believing  that  ovulation  is  favored  and  at  times 
possibly  hastened  by  coition,  but  there  is  no  definite  relation  and 
the  ovulation  regularly  occurs  in  the  absence  of  sexual  contact. 

Ovulation  occurs  in  more  or  less  fixed  cycles  and  is  modified 
somewhat  by  climate,  season,  food  and  housing.  In  the  mare  it 
usually  takes  place  at  intervals  of  about  four  weeks  during  spring 
and  early  summer,  is  less  frequent  and  more  irregular  during 
autumn  and  may  be  quite  absent  during  winter,  except  she  be 
well  fed  and  hou.sed.  The  cow  ovulates  with  considerable  regu- 
larity about  every  three  weeks  and,  if  well  housed,  the  cycle  is 
not  liable  to  interruption  during  the  winter  months. 

In  the  ewe,  ovulation  apparently  occurs  every  two  or  three 
weeks,  but  its  existence  is  not  very  evident,  except  in  the  pres- 
ence of  the  male.  In  carnivora  ovulation  ordinarily  occurs  semi- 
annually in  late  winter  and  early  autumn. 


48  Vetermary  Obstetrics 

In  all  animals  ovulation  is  normally  suspended  [durinj^  Preg- 
nancy, but  exceptions  to  this  rule  occur. 

In  some  cases  the  Graafian  follicles  become  over-distended  with 
follicular  fluid,  their  walls  are  abnormally  resistant,  the  ova  tend 
to  perish,  while  the  enlarged  ovisacs  persist  and  grow,  and  ovu- 
lation does  not  occur.  The  presence  of  such  ovarian  cysts  gen- 
erally inhibits  the  ripening  and  rupture  of  other  follicles  and, 
thus,  not  only  causes  .sterility  (which  see)  but  exerts  a  profound 
influence  upon  the  behavior  of  the  animal,  tending  to  cause  nym- 
phomania, or  .sexual  in.sanity. 

2.     ESTRUM. 

Reproduction  among  higher  animals  is  fundamentally  the  re- 
sult of  an  irre-sistible  .sexual  desire  occurring  simultaneously  in 
the  male  and  female  and  leading  to  coition. 

The  condition  is  known  as  estrum  in  the  female  and,  as  related 
in  the  preceding  section,  occurs  immediately  prior  to  or  concur- 
rently with  ovulation.  It  finds  expression  in  various  ways  with 
difl'erent  species  of  animals.  In  general  there  is  a  nervous  excit- 
ability, the  external  genitals  are  swollen  and  vascular,  there  is 
an  increased  secretion  of  mucus  from  the  vulva  and  vagina.  In 
the  mare  there  are  frequent  emissions  of  urine  in  small  quanti- 
ties, especially  in  the  presence  of  other  horses,  most  of  all  of  a 
stallion,  the  vulvar  lips  are  frequently  opened  and  the  erected 
clitoris  protruded.  In  ruminants  and  the  sow  the  female  imitates 
the  copulatory  act  of  the  male  by  mounting  other  animals  of  its 
.species.  In  certain  pathologic  cases,  the  cow,  especially,  does 
not  confine  her  expre.ssions  of  sexual  desire  to  her  own  species, 
but  when  affected  with  nymphomania  may  attempt  to  mount 
other  .species  of  animals  and  we  have  known  instances  where 
they  have  even  attempted  to  mount  man  and  subjected  him  to 
very  .serious  danger. 

In  all  animals  there  is  a  tendency  for  the  female  to  wander 
from  home  during  estrum.  This  is  most  noticeable  in  carnivora, 
which,  if  not  securely  confined,  regularly  disappear  and  tend  to 
wander  long  distances  and  remain  away  during  a  large  part  or 
all  of  the  estrual  period.  In  all  animals  there  is  a  more  or  less 
apparent  odor  characteristic  of  estrum  and  peculiar  to  the  species. 


Copulation.      Coition  49 

3.  Copulation.     Coition. 

Natural  reproduction  in  higher  animals  can  only  occur  as  a 
result  of  copulation,  which,  in  its  turn,  is  brought  about  by  the 
irresistible  desire  of  the  female,  which  we  term  estrum,  and  the 
corresponding  sexual  excitement  of  the  male.  Artificially  im- 
pregnation is  possible  and  has  been  practiced  to  some  extent  by 
breeders,  by  injecting  the  seminal  fluid  of  the  male  into  the 
uterus  of  the  female. 

During  the  act  of  copulation  the  semen  from  the  male  is  in- 
jected into  the  vagina  of  the  female,  possibly  in  part  into  the 
uterus.  We  have  no  definite  data  as  to  where  the  semen  is 
deposited  during  copulation.  It  is  thought  by  man^^  that  most 
or  all  of  it  is  ejaculated  directly  through  the  cervical  canal 
into  the  body  of  the  uterus,  the  urethral  opening  of  the  male 
coming  in  direct  contact  with,  or  entering,  the  os  uteri.  Harms, 
quoting  Duranton  (Journal  de  Lyon,  1888)  cites  a  case  of  rupture 
of  one  of  the  cornu  of  the  uterus  of  a  cow  during  copulation, 
owing  to  the  entrance  of  the  penis  through  the  cervix.  On  the 
other  hand,  as  related  below,  in  case  of  the  mare,  with  a  far  more 
dilatable  cervical  canal,  injuries  from  too  long  a  penis  occur  in 
the  vagina  and  not  in  the  uterus.  We  have  also  known  of  a 
stallion  with  a  considerable  portion  of  the  penis  amputated  which 
was  quite  as  fertile  after  as  before  the  operation,  although  it 
would  seem  that  the  stump  of  the  organ  could  not  well  reach  the 
OS  uteri.  The  es.sential  condition  to  fecundation,  so  far  as  the 
male  is  concerned,  is  that  physiologically  perfect  spermatozoa 
shall  gain  the  cervical  canal,  traverse  the  uterus  and  oviducts 
and  meet  the  ovum.  From  among  thfe  countless  myriads  of  these 
sperm  cells  in  one  discharge  of  semen,  but  one  of  them  is  essential 
for  the  fertilization  of  an  ovum. 


THE  DANGERS  AND  INFECTIONS  OF  COITION. 

Injuries  and  dangers  to  animals  during  copulation  or  prepara- 
tory thereto,  involving  both  sexes,  are  not  uncommon  and  are  fre- 
quently of  a  serious  character.  They  include  physical  injuries 
to  both  male  and  female,  the  transmission  of  infectious  diseases 
of  a  general  character  and  that  of  .specific  venereal  disorders. 

I.  Physical  Inji'rie.s. 

In  the  wild  state,  severe  and  fatal  battles  between  rival  males 
are  not  infrequent  and  the  .same  prevails  to  some  degree  among 
domesticated  animals,  although,  as  a  general  rule,  if  several  males 
are  kept  together  with  a  number  of  females  they  lose  much  of 
their  combativeness  without,  however,  completely  eradicating  it. 
The  author  has  seen  an  in.stance  of  a  fatal  fray  between  two 
rams  which  had  been  regularly  kept  together. 

When  a  strange  male  wanders  into  a  herd  or  group  of  females 
with  which  a  male  is  regularly  consorting  there  is  at  once  a  de- 
termined fight  between  the  two,  which  ends  only  with  one  or  the 
other  becoming  vanquished.  In  these  battles,  injuries  of  the 
most  diverse  character  occur,  according  to  .species  and  chance. 
Their  onlj-  prevention  depends  upon  the  proper  confinement  of 
male  animals. 

In  most  countries  there  are  laws  against  the  running  at  large 
of  male  animals  but,  by  custom,  the.se  are  not  enforced  against 
carnivora,  an  exception  which  should  be  overcome  by  the  con- 
finement of  all  females. 

There  are  further  dangers,  chiefly  to  the  male,  of  injuries  in 
attempting  to  escape  from  or  break  into  enclosures  in  order  to 
reach  females,  especially  with  horses  and  cattle.  The  appear- 
ance of  a  female  in  estrum  near  by  the  enclosure  of  a  male  is  a 
signal  for  him  to  make  violent  attempts  to  escape  from  his  con- 
finement and  reach  the  female.  It  is  consequently  of  importance 
that  enclosures  intended  for  the  confinement  of  male  breeding 
animals  .should  be  especially  .secure  and,  as  far  as  possible,  all 
elements  avoided  in  their  con.struction  which  would  endanger 
the  animal  in  an  effort  to  escape. 
50 


Physical  Injuries  51 

In  the  preparations  for  copulation  there  is  little  danger  except 
in  case  of  horses.  Breeding  customs  and  conveniences  bring 
into  the  procedure  a  period  of  "  trying  "  or  "  teasing  "  of  the 
mare  by  the  stallion,  both  for  the  purpose  of  determining  the 
existence  of  estruni  and  bringing  about  the  desired  degree  of 
sexual  excitement  before  permitting  an  attempt  at  copulation. 
In  this  act  there  are  numerous  dangers,  especially  to  the  stallion. 

It  is  desirable,  if  not  frequently  essential  to  safety,  that  .special 
conveniences  for  restraint  be  provided  for  this  purpose.  They 
should  consist  ordinarily  of  a  strong,  solid  wall  about  three  feet 
high  and  ten  to  twelve  feet  in  length  with  a  rather  broad  and 
rounded  top.  The  chief  object  of  the  structure  is  the  avoidance  of 
kick  wounds  which  may  be  inflicted  upon  the  stallion  by  the  mare. 
To  this  end  it  should  be  merely  of  sufficient  height  to  guard 
against  such  an  accident  and  sufficiently  resistant  that  the  mare 
cannot  kick  through  it.  The  use  of  a  single  pole  to  .separate 
the  stallion  and  the  mare  is  insecure  and  hazardous  as  either 
may  kick  through  beneath  it  and  injure  the  other. 

It  is  also  highly  essential  that  the  top  of  the  structure  be 
rounded,  smooth  and  free  from  projections.  Either  the  mare  or 
stallion  may  get  beyond  the  control  of  the  groom  and  kick  or 
leap  upon  the  structure  and,  unless  properly  built,  .serious  injury 
is  liable  to  occur.  To  this  end  the  wall  should  be  low  enough 
that,  either  animal,  getting  upon  it  by  rearing  or  kicking,  may 
readily  free  itself  without  injury. 

In  one  instance  the  author  attended  a  stallion,  which,  becom- 
ing impatient,  had  passed  beyond  the  control  of  the  groom, 
reared  to  mount  the  mare  and  became  impaled  upon  a  projecting 
post  at  one  end  of  the  structure,  causing  a  serious  hernia  and 
almost  eveotration.  Posts  should  not  extend  above  the  top  of 
the  structure  or,  doing  so,  should  continue  so  high  as  to  make 
injury  in  this  manner  impossible. 

When  this  preparatory  period  has  been  passed  and  copulation 
has  been  decided  upon,  there  arise  fresh  dangers  to  the  stallion 
from  kicks  by  the  mare  while  approaching  her  or  in  the  act  of 
mounting.  Two  methods  of  avoiding  accidents  at  this  point  are 
used  ;  without  and  with  hobbles.  In  the  first  method,  when  both 
stallion  and  mare  are  well  broken  and  controllable  and  competent 
grooms  have  each  well  in  hand,  the  stallion  should  be  caused  to 
approach  the  mare's  head  and   then  allowed  to  mount  from  the 


52  Vet eH nary  Obstetrics 

side  instead  of  from  the  rear.  If  both  are  kept  well  in  hand,  any 
attempt  to  kick  on  the  part  of  the  mare  should  be  at  once  coun- 
teracted b}-  vigorously  drawing  her  head  toward  the  stallion,  thus 
turning  her  heels  from  him.  After  coition  has  been  completed 
and  the  stallion  is  dismounting  the  .same  rule  should  constantly 
be  applied  and  the  mare  brought  at  once  to  face  the  stallion  in 
order  to  avoid  kicks. 

Owners  of  valuable  stallions  generally  prefer  to  obtain  yet 
greater  security  hy  the  application  of  hobbles.  Two  forms  are 
used,  of  which  there  are  numerous  varieties.  By  one  plan,  a 
hobble  is  buckled  about  each  hind  pastern,  a  rope  of  sufficient 
length  attached  to  each,  and  the  two  free  ends  are  carried  forward 
between  the  forelegs  and  securely  tied  to  a  strong  collar  or  the 
ends  may  be  carried  upwards  on  either  side  of  the  neck  and  tied 
on  the  top  sufficiently  tight  to  prevent  the  mare  from  kicking 
backward  for  any  important  distance.  By  the  second  plan,  the 
hobbles  are  attached  to  the  hocks  instead  of  the  pasterns.  In 
this  case,  each  hobble  is  double  and  one  portion  of  each  is  attached 
above,  the  other  below  the  hock  of  each  hind  leg  and  by  ropes  or 
straps  are  fixed  forward  the  same  as  in  the  preceding.  The  latter 
po.sses.ses  .some  points  of  superiority.  The  mare  is  not  so  liable 
to  become  entangled  in  the  ropes  and  injure  herself  and  the  stal- 
lion is  probabl)'  also  exposed  to  le.ss  danger  of  getting  his  foot 
caught  in  the  .securing  apparatus.  Whatever  the  form  of  breed- 
ing hobbles  or  other  confining  apparatus,  they  need  be  secure  and 
strong.  Nothing  can  well  be  more  dangerous  for  the  breeding 
stallion  than  insecure  hobbles  which  lead  to  a  false  feeling  of 
security  and  throw  the  otherwise  careful  stallion  groom  off  his 
guard.  In  a  recent  instance  the  author  was  called  to  attend  a 
valuable  stallion  suffering  from  a  compound  tibial  fracture,  the 
result  of  a  kick  during  attempted  copulation.  Because  the  mare 
was  not  properly  in  estrum  or  for  other  reason  she  was  unex- 
pectedly cross  and  at  a  critical  moment  when  the  stallion  was 
attempting  to  mount  she  commenced  to  kick  and  the  old  hobbles, 
in  which  the  owner  of  the  stallion  had  trusted,  gave  way,  and 
the  fatal  accident  at  once  followed.  The  breeder  should  never 
trust  partly  to  hobbles  and  partly  to  the  gentleness  of  the  mare 
or  good  luck.  If  hobbles  are  to  be  trusted  at  all,  the  breeder 
should  know  that  they  are  so  strong  that  no  mare  can  break 
them  and   always  allow  a  safe  margin  of  strength  beyond  that 


Physical  hi  juries  53 

considered  essential  and  the  fastenings  should  be  secure  in 
every  detail  and  beyond  the  possibility  of  slipping  or  accidental 
detachment. 

If  accidents  are  to  be  avoided,  it  is  also  highh*  important  that 
the  mare  is  properly  in  estrum  and  that  she  is  not  frightened  or 
angered.  Gentleness  and  patience  in  the  handling  of  both  stal- 
lion and  mare  and  postponing  copulation  vintil  the  proper  moment 
are  always  essential  elements  of  safety  in  breeding.  Some 
breeders  place  a  twitch  upon  the  mare's  nose  until  the  stalliou 
has  safely  mounted  her. 

In  breeding  mares  to  jacks,  it  is  customary  to  place  the  mare 
in  a  pit  where  she  is  clcsely  confined  and  rests  upon  a  plane  a  foot 
or  more  lower  than  that  upon  which  the  jack  stands.  This  not 
only  gives  an  advantage  to  the  comparatively  small  male  b}^ 
aflfording  him  an  elevation,  but  also  secures  him  against  kicks 
from  the  mare,  a  highly  essential  precaution  becau.se  the  mare 
ordinarily  resents  copulation  with  the  ass,  so  that  the  act  is 
largely  in  the  nature  of  rape. 

False  copulation,  or  entrance  of  the  penis  into  the  anus  in- 
stead of  the  vulva,  is  possible  in  almost  any  of  our  domestic  ani- 
mals and  Harms  records  it  as  occurring  in  the  mare,  cow  and 
sow.  The  author  has  observed  it  only  in  the  mare  and,  in  all, 
four  times,  though  he  has  known  of  numerous  other  instances. 
It  is  by  no  means  rare  and  is  highly  dangerous.  Its  cau.ses  are 
various  but  it  is  probably  largeh'  due  to  some  resistance  on  the 
part  of  the  mare  as  a  result  of  not  being  properly  in  estrum  or 
otherwise  becoming  excited  and  attempting  to  kick  or  move 
about. 

Coition  is  safe  only  when  estrum  is  present  in  the  proper  de- 
gree. The  mare  has  ample  power  to  close  the  vulva  against  the 
ready  entrance  of  the  penis  and  thus  cause  it  to  glide  upward 
and  forwards  against  and  into  the  anus,  which  opening  may  be 
more  readily  forced. 

The  accident  is  also  invited  in  aged  cows  or  mares  with  pendu- 
lous abdomen  in  which  the  anus  is  retracted  and,  drawing  the  supe- 
rior commi.ssure  of  the  vulva  with  it,  causes  the  vulvar  opening  to 
approach  the  horizontal  instead  of  the  perpendicular  and  the  penis 
to  glide  forward  and  slightly  upward  over  the  oblique  vulvar 
opening  to  strike  against  the  inferior  surface  of  the  tail  and  be 
deflected  into  the  anus.     It  may   be  purely  accidental.     Harms 


54  Veterijiary  Obstetrics 

thinks  it  ma}'  result  from  smallness  of  the  female.  All  cases  we 
have  observed  have  been  in  mares  of  medium  or  large  size,  whether 
viewed  actually  or  comparatively  as  related  to  the  size  of  the 
stallion. 

The  extent  of  the  injury  varies.  Apparently,  the  accident  may 
cause  little  or  no  injury  in  some  cases,  though,  in  those  which  are 
brought  to  the  attention  of  the  veterinarian,  a  large  proportion 
are  fatal.  The  extent  of  the  lesions  will  vary  according  to 
the  .size  and  form  of  the  penis,  the  violence  of  the  copulatory  act 
and  the  quantity  and  character  of  the  feces  in  the  posterior  por- 
tion of  the  rectum.  Should  the  rectum  be  quite  empty  or  filled 
only  with  pultaceous  feces,  as  in  a  cow,  or  in  the  mare  on  green 
food,  the  penis  may  force  its  way  along  in  the  bowel  unless  it  is 
caught  in  the  folds.  If  the  rectum  is  impacted  with  dry  feces,  as 
is  usuall}'  the  ca.se  in  the  mare,  the  penis  is  deflected  and  tends 
to  pa.ss  through  the  rectal  walls.  The  rupture  may  occur  either 
into  the  peritoneal  cavity  or  into  the  periproctal  connective  tis- 
sue. In  the  former  case  in  the  mare,  the  opening  is  so  great 
that  feces  at  once  drop  into  the  peritoneal  cavity  and  cause  pro- 
found irritation.  No  sooner  has  the  stallion  dismounted  than 
the  mare  trembles,  looks  anxiously  at  her  sides,  may  pass  some 
feces  and  blood,  moves  uneasily  and  may  lie  down  but  does  not 
roll  violently.  The  pulse  is  rapid  and  weak,  the  breathing  is 
shallow  and  quickened,  the  abdomen  is  held  rigid  and  the  patient 
looks  as  if  tA-mpanitic. 

The  symtoms  resemble  in  many  particulars  those  of  rupture  of 
the  stomach.  The  diagnosis  is  readily  made  by  manual  explor- 
ation per  rectum,  the  hand  easily  pa.s.sing  out  through  the  rup- 
ture into  the  peritoneal  cavity.  In  one  of  our  cases  of  rupture 
into  the  peritoneal  cavity,  the  mare  lived  some  eight  hours  ;  in 
another,  less  than  four  hours. 

Not  all  ca.ses  lead  to  rupture  into  the  peritoneal  cavity.  In 
one  instance  under  our  observation,  in  an  old  brood  mare,  no  his- 
tory of  injury  was  obtainable  and  apparently  it  had  not  occurred 
during  the  several  years  of  ownership  by  her  la.st  proprietor. 
She  died  under  symtoms  of  colic  and  an  autopsy  revealed  a  large 
intra-pelvic  sac,  opening  into  the  rectum,  which  had  been  habit- 
ually filled  with  feces  but,  becoming  over  distended,  had  obstructed 
the  bowel  and  cau.sed  a  rupture  of  the  sac  into  the  peritoneal  cav- 


Physical  Injuries  55 

ity.  It  was  almost  certainly  the  result  of  a  long-standing  penial 
wound. 

In  another  case  to  which  the  author  was  called  the  accident 
was  recognized  at  the  time  of  its  occurrence,  blood  and  feces 
were  voided,  the  perineal  region  was  swollen.  Manual  explora- 
tion revealed  a  large  rent  through  the  rectal  walls  into  the  peri- 
proctal  connective  tissue  six  to  eight  inches  from  the  anus,  con- 
taining a  mass  of  feces  equal  to  about  two  liters  impacted  into 
the  readily  distensible  wound.  The  feces  occupying  the  sac  and 
those  from  the  rectum  immediately  anterior  to  the  rupture  were 
carefully  removed  by  the  hand  and  the  sac  was  cautiously  flushed 
out  with  an  antiseptic  solution.  This  method  of  handling,  re- 
peated twice  daily,  along  with  restricted,  laxative  diet  and  com- 
plete rest,  brought  about  a  prompt  recovery  with  little  sacculation. 

According  to  Harms,  false  copulation  in  the  sow  is  usually  fol- 
lowed by  no  more  serious  consequences  than  a  swollen  anus, 
accompanied  by  a  bloody  discharge. 

In  the  mare  the  accident  is  preventable  b}^  ordinary  precautions 
on  the  part  of  the  stallion  groom,  whose  duty  it  is  to  see  that  the 
penis  is  guided  into  the  vulva  or,  at  least,  not  permitted  to  enter 
the  rectum.  To  this  end,  it  is  best  not  to  attempt  service  in  case 
of  a  mare  not  certainly  in  proper  estrum.  It  is  a  part  of  the  busi. 
ness  of  the  groom  to  see  and  to  know  that  the  penis  of  the  stal- 
lion is  properly  entering  the  vulva  of  the  mare.  If  the  mare  is 
kicking  or  otherwise  violently  resisting  the  stallion,  he  should  be 
promptly  withdrawn,  since  copulation  under  such  circumstances 
is  uuwarrantedly  dangerous  for  both  animals.  Such  violent  re- 
sistance of  the  mare  is  sometimes  offered  by  the  groom  as  an 
excuse  for  his  failure  to  see  and  know  that  the  penis  of  the 
stallion  was  being  properly  entered  in  the  vulva,  but  it  is  not 
valid.  The  mare  or  cow  with  retracted  anus  should  be  placed 
with  her  hind  feet  on  a  lower  level  than  her  anterior  members, 
leaving  the  ground  upon  which  the  male  is  to  stand  at  a  higher 
level  and  thus  bringing  the  vulvar  opening  more  nearly  perpen- 
dicular. In  the  cow  and  sow,  the  accident  is  not  usually  pre- 
ventable. 

The  prognosis  of  penial  injuries  to  the  rectum  must  be  based 
largely  upon  the  position  and  extent  of  the  injury.  When  the 
lacerations  perforate  the  peritoneum  and  cause  escape  of  feces 
into  the  peritoneal  cavit\-  the  injury  is  essentially   fatal,  veteri- 


56  Veterinary  Obstetrics 

narians  having  not  yet  succeeded  in  successfully  handling  such 
lesions.  When  the  rupture  of  the  rectal  wall  occurs  behind 
the  peritoneum  or  otherwise  does  not  perforate  it,  the  prognosis 
is  good  if  timely  surgical  aid  is  given,  though,  after  a  long  period 
of  time,  serious  or  fatal  results  may  follow  the  impaction  of  feces 
in  the  sac  formed  in  the  pelvic  connecting  tissue.  The  pressure 
of  the  feces  escaping  from  the  rectum  tends  constantly  to  push 
the  loose  connective  tissue  aside  and,  eventually,  to  form  a  large 
sac,  which  is  constantly  filled  with  fecal  masses. 

The  handling  in  such  cases  consists  of  gently  removing  the 
feces  from  the  sacculated  wound  cavity  in  the  pelvic  connective 
ti.ssue  and  cautiou.sly  flushing  it  out  at  least  twice  daily  wath  a 
mild  antiseptic  solution.  At  the  same  time,  the  rectum  should 
be  manually  emptied  as  far  as  the  attendant  can  reach  and  the  feces 
thus  prevented  from  dropping  into  the  sac.  The  patient  should 
be  kept  at  rest  on  a  very  .scant,  laxative  diet  during  the  treatment, 
which  should  be  continued  until  the  rupture  is  quite  healed  as  it 
is  highly  important  to  guard  again.st  extensive  sacculation  in  the 
part,  which  can  only  be  done  b\'  avoiding  the  accumulation  of 
feces  in  it. 

In  some  instances,  the  injuries  to  the  rectum  from  the  entrance 
into  it  of  the  penis  are  comparativeh^  trivial  and  consist  merely 
of  wounds  of  the  mucosa  and  somewhat  of  the  mu.scular  walls, 
with  the  pa.ssage  of  bloody  feces,  some  swelling  about  the  anus 
and  other  slight  sj^mptoms  of  injury,  which  readily  pass  awaj' 
under  repeated  antiseptic  euemata. 

From  a  foren.sic  standpoint,  the  owner  of  the  stallion  is  probably 
always  responsible  for  the  damages  to  the  mare,  since  the  acci- 
dent is  preventable  with  proper  care  upon  the  part  of  the  groom. 
Such  were  the  findings  in  the  only  case  which  we  have  seen  tested 
in  the  courts. 

Harms,  quoting  Hinrichsen,  mentions  an  instance  in  which  a 
cow  had  her  tail  fractured  at  the  base  during  copulation. 

The  vagina,  especially  of  the  mare,  is  not  infrequently  lacer- 
ated or  ruptured  by  the  penis  of  the  male.  The  size  of  the  penis 
of  the  stallion  does  not  bear  a  constant  ratio  to  the  size  of  the 
body,  but  is  comparatively  excessive  in  coarsely  bred  animals 
with  long  legs  and  large  heads.  Such  stallions,  copulating  with 
small  mares,  con.stantly  tend  to  produce  vaginal  injuries.  Some- 
times it  is  merely  a  slight  laceration   in   the  mucous  membrane. 


Physical  hijiiries  57 

which  may  cause  hmited  hemorrhage  and  some  straining  ;  some- 
times the  lacerations  in  the  mucosa  and  muscular  walls  are  ex- 
tensive and  induce  marked  symtoms  of  wound  infection  in  the 
vagina  with  tumefaction,  discharge  and  straining  ;  while,  in  other 
cases,  the  vaginal  walls  are  completely  ruptured,  with  great  dan- 
ger of  fatal  peritonitis. 

In  one  instance  investigated  by  us  a  series  of  injuries  was  caused 
by  a  recently  imported  stallion,  which  had  been  put  to  service 
among  comparatively  small  mares.  Almost  every  mare  served 
by  him  exhibited  signs  of  vaginal  injury  ;  some  were  severely 
lacerated;  in  one  there  was  a  fatal  rupture.  Inspecting  the  horse, 
he  was  found  to  be  an  overgrown,  coarse,  leggy  grade  draft  stal- 
lion about  eighteen  hands  high  and  with  an  enormous  penis 
which  would  have  been  dangerous  with  heavy  draft  mares,  while, 
in  his  neighborhood,  most  animals  were  of  small  roadster  or  com- 
mon stock. 

When  such  injuries  occur,  there  is  observed  an  abnormal  amount 
of  straining  immediately  after  copulation,  with,  perhaps,  some  dis- 
charge of  blood  from  the  vulva.  Later,  swelling  of  the  vulva  and 
a  muco-purulent  discharge  may  occur. 

If  the  wound  penetrates  the  peritoneal  cavity,  septic  peritonitis 
is  highly  probable,  with  early  collapse  and  death. 

Injuries  to  the  mare  from  this  cause  should  be  obviated  by 
means  of  a  roll  or  padded  surcingle  encircling  the  body  and  pass- 
ing just  in  front  of  the  sheath  in  a  manner  to  prevent  the  penis 
from  entering  the  vagina  to  its  full  length,  the  pad  or  roll  being 
adjusted  in  size  according  to  the  case.  The  diameter  of  the  roll 
should  alwa5's  be  ample,  since  little  fear  need  be  entertained  that 
the  prevention  of  the  entrance  of  the  entire  length  of  the  penis 
will  unfavorably  affect  the  results  of  copulation,  as  general  obser- 
vations show  to  the  contrary.  In  constructing  this  roll  or  pad 
an  ordinary  surcingle  may  be  used  and  a  tube  made  of  sheeting 
or  other  sufficiently  strong  material  and  this,  open  at  each  end, 
slipped  over  the  surcingle.  Padding  of  cotton,  oakum  or  other 
material  is  then  to  be  inserted  into  the  tubular  covering  until  it 
is  tightly  filled  so  that  it  presents  a  diameter  of  4  to  8  inches 
in  that  part  of  the  surcingle  to  come  in  contact  with  the  abdomi- 
nal floor,  after  which  the  open  ends  of  the  tube  are  to  be  .secured 
to  the  surcingle  and  closed  by  tying.  When  the  stallion  is 
ready  for  .service,  the  surcingle  is  passed  around  his  body  just  in 


58  Veterinary   Obstetrics 

front  of  the  opening  of  the  sheath  and  secured  by  buckling.  In 
copulation,  only  that  portion  of  the  penis  projecting  beyond 
the  roll  can  enter  the  vagina. 

Non-fatal  laceration  of  the  vagina  should  be  handled  along 
general  antiseptic  lines,  the  practitioner  remembering  constantly 
that  this  organ  reacts  strongly  to  irritants  and  that  thorough  dis- 
infection should  be  brought  about  largely  by  mechanical  flushing 
rather  than  by  heroic  attempts  to  destroy  the  micro-organisms 
in  po.sition. 

Lacerations  of  the  vulvo- vaginal  canal  during  copulation  some- 
what rarely  occur  becau.se  of  pathologic  changes  due  to  prior 
diseases,  especially  to  adhesive  inflanunations  leading  to  impor- 
tant stricture  or  occulusion.  In  one  instance  coming  under 
observation,  in  a  mare,  there  were  old  adhesions  of  the  vaginal 
walls  in  their  anterior  portion.  An  attempt  to  breed  her  caused 
such  injury  as  to  lead  to  violent  expulsive  efforts,  by  which  she 
iorced  the  urinary  bladder,  covered  by  the  vulvo- vaginal  floor, out 
through  the  vulvar  opening — vcsico-vaginocele — which  persisted 
in  spite  of  trus.ses,  sutures  and  other  expedients  and  was  only 
controlled  b}^  producing  prolonged  and  deep  anaesthesia  with 
chloral. 

In  cows, adhesions  of  the  vaginal  parietes  may  occur  as  a  result 
of  infectious  vaginitis  and  naturally  render  coition  unsafe  if  not 
impo.s.sible. 

Lacerations  of  the  vagina  by  the  penis  are  also  liable  to  occur 
in  other  dome.stic  animals  though  less  probable  than  in  the  mare. 
Their  symptoms,  prognosis  and  treatment  are  e.s.sentially  the 
same. 

Duranton  (Journal  de  Lyon,  1888  j  records  a  case  in  which  the 
uterine  cornu  of  a  cow  was  ruptured  about  3.5  cm.  anterior  to 
the  OS  uteri,  suppo.sedly  by  the  penis  of  the  bull  during  copula- 
lation.  We  consider  the  record  open  to  question  and  would 
think  it  more  probable  that  the  rupture  had  occurred  from  other 
cau.ses. 

Injuries  to  the  bladder  by  the  penis  of  the  male  have  been 
recorded,  though  very  rarel}-.  Harms,  quoting  Nebele  (Reper- 
torium)  mentions  one  case  in  a  cow  in  which  the  bladder  was 
ruptured  owing  to  the  entrance  of  the  penis  through  the  meatus 
urinarius.  The  probability  of  such  an  accident  seems  especially 
remote  in  the  cow  becau.se  of    the  small   valve    arising  from  the 


Physical  Injuries  59 

floor  of  the  meatus  and  extending  forwards.  In  the  mare,  this 
accident  would  seem  quite  as  possible  because  of  the  very  wide, 
valveless  meatus,  through  which  several  fingers  may  be  passed, 
but  the  penis  of  the  stallion  is  much  larger  and  the  glans  very 
broad. 

In  one  instance,  a  somewhat  coarse  two-^-ear  filly,  weighing 
1700  pounds  was  presented  for  service  to  a  2400  pound  stallion 
with  a  large  penis.  Upon  mounting  her, the  stallion  entered  his 
penis  into  the  vulva  a  short  distance,  where  an  obstruction  was 
apparently  encountered,  and  after  a  time  he  dismounted.  After 
repeated  unsuccessful  efforts  the  author  was  asked  to  examine 
her  and  found  a  persistent  hymen  across  the  lower  portion  of  the 
vagina,  sloping  upward  and  backwards  which  had  directed  the 
penis  downward  against  the  meatus  urinarius,  through  which  the 
hand  could  be  easily  passed,  but  no  injury  from  the  penis  could 
be  detected  at  the  time  or  later  ;  on  the  other  hand  when  the 
penis  encountered  the  obstruction,  the  stallion  desisted  from 
further  attempts  at  copulation. 

Injuries  to  the  female  because  of  great  weight  of  the  male  are 
not  rare  though  far  less  common  than  one  would  be  inclined  to 
expect  when  the  disparity  in  size  is  considered.  It  is  not  rare 
to  see  females  served  by  males  two,  three  or  more  times  their 
weight  and  yet  escape  injury  entirely.  In  the  smaller  species  of 
animal,  like  the  pig  and  dog,  the  female  can  quite  readily  drop 
to  the  ground  under  excessive  weight  and  escape  injury,  but, 
in  the  cow  and  mare  there  is  danger  of  serious  injury  when 
the  weight  of  the  male  becomes  too  great.  Ordinarily,  a  cow 
or  mare  can  readily  withstand  copulation  with  a  male  weighing 
150%  more  than  herself,  or  a  cow  or  heifer  weighing  800  pounds 
can  be  safely  bred  to  a  bull  weighing  2000  pounds  or  slightly 
more.  When  this  point  has  been  greatly  exceeded, danger  arises 
and  increases  in  proportion  to  the  variation  in  weight.  In  one 
instance  a  heifer  of  about  five  months  and  weighing  about  400 
pounds  was  served  by  a  bull  weighing  2000  pounds  and  suf- 
fered a  fracture  of  the  pelvis,  though  not  sufficiently  serious  to 
prevent  her  giving  birth  in  due  time  to  a  calf  from  the  service 
which  caused  the  injury.  In  another  instance,  a  sucking  filly 
was  ridden  by  a  large  stallion,  causing  dislocation  of  the  sacro- 
iliac articulation  on  one  side  and  fracture  of  the  iliac  shaft  on 
the  other,  rendering  her  useless  for  labor  and,  after  having  been 


6o  Ve/er/nary  Obstetrics 

bred  at  two  years,  necessiating  her  destruction  at  three  years, 
because  of  irremediable  dystokia.  It  is,  therefore,  desirable  that 
young  females  which  come  in  estrum  very  early  in  life,  should 
be  securely  segregated  from  mature  males,  not  alone  because  of 
the  undesirability  of  very  early  breeding,  but  in  order  to  avoid 
serious  injuries  from  disparity  in  size.  It  is  also  essential  to 
remember  that  a  male  breeding  animal  regularly  confined,  in 
case  of  accidental  escape,  will  attempt  rape  upon  the  most  im- 
mature young  as  in  the  foregoing  case,  with  serious  or  fatal 
results. 

In  the  mare,  injuries  to  the  neck  and  withers  are  also  liable  to 
occur  from  bites  by  the  stallion  during  coitus.  This  is  probably 
most  common  among  heavy  draft  stallions,  some  of  which  are 
ver}'  rough  and  cause  more  or  less  .serious  lacerations  or  contu- 
sions, at  times  leading  to  fistulous  withers.  There  .seems  to  be 
no  means  for  breaking  the  stallion  of  the  vice  and  the  only  ef- 
fective method  of  control  with  which  we  are  acquainted  is  the 
application  of  a  muzzle  during  coition. 

Injuries  to  the  male  becau.se  of  over- .size  of  the  female  also  oc- 
cur, especially  in  the  bull.  When  young  bulls  of  small  size  at- 
tempt copulation  with  mature  or  large  cows,  they  are  liable,  at 
the  moment  of  the  violent  copulatory  thrust  to  take  their  feet 
off  the  ground  to  such  a  degree  that  in  coming  down  they 
miss  their  footing,  their  hind  feet  glide  forwards  and  they  fall 
heavily  backwards,  sometimes  causing  fracture  of  the  spine  or 
other  serious  injury.  It  is  to  be  avoided  by  guarding  against  too 
great  a  di.sparity  in  size  and  by  placing  the  small  male  in  as 
advantageous  a  position  as  po.ssible  both  as  to  .slope  of  ground 
and  security  of  footing,  especially  avoiding  damp,  slippery  ground. 

In  one  case  brought  to  our  attention  a  similar  accident  oc- 
curred to  a  cow,  which  being  in  heat,  mounted  one  of  her  mates 
slipped,  fell  and  fractured  her  spine  so  that  she  had  to  be  de- 
stroyed. 

Injuries  to  the  penis  of  the  male  during  copulation  are  by  no 
rare.  The  penis  of  the  stallion  is  most  liable  to  injury  from  kicks 
by  the  mare,  the  avoidance  of  which  we  have  considered  above 
while  discussing  the  subject  in  a  general  way.  These  contusions 
of  the  penis  during  its  great  vascularity  in  the  breeding  season 
are  very  difficult  and  refractory  to  handle.  The  stallion  needs  be 
kept  quiet,  free  from  .sexual   excitement,  the  penis  retained  at 


Physical  Injuries  6i 

rest  within  the  sheath  by  means  of  a  suspensorium  and  the  re- 
sulting local  inflamation  ameliorated  by  the  application  of  cool- 
ing astringents  such  as  lead  acetate,  hamamelis,  tannin,  bella- 
donna, etc.,  combined  in  cases  of  necessity  with  antiseptics.  Gen- 
erally the  patient  may  have  quiet  walking  exercise,  a  restricted 
laxative  diet,  saline  laxatives  or  in  case  of  serious  disturbance, 
prompt  cathartics  of  the  hypodermic  alkaloidal  group. 

Lesser  injuries  to  the  penis  of  the  stallion  are  caused  by  the 
pushing  of  tail  hairs  of  the  mare  into  the  vagina  by  the  glans 
penis.  These  being  drawn  tightl}'  across  the  penis,  cut  the  organ. 
This  is  to  be  prevented  by  the  stallion  groom  by  drawing  the  tail 
of  the  mare  aside  at  the  commencement  of  the  copulatory  act  or 
better  by  means  of  a  bandage  about  the  base  of  the  tail  extending 
low  enough  to  secure  any  hairs  that  might  be  caught  upon  the 
glans  penis  or  b}'  braiding  the  upper  hairs  of  the  tail  upon  the 
dorsal  surface. 

In  bulls  and  other  male  ruminants,  the  penis  occasionally  be- 
comes caught  against  the  side  of  the  vulva  or  elsewhere  and  the 
animal  at  the  moment  of  making  the  violent  copulatory  thrust, 
doubles  the  organ  sharplj' upon  itself,  "breaking"  it  or  other- 
wise causing  serious  injury.  Sudden  and  violent  bending  of  the 
erected  penis  causes  such  injuries  to  its  tissues  that  the  "broken" 
organ  remains  curved  or  bent  at  an  angle,  or  that  portion  beyond 
the  point  of  injury  does  not  become  erected,  which  renders  him 
u.seless  as  a  breeder  (see  Sterility)  or  the  injury  causes  balanitis 
or  inflammation  of  the  prepuce  which  leads  to  adhesions  so  that 
the  organ  cannot  be  protruded. 

The  prevention  of  such  injuries  is  more  important  and  practica- 
ble than  their  handling.  They  are  most  liable  to  occur  in 
confined  males  which  are  suddenly  brought  in  contact  with  fe- 
males in  estrum,  not  always  in  a  proper  state  for  coition.  The 
female  may  be  nervous  or  timid  at  the  approach  of  a  strange  male 
or,  still  worse,  estrum  may  not  yet  have  reached  its  fullness  or  has 
begun  to  decline  so  that  she  will  not  stand  well  and,  as  a  result 
of  resistance,  the  accident  may  occur.  Slipper}^  or  uneven  ground 
may  also  render  the  act  insecure  and  lead  to  injuries  to  the  penis. 

Prevention  should  be  based  chiefly  on  the  avoidance  of  these 
and  other  dangers.  In  cows  especially,  it  is  important  that  they 
be  properly  in  estrum,  that  the  enclosure  in  which  copulation  is 
to  occur  is  reasonably  even  and  the  footing  secure.      Zschokke 


62  l^f/crifiary  Obstetrics 

commends  ( Der  Uufruchtharkeit  des  Rindes,  Page  66)  service 
stocks  consisting  of  five  posts  upon  which  are  fixed  two  beams 
which  meet  in  front  to  constitute  an  acute  triangle,  open  at  the 
base,  into  which  the  cow  is  led  and  from  which  she  can  not 
readily  escape  or  make  any  extensive  movements. 

In  the  handling  of  such  injuries  to  the  penis,  little  can  be  done 
beyond  the  allaying  of  infection  by  means  of  anteseptic  douches 
and  the  avoidance  of  sexual  excitement,  combined  with  such  lo- 
cal and  general  treatment  as  would  tend  to  control  infianmiation. 

In  the  dog,  in  which,  during  copulation,  the  prominent  glans 
penis  becomes  tightly  fixed  in  the  vulva  of  the  bitch,  the  male 
may  dismount  and  turn  in  the  opposite  direction  thus  bending 
the  penis  abruptly.  If  disturbed  by  other  dogs  or  in  any  other 
manner,  violent  dragging  upon  the  penis  follows,  which  leads  to 
injuries  of  a  more  or  less  serious  character,  chiefly  to  swelling 
and  inflamation  of  the  parts,  occasionally  accompanied  by  para- 
phymosis.  These  injuries  are  not  usually  observed  under  proper 
breeding  arrangements  but  are  generally  seen  where  bitches  are 
permitted  to  run  at  large  and  a  large  number  of  dogs  to  congre- 
gate, with  the  resultant  fighting. 

The  handling  of  such  injuries  to  dogs  consists  of  essentially  the 
same  methods  as  in  the  bull,  chiefly  of  disinfection.  If  para- 
phymosis  results,  it  .should  be  overcome.  A  solution  of  eucaine, 
with  perhaps  .some  adrenalin,  may  be  applied  to  the  swollen  glans 
penis,  after  which,  by  the  application  of  digital  compression  or  by 
means  of  an  elastic  bandage,  the  size  of  the  congested  organ  may 
be  so  reduced  that  it  can  be  pressed  back  into  the  prepuce.  If 
not,  the  margin  of  the  prepuce  is  to  be  enlarged  by  incision  suffi- 
ciently to  permit  the  penis  to  return. 

Copulation  is  one  of  the  most  common  causes  of  strangulated 
inguinal  hernia  in  the  stallion  and  the  accident  is  occasionally 
induced  in  this  way  in  other  male  animals.  When  the  stallion 
mounts  the  mare,  his  position  subjects  the  inguinal  region  to 
increa.sed  pressure  from  the  weight  of  the  abdominal  viscera,  the 
po.sition  of  the  abdomen  having  been  changed  from  horizontal,  or 
a  declination  downwards  and  forwards  from  the  inguinal  ring 
towards  the  diaphragm,  to  almost  the  perpendicular,  with  the 
entire  weight  of  the  abdominal  viscera  pressing  downwards  upon 
the  pelvic  inlet  and  inguinal  opening.  The  pressure  is  further 
augmented  by  the  abdomen  of  the  stallion  becoming  forcibly  com- 


Physical  Injuries  63 

pressed  against  the  buttocks  of  the  mare,  as  well  as  by  the  vigor- 
ous contraction  of  the  abdominal  muscles  during  the  act  and  all 
combine  to  increase  the  intra-abdominal  pressure  and  tend  to 
force  a  small  section  of  intestine  through  the  inguinal  ring,  where 
it  quickly  becomes  strangulated  unless  it  promptly  returns  to  its 
proper  position  when  the  stallion  dismounts. 

In  such  case,  soon  after  dismounting,  in  15  to  30  minutes,  or 
even  earlier,  the  stallion  exhibits  symptoms  of  colic,  kicks  at  his 
belly,  looks  at  his  flank,  breathes  rapidly,  sweats  profusely  and 
rolls  violently. 

The  agony  is  excruciating  and  constant,  increasing  in  intensity, 
the  sweat  becoming  more  profuse  until,  after  ten  to  twelve  hours 
in  very  acute  and  unrelieved  cases,  the  violence  abates,  the  bod}^ 
surface,  bedewed  with  sweat,  becomes  cold,  the  pulse  rapid  and 
weak  or  imperceptible,  indicating  gangrene  of  the  incarcerated 
bowel,  to  be  soon  followed  by  death. 

If  the  inguinal  region  is  carefully  examined  a  tense  fluctuating 
svvelling  may  be  recognized,  but,  in  many  cases,  the  incarcerated 
intestinal  loop  is  so  small  that  its  presence  can  be  determined 
only  by  very  careful  palpation.  Examination  per  rectum 
usually  gives  more  definite  results,  and  the  incarcerated  intestine 
can  be  felt  and  grasped,  making  the  diagnosis  definite  and  final. 

The  handling  needs  be  prompt  and  usually  radical,  if  the  life 
of  the  patient  is  to  be  saved,  although  spontaneous  recovery 
occurs  in  some  cases.  If  the  agony  of  the  patient  does  not  pro- 
hibit the  attempt,  the  operator  may  insert  his  hand  per  rectum 
and. grasping  the  incarcerated  intestine,  drag  gently  and  cau- 
tiously upon  it  and  thus  attempt  its  replacement.  At  times  this 
succeeds. 

Should  this  fail,  the  animal  is  to  be  cast  in  dorsal  recumbency 
with  the  hind  legs  sharply  abducted  and  the  inguinal  region 
freely  opened.  The  dragging  on  the  incarcerated  bowel  per 
rectum  may  now  be  repeated,  accompanied  by  digital  manipula- 
tion or  compression  externally  with  the  other  hand  or  by  an 
assistant.  If  the  hernia  is  not  promptly  reduced,  chloroform 
anaesthesia  should  be  induced,  which  further  relaxes  the  parts, 
and  replacement  may  yet  succeed. 

Failing  in  these  efforts,  herniotomy  should  be  performed  with 
the  least  possible  delay.  After  thorough  disinfection  of  the  re- 
gion, proper  sterilization  of  hands  and  instruments,  and  covering 


64  Veterinary  Obstetrics 

the  adjacent  parts,  including  the  hind  feet  and  legs,  with  aseptic  or 
antiseptic  towels  or  napkins,  the  scrotum  is  to  be  freely  and  cau- 
tiously incised  down  to  the  incarcerated  intestine,  after  which  the 
carefully  disinfected  and  moistened  index  finger  is  to  be  passed 
up  along  the  anterior  side  of  the  herniated  bowel  to  the  point  of 
incarceration  in  the  internal  ring.  Using  the  finger  as  a  guide,  a 
herniotome,  probe  pointed  bistoury,  scalpel,  or  such  other  instru- 
ment as  the  exigencies  of  the  situation  afford,  is  introduced 
through  the  ring  at  its  antero-external  angle  and  the  tissues  are 
sufficientl}'  divided  in  a  direction  forwards  and  outwards  to  per- 
mit the  incarcerated  intestine  to  return.  Sterile  or  anti.septic 
gauze  is  then  introduced  into  the  wound  and  packed  closely 
again.st  the  internal  ring  in  a  manner  to  avoid  all  danger  of  a  re- 
currence of  the  hernia  and  the  scrotal  wound  is  closed  by  sutures. 
The  tampon  may  be  omitted  and  deep  sutures  taken  in  the  inter- 
nal ring,  closing  it  against  future  hernia. 

Twenty- four  to  forty-eight  hours  later  the  antiseptic  gauze  may 
be  removed,  the  wound  disinfected  and  closed  and  thereafter  left 
undisturbed  or  handled  according  to  indications. 

2.   General  Infections  ok  Coition. 

Coition  brings  the  involved  animals  into  such  intimate  contact 
that  it  offers  special  facilities  for  the  transmission  of  infectious 
disorders  from  one  to  the  other,  regardless  of  the  natural  avenue 
of  entrance  of  the  microorganism.  In  their  sexual  maraudings 
animals  make  close  approach  to  each  individual  of  their  species 
with  which  the}^  meet  and  thereby  tend  to  contract  any  conta- 
gion which  may  be  extant  in  the  neighborhood  or,  having  such 
disease,  to  distribute  it  everywhere  in  its  path.  Thus,  the  author 
recalls  an  instance  of  a  boar  pig,  wandering  from  the  farm,  to  re- 
turn later  and,  sickening  from  hog  cholera,  spread  the  malady 
to  the  entire  herd,  causing  the  death  of  more  than    100  animals. 

The  dangers  are  little  less  at  times  among  breeding  animals 
kept  confined.  A  young  foal  with  strangles  accompanies  its 
dam  to  the  breeding  place,  scatters  the  infection  about  the  prem- 
ises where  other  colts  may  later  come  in  contact  with  it  or  the 
stallion,  being  young  and  non-immune,  contracts  the  disorder  and 
transmits  it  to  susceptible  animals  coming  in  contact  with  him, 
thus  dis.seminating  the  infection  over  a  wide  area.  Bierstadt 
(Woch,  fur  Thierheilkunde)  records   the   transmission  of  stran- 


Physical  Injuries  65 

gles  by  a  supposedly  convalescent  stallion  to  mares,  apparently 
through  the  genital  canal,  as  abcesses  formed  in  the  pelvis  about 
the  rectum  and  vagina.  While  abcesses  occur  in  these  parts 
from  the  usual  mode  of  infection,  the  observations  of  B.  are 
highly  significant  and  interesting. 

In  the  infections  cellulitis  or  "  pink  eye  "  of  the  horse  (see  page 
68)  with  the  prevailing  orchitis  in  the  stallion,  the  malady  is 
very  liable  to  be  transmitted  through  coition.  In  contagious 
abortion,  coition  is  quite  generally  regarded  as  one  of  the  most 
fruitful  sources  of  dissemination,  it  being  assumed  that  the  spe- 
cific microorganism  is  carried  directly  into  its  native  habitat  and 
most  favorable  position  for  growth,  upon  the  penis  of  the  bull. 
In  one  instance  the  author  has  seen  actinomycosis  of  the  uterus 
and  broad  ligaments  of  a  cow,  resulting  in  her  sterility,  without 
other  discoverable  actinomycotic  lesions,  which  suggested  the 
probability  of  the  infection  having  been  lodged  in  the  genital 
canal  by  copulation.  The  dissemination  of  general  contagions 
through  sexual  contact  applies  e.specially  to  males  kept  for  gen- 
eral breeding  service  and  serving  females  coming  from  a  wide 
area ;  the  arrival  of  females  from  so  many  different  points  tends 
to  carry  any  contagion  to  the  breeding  place,  thence  to  be  dis- 
seminated by  him  to  every  part  of  the  territory  involved. 

If  a  healthy  male  escapes  from  an  enclosure,  wanders  from  home 
and  contracts  a  disease,  he  carries  it  back  and  exposes  the  other 
animals  of  his  species  ;  if  diseased  and  he  wanders  into  a  neigh- 
boring healthy  group  of  breeding  animals,  he  carries  the  infec- 
tion to  them.  Similarl}'  a  female,  especially  when  in  cstrum,  may 
prove  an  important  disseminator  of  contagion. 

It  is,  therefore,  well  to  consider  the  breeding  place  as  one  of 
the  most  important  of  distributing  points  for  contagious  diseases 
of  animals  and  the  veterinarian  should  constantly  regard  it  as 
such  and  be  in  a  position  to  direct  capably  how  the  dangers  may 
be  reduced  to  a  minimum.  When  a  breeder  has  an  adequate 
number  of  females  to  warrant  the  keeping  of  a  breeding  male 
of  the  desired  quality  for  his  own  use,  it  is  good  economy  to  do 
so,  to  breed  all  his  females  to  the  one  male  and  to  accept  no 
females  from  outside  for  breeding.  This  is  only  rarely  practi- 
cable. When  breeding  males  are  kept  for  public  service,  the 
females  offered  for  breeding  should  be  rigidly  scrutinized.  Not  only 
5 


66  Veterinary  Obstetrics 

should  they  show  no  sign  of  disease  but  they  should  come  from 
a  herd  where  no  contagion  is  known  or  believ^ed  to  exist.  The 
manager  of  public  breeding  animals  should  keep  himself  thor- 
oughh'  posted  upon  the  prevalence  of  infectious  diseases  in  his 
area  and  should  carefull}^  investigate  any  reported  appearance  of 
such  diseases.  When  infectious  maladies  appear  in  the  com- 
munity he  should  ascertain  as  clearly  as  possible  the  extent  of 
dissemination,  the  location  of  each  center  of  infection,  and  then 
take  such  measures  as  are  necessary  to  prevent  the  contraction  of 
the  disease  by  the  breeding  male  or  his  transmitting  it  to  other 
females.  Here  the  general  rules  of  disinfection  should  be  rigidh' 
carried  out  and,  if  necessary,  isolation  and  the  suspension  of 
breeding  be  applied.  The  exclusion  from  the  breeding  pen  or 
place  of  males,  females  or  suckling  young  affected  with  con- 
tagious diseases,  however  mild  or  convalescent,  should  be  rigid- 
ly enforced,  the  place  should  be  kept  clean,  disinfected  if  con- 
ditions suggest,  and,  whenever  warranted  (perhaps  it  always  is), 
the  penis  and  prepuce  of  the  male  should  be  disinfected  before  or 
after  each  service.  This  is  a  matter  of  but  a  few  moments  if  prop- 
er conveniences  are  arranged  and  would  frequently  avoid  seri- 
ous outbreaks  of  contagious  disease. 

The  arrangements  for  the  disinfection  of  the  genitals  of  male 
breeding  animals  should  be  simple  and  thoroughly  convenient 
and  effective.  A  pail  or  other  vessel  of  copper,  galvanized 
iron  or  tin  fitted  with  lid  and  bail  and  having  a  capacity  of  one 
to  two  and  one  half  gallons  will  readily  serve  the  purpose.  At  or 
near  the  bottom  of  this  vessel  have  inserted  a  small  horizontal  tube, 
curved  downward  at  the  external  end,  over  which  the  end  of  a 
piece  of  rubber  tubing  six  to  ten  feet  long  is  slipped  and  secured. 
After  the  disinfecting  solution  is  placed  in  the  vessel,  the  latter 
is  to  be  elevated  by  means  of  a  cord  attached  to  the  bail  and 
passing  over  a  pulley  or  beam,  until  a  sufficient  height  is  reached 
to  supply  the  desired  force  b)'^  gravit3\  Usually  a  height  of  three 
to  six  feet  above  the  part  to  be  treated  suffices.  The  distal  end 
of  the  tube  may  then  be  inserted  into  the  sheath  of  the  penis, 
the  opening  of  the  sheath  grasped  and.  held  closed  for  a  time  and 
the  entire  cavity  distended  with  the  antiseptic  fluid  ;  or  the  tube 
may  be  pushed  far  back  to  the  posterior  end  of  the  sheath  and 
the  current  of  antiseptic  fluid  be  depended  upon  to  reach  every 
part. 


Ge7ieral  hifections  of  Coition  67 

Another  very  simple  method  for  flushing  out  the  penial  sheath 
is  to  use  an  ordinar}-  pure  gum  horse  catheter  for  a  tube,  its 
rounded  distal  end  offering  an  ideal  shape  for  introduction  into 
sheath,  while  a  small  funnel,  inserted  into  the  other  end,  affords 
facility  for  pouring  the  antiseptic  fluid  through  the  tube  into  the 
sheath  and  the  funnel,  held  as  high  as  the  length  of  the  catheter 
will  permit,  affords  sufficient  force  of  gravit)^  for  the  purpose  de- 
sired. The  entire  apparatus  is  cheap,  compact,  withstands  steri- 
lization by  boiling  and  is  efficient. 

Any  reliable  disinfectant  will  answer  the  requirements  but 
those  which  tend  to  dissolve,  or  are  miscible  wath  fats  are  best,_ 
especially  about  the  preputial  opening  and  the  surrounding  skin. 
Among  these,  lysol  and  carbolic  acid  take  a  high  place.  The 
antiseptic  solutions  should  preferably  be  used  warm  and,  in  dis- 
infecting the  skin  adjacent  to  the  preputial  opening,  soap  should 
be  added.  The  strength  of  the  disinfectant  introduced  into  the 
sheath  should  not  be  great,  %  to  1%  of  lysol  or  carbolic  acid 
being  as  strong  as  the  naked  mucosa  of  the  penis,  especialh*  of 
the  bull,  will  readily  tolerate. 


CONTAGIOUS  CELLULITIS.     EPIZOOTIC    CELLULITIS. 

PINK  EYE.     RHEUMATIC  INFLUENZA. 

MUCO-ENTERITIS 

Bibliography — Williams,  E;pizootic  Cellulitis  ;  Principles  and  Practice 
of  Veterinary  Medicine,  4th  edition,  1888,  p.  251.  Cave,  Pink  Eye:  Vet- 
erinary Journal,  1883,  Vol.  XVI,  p.  336.  Whitworth,  Pink  Eye  Disease  ; 
ibid,  1883,  Vol.  XVII,  p.  153.  Pottie,  Jour.  Comp.  Path.  andTherap.,  Vol. 
I,  p.  37.  Clark,  ibid.  Vol.  V,  p.  261.  Reeks,  The  Tran.smission  of  Pink 
Eye  from  Apparently  Healthy  Stallions  to  Mares  ;  ibid.,  Vol.  XIV,  p.  159 
and  Vol.  XV,  p.  97. 

ContagioiLS  Cellulitis  is  a  highly  contagious  acute  fever  of  the 
horse,  which  has  been  generally  ignored  except  by  British  veter- 
inary writers,  although  it  .seems  to  be  widely  distributed  in  vari- 
ous countries.  It  is  common  in  parts  of  America,  but  fre- 
quently confused  with  influenza  or  catarrhal  fever,  although 
wholly  distinct. 

We  in.sert  an  account  of  this  disease  here  becau.se  of  its  inti- 
mate bearing  upon  the  question  of  horse  breeding,  which  it  affects 
chiefly  in  three  distinct  ways. 

It  is  frequently  spread  from  apparently  healthy  stallions  to 
mares  through  copulation,  in  which  respect  it  approaches  the 
character  of  a  venereal  di.sease,  although,  as  a  general  rule,  this  is 
not  the  method  by  which  it  is  transmitted  from  animal  to  animal. 

It  has  a  relation  to  sterility  becau.se  it  causes  an  orchitis  in 
the  stallion,  which  frequently  leads  to  a  permanent  loss  of  func- 
tion in  the.se  glands. 

It  is  related  to  abortion  in  that  it  very  frequently  cau.ses  the 
death  of  the  fetus  in  utero  when  affecting  the  pregnant  mare. 

Symptoms.  The  symptoms  of  the  di-sease  consist  primarily  of 
an  elevation  of  temperature,  sometimes  accompanied  by  chills, 
dullness  and  other  phenomena,  which  belong  in  general  to  acute 
contagious  fevers.  The  fever  appears  very  suddenly,  usually 
ranging  from  103  to  105°  F.  although  it  may  exceed  this.  Gen- 
erally speaking,  the  temperature  is  higher  than  in  influenza  and 
lower  than  in  the  contagious  pneumonia  of  the  horse.  The 
pulse  is  hard  and  full  and  somewhat  quickened,  while  the  res- 
piration is  not  very  greatly  disturbed.  Some  cough  is  present, 
though  this  does  not  constitute  a  very  prominent  symptom  of 
the  affection. 
68 


Contagious  Cellulitis  69 

Early  in  the  disease  there  is  a  manifestation  of  pain  in  the 
limbs,  which  is  shown  by  shifting  of  the  weight  from  one  foot  to 
another  while  the  animal  is  standing  and  by  great  stiffness  and 
soreness  when  forced  to  move,  the  movements  being  accompan- 
ied by  a  cracking  sound  in  the  joints.  After  a  time  the  legs  be- 
gin to  swell,  commencing  at  the  feet  and  extending  upward  until 
at  times  it  reaches  the  body.  This  tumefaction  has  its  chief 
seat  in  the  subcutaneous  connective  tissue  and  is  at  times  very 
great.  As  the  swelling  of  the  limbs  increases,  the  pain  in  them 
tends  to  abate  and  at  the  same  time  the  fever  begins  to  decrease. 

The  alimentary  tract  is  greatly  disturbed,  there  being  a  very 
marked  tendency  to  constipation  at  first,  in  which  the  feces  are 
covered  with  large  quantities  of  mucus  and  their  color  considera- 
bly altered.  Defecation  causes  some  pain  and  straining.  Later 
there  is  a  tendency  to  diarrhoea,  which  is  easily  and  often  fatally 
intensified  by  the  administration  of  purgatives,  especially  of 
aloes.  The  conjunctiva  is  markedly  altered  in  color,  becoming  a 
bright,  pink  hue,  .swollen  and  edematous.  At  times  the  con- 
junctivae are  so  badly  swollen  that  the  eyelids  become  somewhat 
everted  and  the  edematous  membrane  pushed  out  between  them. 
The  eyes  are  very  sensitive  to  light  and  the  animal  attempts  to 
keep  them  closed.  There  is  a  profuse  secretion  of  tears,  which 
flow  down  over  the  cheeks.  The  cornea  is  frequently  clouded 
so  that  vision  may  for  a  time  be  interrupted.  There  is  some 
tendency  toward  pleurisy,  pneumonia  and  other  pulmonary 
complications. 

From  an  obstetric  standpoint,  the  chief  interest  lies  in  the 
complications  of  the  genital  organs.  In  our  experience,  the 
breeding  stallion  shows  a  great  tendency  to  suffer  from  orchitis. 
We  have  seen  in  large  importing  stables  50  to  75%  of  the  stall- 
ions attacked  with  pink  eye  suffering  from  inflammation  of  the 
testicles.  Along  with  the  swelling  of  the  scrotum  and  sheath, 
which  accompanies  that  of  the  legs,  there  usually  appears  a 
tense,  painful  enlargement  of  the  testicles,  which  tends  to  persist 
for  a  considerable  period  after  the  general  .symptoms  of  the  dis- 
ease have  largely  disappeared.  In  some  instances  we  have  seen 
permanent  sterility  result  so  that  the  breeding  value  of  the 
stallion  was  completely  destroyed. 

In  other  cases  we  have  noted  that  stallions  apparently  re- 
covered from  the  disease  have  quite  uniformly   transmitted  it, 


yo  Veterinary  Obstetrics 

during  copulation,  to  susceptible  mares.  These  observations  are 
entirely  in  harmon}-  with  those  of  Reeks,  who  records  an  instance 
where  an  apparently  sound  stallion  transmitted  the  disease  to 
susceptible  mares  almost  uniformly  over  a  period  of  two  years. 
This  observation  is  a  not  uncommon  experience. 

It  is  notable  also  that,  when  the  disease  attacks  a  pregnant  mare 
it  generally  causes  abortion  or,  if  attacking  her  just  prior  to 
parturition,  the  living  foal  is  likely  to  succumb  within  a  few  days 
after  birth.  Reeks,  recording  an  outbreak  under  his  charge,  re- 
lates that  four  pregnant  mares,  or  mares  which  had  just  foaled, 
contracted  the  disease.  Two  of  the  pregnant  mares  aborted,  and 
the  foals  of  the  other  two  died  suddenly  shortly  after  birth.  In 
our  experience,  in  an  extensive  horse  breeding  district,  the  dis- 
ease quite  uniformly  leads  to  abortion  in  pregnant  mares. 

Although  highly  contagious,  the  affection  is  of  short  duration, 
usually  runs  a  favorable  course,  in  from  four  to  six  days,  and 
leaves  the  animal  but  little  altered,  except  in  those  used  for 
breeding.  The  eyes  also  may  become  permanently  weakened 
and  invite  later  attacks  of  disease.  In  some  unfavorable  cases 
the  pulse  becomes  weak  and  there  is  a  general  depression,  which 
is  liable  to  be  followed  by  sudden  death  owing,  it  appears,  to  heart 
failure,  in  which  case  there  are  usually  found  large  thrombi  in 
the  cardiac  cavities. 

No  specific  treatment  has  been  discovered.  In  our  experience 
the  greatest  benefit  is  to  be  derived  from  the  administration  of 
diffusible  stimulants,  like  nitrous  ether  or  carbonate  of  ammonia, 
along  with  quinine.  Purgatives  are  to  be  avoided,  aloes  being 
especially  dangerous.  The  bland  oils  might  be  used  in  some 
cases  as  aperients,  or  very  small  doses  of  eserine,  arecoline  or 
other  alkaloid  hypodermic  cathartic,  taking  care  to  make  the 
dose  sufficiently  small  to  induce  no  harmful  degree  of  excite- 
ment and  barel}' sufficient  to  induce  gentle  purgation.  There  is 
naturally  much  divergence  of  opinion  among  veterinarians  in 
reference  to  the  treatment  of  this  affection,  but  in  its  general 
handling  we  are  not  specially  interested. 

From  an  obstetric  standpoint,  we  are  chiefl}'  concerned  in  the 
question  of  the  spread  of  the  malady  from  the  breeding  pen  and 
its  tendency  to  induce  sterility  and  abortion. 

When  the  disease  appears  in  a  breeding  area  it  should  be  han- 
dled with  the  greate.st  rigor  as  to  quarantine,  and  breeding  quar- 


Contagious  Cellulitis  71 

ters  should  receive  special  consideration.  Diseased  mares  or 
mares  coming  from  infected  premises  should  on  no  account  be 
admitted  to  the  breeding  place.  Should  the  malady  become  gen- 
eral in  a  neighborhood,  as  it  usually  does  when  an  outbreak  oc- 
curs, breeding  should  be  suspended  until  the  disease  is  extermin- 
nated. 

When  a  breeding  stallion  has  become  infected,  aside  from  the 
general  handling  of  the  malady,  special  attention  should  be  given 
to  reducing  to  a  minimum  the  dangers  from  orchitis  and  later, 
after  the  acute  symptoms  have  passed,  to  overcoming  the  linger- 
ing chronic  infection,  through  which  he  may  continue  to  spread 
the  disease  to  mares. 

When  it  is  known  that  a  non-immune  breeding  stallion  has 
been  exposed  to  this  disease,  immediate  precautions  should  be 
taken  to  guard  the  animal  against  a  severe  attack.  He  needs  be 
placed  at  rest,  physically  and  sexually.  The  usual  high  feeding 
of  breeding  stallions  should  at  once  be  displaced  by  a  very  light 
laxative  diet,  such  as  grass,  roots  and  bran,  with  an  abiindance  of 
salt.  If  these  measures  do  not  induce  a  prompt  unloading  of 
the  alimentary  tract  the  bowels  should  be  evacuated  by  means 
of  small  doses  of  eserine  or  arecoline  and  the  system  placed  in 
first  class  condition  to  withstand  the  onset  of  the  disease.  Pend- 
ing the  advent  of  the  disease,  the  animal  should  have  regular  daily 
exercise,  great  care  being  taken,  however,  not  to  continue  it 
after  the  advent  of  the  first  symptom  of  the  malady,  fever, 
has  become  established,  as  indicated  by  thermometry.  At- 
tacked without  these  precautious,  similar  measures  should  .still 
be  adopted,  the  ration  reduced  and  confined  to  laxative  foods, 
while  the  bowels  are  promptly  and  cautiously  evacuated. 

The  patient  is  to  be  guarded  jealously  against  phy.sical  or 
sexual  excitement.  Strange  mares  should  not  be  allowed  in 
sight  or  hearing,  and  every  precaution  should  be  taken  against 
arousing  sexual  desire.  In  most  stallions  the  application  of 
the  stud  bridle  occa.sions  excitement,  which,  at  such  times, 
should  be  avoided. 

If  orchitis  appears,  as  it  frequenth^  does,  in  addition  to  the 
foregoing  measures,  including  the  internal  administration  of 
nitrous  ether  and  quinine,  local  applications  to  control  the  in- 
flammation in  the  glands  should  be  applied.  First  among  these 
in  the  early  stages  is  local  refrigeration  bj-  the  application  of  cold 


72  Veterhiary  Obstetrics 

water  or  ice.  Probabl}'  the  most  efficient  means  is  the  applica- 
tion of  broken  ice  by  means  of  a  suspensorium,  which  serves  the 
double  purpose  of  refrigeration  and  supporting  the  weight  of  the 
pendant  glands.  This  treatment  should  be  con.stantly  and  faith- 
fully applied  until  the  crisis  of  the  malady  has  passed,  since  the 
eflfective  handling  of  these  glandsmaydetermine  whether  the  ani- 
mal is  to  be  of  further  value  as  a  breeder  or  not.  Such  remedies 
as  belladonna  and  camphor,  applied  locally,  tend  to  relieve  con- 
gestion and  overcome  the  inflammation,  but,  in  a  critical  case  we 
believe  the  refrigeration  superior. 

Later,  when  the  acute  symptoms  have  passed,  chronic  infection 
should  be  con.sidered,  precautions  taken  against  the  spread  of  the 
malady  to.  mares  and  measures  adopted  to  eradicate  the  infection 
from  the  system  as  quickly  as  possible. 

P'or  this  purpose  an  extended  course  of  potassium  iodide  at 
the  rate  of  ^4,  ounce  per  day  for  each  r,ooolbs.  of  body  weight  is, 
in  our  judgment,  the  safest  remed5^  By  some  veterinarians,  fears 
are  entertained  that  the  prolonged  admini.stration  of  this  drug 
may  induce  a  harmful  atrophy  of  the  testicles,  but  we  consider 
this  quite  imaginary  and  without  foundation.  We  would  con- 
tinue the  drug  for  three  or  four  weeks,  or  longer  if  necessary. 

Abundant  time  should  be  allowed  to  elapse,  after  the  disappear- 
ance of  all  visible  symptoms  of  the  disease,  before  permitting  the 
animal  to  serve  mares.  It  is  advisable,  in  case  the  disease  attacks 
the  stallion  during  the  breeding  season,  to  withdraw  him  from 
the  stud  for  the  year.  In  an}-  case  it  is  wise  to  begin  breeding 
cautiously  and  watch  closely  for  evidences  of  the  transmission  of 
the  infection  to  susceptible  mares.  When  a  stallion  which  has 
suflfered-from  pink  eye  shows  evidences  of  sterilit}',  careful  examin- 
ation of  the  genitals  and  of  the  semen  should  be  made  and,  should 
any  restoration  of  the  breeding  powers  seem  possible,  appropriate 
measures  undertaken  but  usually,  in  our  observation,  the  sterility 
following  pink  eye  is  permanent  and  irremediable  and  the  animal 
must  be  removed  from  the  stud  and,  with  or  without  castration, 
used  as  a  work  horse. 


SPECIFIC  INFECTIONS  OF  COITION 
Venereal  Diseases. 

Venereal  diseases  have  been  described  in  nearly,  if  not  all  of 
our  domesticated  animals,  especially  in  horses,  cattle,  sheep  and 
dogs,  with  briefer  references  in  our  literature  to  such  diseases  in 
goats,  swine  and  rabbits.  In  horses  we  recognize  two  well  defined 
venereal  affections,  Dourine  or  Maladie  dti  Co'it  and  the  Eruptive 
Venereal  Disease  or  Geiiital  Horse  Pox  ;  in  cattle  the  Vesicular 
Venereal  Disease  2lX\^  the  Infectious  Grajiular  Venereal  Disease  ; 
in  the  dog  the  Venereal  Gra?nilomata  ;  and  in  sheep  an  Ulcerative 
Venereal  affection. 

I.  Dourine  or  Maladie  du  Coit.     Beschalseuche. 
Equine  Svphilis. 

Bibliography.  Baldre_v  ;  Jour.  Comp.  Path,  and  Therap.,  1905,  Vol.  18, 
p.  7  ;  de  Does,  Jahresbericht,  1902.  Hutyra  und  Marek  ;  Spezielle  Pathol- 
ogic and  Therapie.  Thanhoffer ;  Ueber  Zuchtlahme.  W.  L.  Williams ; 
Report  Illionois  State  Board  of  Live  Stock  Commissioners.  1S87. 

Dourine  of  the  horse  is  the  most  serious  venereal  disease  known 
among  domestic  animals,  both  on  account  of  its  wide  geograpical 
distribution  and  the  mortality  and  loss  caused  by  it.  It  is  widelj' 
dissemminated  in  Europe,  Asia,  Africa  and  North  America.  It 
has  been  recognized  for  more  that  a  century  and  has  appeared  in 
all  the  leading  countries  on  the  European  continent.  In  English 
speaking  countries,  it  was  first  recognized  by  the  author  at  Wa- 
pella  in  DeWitt  County,  Illinois,  in  the  spring  of  1886  among 
imported  French  draft  stallions  and  the  mares  which  had  been 
served  by  them.  The  disease  in  Illinois  apparently  broke  out 
in  1884  or  1885,  but  its  nature  was  not  determined  until  1886  and 
even  then  its  seriousness  was  not  fully  appreciated  so  that  it  was 
not  until  1887  that  vigorous  measures  were  undertaken  for  its 
control  and  eradication.  In  the  meantime,  numerous  animals  had 
been  sold  from  the  infected  area  and  widely  disseminated  over 
the  country  in  a  manner  which  made  it  impracticable  to  effect- 
ively trace  them  to  their  ultimate  destination.  When  the  im- 
portance of  the  malady  became  recognized  it  was  promptly  placed 
under  control  and  was  so  completely  eradicated  that  up  to  the 
73 


74  Veterinary  Obstetrics 

present  time,  a  period  of  twenty  Ncars,  it  has  not  reappeared  in 
that  territory. 

Since  that  time  the  affection  has  been  recognized  in  Nebraska, 
South  Dakota,  and  in  the  province  of  Alberta,  Canada.  In  these 
areas  of  infection  the  disease  has  not  been  definitely  traced  to  its 
.source.  Tlie  outbreak  in  Illinois  was  believed  to  have  been  in- 
troduced by  stallions  imported  from  France,  a  conclusion  which, 
although  unproven,  time  has  not  served  to  change.  The  affected 
area  in  Illinois  produced  considerable  numbers  of  grade  draft 
stallions  and  mares,  which  were  sold  to  go  to  the  West  and  North- 
west for  breeding  purposes,  and,  although  it  cannot  be  clearly 
shown,  there  is  good  reason  to  conclude  that  this  outbreak  furn- 
ished the  infection  for  the  others  which  have  occurred  in  Amer- 
ica. 

It  has  now  become  .so  widely  di.s.seminated,  its  eradication  from 
among  range  animals  is  so  uncertain,  and  the  po.ssibility  of  fresh 
importation  so  apparent,  that  the  malady  is  of  great  importance 
to  the  horse  breeding  industry  of  America,  since  it  may,  possi- 
bly, manifest  itself  at  any  time  in  any  breeding  district.  These 
facts  render  it  important  that  veterinary  practitioners,  in  horse 
breeding  districts,  should  be  on  the  alert  and  ready  to  recognize 
the  disea.se  in  the  early  stages  of  an  outbreak,  ere  it  gains  a  wide 
distribution  and  its  eradication  is  rendered  difficult  and  uncertain. 

Nature.  Dourine  is  a  highly  infectious  venereal  disease  trans- 
mitted naturally  by  coition  only.  Experimentally,  it  may  be  trans- 
mitted by  innoculation  and  to  other  animals  than  solipeds.  It  is 
due  to  a  protozoan  parasite  belonging  to  the  trypanosoma  group. 
This  parasite,  the  tiypa^iosoviuvi  eqiiiperduvi,  was  discovered  by 
Rouget  in  1896  and  its  relation  to  the  disease  clearly  demonstrated 
by  Schneidei  and  Buffard  in  1899.  Tlie  trypanosome  of  Dourine 
is  a  one-celled  organism  provided  with  a  fiagellum  at  the  anterior 
end.  It  is  about  18  to  26  microns  in  lengtli  and,  when  observed 
in  the  living  state,  is  highly  motile.  It  occurs  in  the  blood,  spinal 
fluid,  the  discharges  from  the  genital  organs,  in  the  plaques  of 
the  skin  and  perhaps  in  other  tissues  and  fluids  of  the  infected 
animal.  It  multiplies  by  longitudinal  division.  When  removed 
from  an  animal  and  kept  moist,  it  will  live  for  several  days  or 
even  a  week. 

It  is  not  always  easily  found.     It  is  .said  to  be  mo.st  readily  dis- 


Doiirine  75 

covered  in  recently  formed  plaques.  Baldre}'  says,  in  reference  to 
the  appearance  of  the  trypanosoma  in  the  fresh  plaques,  ' '  If  these 
appear,  then  a  positive  diagnosis  can  be  made  ;  if  not,  the  case 
is  not  Dourine."  The  parasites  are  said  to  disappear  quickly 
from  these  plaques,  so  that  it  is  dificult  or  impossible  to  find  them 
after  twenty-four  hours.  They  may  be  found  in  the  discharges 
from  tie  vagina  or  urethra  of  the  infected  animal,  but  it  seems 
that  their  existence  here  is  not  so  uniform  as  in  the  fresh  plaques. 
Some  investigators  believe  that  they  are  quite  uniformly  present 
in  the  spinal  fluid.  It  is  frequently  very  diflficult  to  discover 
them  in  the  blood. 

This  parasite  constitutes  an  exception  to  the  general  rule  in 
the  trypanosomic  group  of  diseases,  in  that  it  is  not  transmitted 
from  animal  to  animal  by  the  bite  of  an  insect.  For  laboratory 
uses  it  is  generally  cultivated  in  dogs. 

Symptoms.  The  period  of  incubation  following  natural  in- 
fection is  not  definitely  determined  and  varies  considerably  in 
different  cases.  Generally  there  appear  some  physical  signs  of 
disease  in  from  eight  to  ten  days  after  exposure,  but  these  may 
not  be  very  marked  and  may  pass  unnoticed  by  an  inexperienced 
obserA^er. 

The  symptoms  of  the  disease  may  be  divided  into  three  im- 
portant groups  ;  the  local  lesions  of  the  genital  organs  and  the 
contiguous  parts ;  those  of  the  .skin  and  other  mucous  mem- 
branes than  that  of  the  genital  organs  ;  and  the  symptoms  which 
emanate  from  the  central  nervous  system. 

The  local  symptoms  in  the  genital  organs  are  the  first  to 
appear  after  infection  and  usually  the  last  to  disappear  in  case  of 
recovery. 

In  the  stallion  there  usually  appears  after  eight  or  ten  days, 
subsequent  to  infection,  a  swelling  of  the  penis  and  prepuce,  with 
some  degree  of  protrusion  of  the  penis  from  the  sheath,  still 
covered  by  the  prepuce.  The  prepuce  shows  a  tense,  elastic 
swelling  and  has  a  smooth,  glistening  appearance.  If  the  uretha 
is  exposed  to  view,  its  meatus  will  be  found  swollen,  dark  red 
and  intensely  injected.  From  it  exudes  a  small  amount  of  a 
thin,  dirt}^,  muco-purulent  discharge.  As  the  disease  progresses, 
the  tumefaction  of  the  prepuce  and  penis  increases  and  extends 
to  the  sheath  and  scrotum,  which  may  eventually  become  enorm- 
ously swollen  and  remain  in  an  indurated  condition  for  one  to 


76 


Veterhiarv  Obstetrics 


two  years  or  more.  The  animal  gradually  becomes  less  able  to 
retain  the  penis  in  its  position,  and  the  swollen  organ  protrudes 
farther  and  farther  out  of  the  sheath,  sometimes  extending  en- 
tirely out  of  the  prepuce  and  hanging  flaccid  and  fully  exposed. 
The  di.scharge  from  the  urethra  may  become  somewhat  ichorous 
and, with  the  general,  .soiled  condition  of  the  penis  and  surround- 
ing parts,  may  lead  to  ulcerations  or  erosions  upon  these.  Later 
in  the  course  of  the  disea.se,  the  weakened  condition  of  the 
tissues  of  the  part  may  lead  to  purulent  infection  and  the  forma- 


Fk;.  7.     DouRixE. 

Arab  pony  at  liegiiining  of  the  second  stage  of  the  malady,  show- 
chiefly  the  enormously  swollen  sheath  and  penis  and  depressed  as- 
pect of  the  patient.  ( Baldrey. ) 


Doiirine 


77 


tion  of  abscesses  in   the  sheath,  scrotum  and    inguinal    region. 
(See  Figs.  7  and  8  ). 

The  testicles  may  undergo  inflammation  and  swelling,  which 
after  a  time  may  be  followed  by  atrophy, and  the)^  may  be  pushed 
upward  by  the  swelling  or  abscesses  in  the  scrotum  until  they 
rest  high  up  in  the  inguinal  space,  where  they  can  not  be  readily 
fell.  No  vesicles  or  pjistiiles  occur  upon  the  genitals  as  an  essential 
part  of  this  disease,  but  there  occurs  with  considerable  uniformity 
a  depigmentation  of  the  skin  and  covering  of  the  penis  so  that  it 
may  largely  lose  its  pigment  and  become  white.  This  depig- 
mentation begins  upon  the  penis  and  may  extend  to  the  prepuce^ 
sheath  and  scrotum.  In  studying  this  symptom,  it  is  well  to 
bear  in  mind  that  in  gray  horses  and  in  those  having  white  eyes, 
faces  or  feet  it  is  quite  common  to  observe  an  absence  of  pigment 


Fig.  8.     Doi-rine  in  Final  vStage. 

English  ThoroughVjred    stallion  showing  paralysis  and  edema  of 
penis.  (Baldrey. ) 


78  Veterinarv  Obstetrics 

on  the  penis,  but  this  is  regular  in  outline,  whereas  in  dourine 
the  depigmentation  spreads  out  in  patches. 

In  the  mare,  about  eight  to  ten  dajs  after  infection  there  ap- 
pears a  well  marked  swelling  of  the  lips  of  the  vulva.  The 
mucous  membrane  of  the  vulva  and  vagina  is  intensel)'  injected 
and  swollen  and  from  the  vulva  there  escapes  a  more  or  less  pro- 
fuse discharge  of  a  mucous  or  muco-purulent  character,  which 
soils  the  tail  and  surrounding  parts.  The  mare  urinates  fre- 
quently in  small  quantities,  which  causes  pain,  as  indicated  by 
straining,  stamping  with  the  feet  and  switching  of  the  tail. 

There  seems  to  be  an  increased  sexual  excitement,  which  may 
be,  to  some  degree,  misleading,  depending  largely  for  its  expres- 
sion upon  the  frequent  urination,  rather  than  upon  genuine  sex- 
ual desire. 

As  the  disease  progresses,  the  volume  of  the  discharge  tends 
to  increase,  in  some  cases,  assumes  a  dirty  grayish  character  and 
may  become  fetid.  The  swelling  of  the  vulva  increases,  the  la- 
bi9e  become  much  enlarged,  are  tense,  elastic  and  glistening. 
Their  margins  stand  somewhat  apart,  so  that  the  vulva  is  partly 
open,  especially  at  its  lower  commisure. 

Within  afeiv  weeks,  after  the  advent  of  the  disease,  there  appears 
quite  regularly,  a  characteristic  loss  of  pigment  in  the  ski7i  of  the 
vulva  and  the  neighboring  parts.  This  depigmentation  begins 
along  the  margins  of  the  vulva,  without  prior  vesicular  or  pustular 
eruptions,  as  simple,  white  patches,  and  thence  extends  onward  in 
irregular  lines,  or  spots,  until  it  may  involve  the  entire  vulva, 
perineum  and  anus.  The  white  patch,  or  patches,  have  irregu- 
lar borders  and  are  of  various  shapes  and  sizes.  They  persist  for 
several  months,  and,  in  case  of  the  recovery  of  the  animal,  they 
tend,  finally,  to  disappear ;  fading  first  at  the  periphery,  while 
upon  the  margins  of  the  vulvar  lips  they  persist  for  six  months 
or  a  year.      (See  Fig.  9). 

Of  even  greater  significance,  are  the  changes  which  occur  in 
the  clitoris.  Comparatively  early  in  the  course  of  the  disease, 
this  organ  becomes  swollen,  and,  the  vulva  being  somewhat 
open  at  the  inferior  commissure,  it  becomes  visible,  ordinarily, 
without  mechanically  parting  the  labiae.  The  secretion  of  sebum 
in  the  prepuce  of  the  clitoris  apparently  ceases,  and  the  swollen 
organ  seems  dry  and  glistening.  Depigmentation  of  the  clitoris 
and  its  prepuce  occurs  early  and   persists  for  one    to  two  years 


Douri7ie 


79 


in  those  mares  which  apparently  recover  and  is  the  last  symp- 
tom, in  our  experience,  to  disappear.  The  swollen,  depigmented 
clitoris,  with  gaping  vulva,  constitutes  one  of  the  most  uniform 
and  persistent  symptoms  of  the  malady,  and  gives  to  a  young 
mare  the  appearance  of  extreme  old  age,  in  this  part. 

Following  closely  upon  the  first  appearance  of  local  lesions, 
within  a  few  weeks  after  infection,  there  appear  peculiar  and 
pathognomonic  cutaneous  eruptions  in   the  form  of  placques, 


Fig.  9.     DouRixE  IX  M.\RE. 

Depigmented  spots  on  labise  vulvae  and  "extreme  emaciation. 
<Hutyra  and  Marek. ) 


8o  I'^eterinary  Obstetrics 

elliptical  elevations  or  "  talerflecke."  These  eruptions  appear 
suddenly,  largely  about  the  flanks,  neck,  sjioulders,  sides  and 
thighs  as  more  or  less  circular  elevations,  one  to  several  inches 
in  diameter.  The  margins  of  these  are  very  abrupt  and  stand 
up  above  the  level  of  the  healthy  skin  like  the  eruptions  of  urti- 
caria, the  hairs  upon  them  being  erect.  They  appear  suddenly, 
not,  usually,  in  great  numbers,  but  only  one  to  five  or  six  at  a 
time,  remain  a  few  days  and  disappear  without  leaving  a  mark, 
to  be  succeeded  by  a  new  crop.  It  is  claimed  that,  in  these 
placques,  the  trypanosomes  are  very  abundant  during  the  first 
stages  of  their  existence,  but  as  the  eruptions  grow  old  the  para- 
sites rapidly  disappear  from  them. 

It  has  been  stated  that  these  placques  may  cause  intense  itch- 
ing and  lead  the  animal  to  bite  or  rub  the  part  and  that  they 
sometimes  suppurate.  None  of  these  symptoms  have  been 
observed  by  us. 

It  is  not  uncommon  to  observe  in  the  latter  stages  of  the  dis- 
ease a  more  or  less  profuse  discharge  from  the  nostrils.  This 
nasal  discharge  may  in  some  cases  be  suggestive  of  glanders  and 
superficial  ulceration  of  the  mucous  membrane  may  rarely  be 
present.  These  erosions,  when  present,  have  no  specific  charac- 
ter in  appearance  and  suggest  rather  a  necrosis  of  a  greatly  de- 
bilitated tissue  as  the  result  of  an  irritant  applied  externally.  It 
must  not  be  forgotten  that  glanders  and  dourine  may  coexist 
and  that  the  latter  would,  naturally,  greatly  intensify'  the  former. 

The  general  debility  or  cachexia  of  the  disease  shows  itself 
clearly  in  lesions  of  the  skin.  Any  wound  of  the  part  heals 
tardily  and,  if  the  animal  is  so  weak  that  it  is  recumbent  a  large 
part  of  its  time,  it  suffers  from  extensive  decubitis  gangrene. 

The  symptoms,  which  are  largely  referable  to  the  nerv- 
ous system,  appear  at  about  the  same  time  as  the  placques  or  not 
long  afterward.  The  first  and  most  pronounced  of  this  group  is 
usually  a  progressive  paresis,  which  is  chiefly  observable  in  the 
hinder  parts.  At  first  there  is  an  unsteady  gait,  the  animal  bring- 
ing the  hind  feet  forward  in  a  difficult  and  somewhat  uncertain 
manner.  There  is  a  tendency  to  drag  the  toe  along  the  ground 
or  to  strike  it  at  the  middle  of  the  stride.  When  weight  is 
placed  upon  the  foot  the  toe  is  usually  brought  down  first,  with 
the  fetlock  flexed,  and  the  heel  is  then  lowered  suddenly.  While 
standing,  there  is  a  tendency  for  the  fetlocks  to  be  maintained  in 


Dourhie  8i 

a  flexed  position  or  somewhat  knuckled  over.  This  knuckling 
over,  whether  standing  or  during  progression,  is  a  rather  common 
symptom  in  trypanosomic,  if  not  protozoan  diseases  generally. 

This  imperfect  control  may  appear  in  one  or  both  hind  limbs 
or  may  alternate  between  the  two  and  is  subject  to  great  varia- 
tion from  day  to  day.  Sometimes  this  partial  paralysis  is  of  a 
somewhat  spasmodic  nature,  faintly  resembling  stringhalt.  At 
times  there  may  be  swelling  about  an  articulation  and  the  animal 
may  seem  to  be  decidedly  lame  in  the  joint.  As  the  disease 
advances,  the  paresis  tends  to  increase  until  there  is  such  com- 
plete parah'sis  that  the  animal  is  unable  to  rise  when  down. 
When  the  patient  becomes  unable  to  rise,  a  fatal  termination 
usually  occurs  in  the  course  of  a  few  daj'S  to  several  weeks, 
largely  hastened  by  the  decubitis  and  the  accompanying  compli- 
cations. In  other  cases,  after  being  recumbent  for  days  or 
having  had  to  be  assisted  in  rising  for  weeks,  the  animal  improves 
and  eventually  recovers. 

With,  and  even  before,  the  advent  of  the  paretic  symptoms. 
there  appears  a  very  rapid  emaciation,  which  is  especially  prom- 
inent in  the  posterior  parts  of  the  body.  This  emaciation  is" 
noticeable  from  the  fact  that  it  occurs  in  spite  of  a  good  appetite, 
and  the  allowance  of  abundant  food  with  apparently  good  diges- 
tion. It  seems  that  both  the  paralysis  and  emaciation  are  largely 
dependent  upon  changes  taking  place  within  the  spinal  cord  and 
that  these  symptoms  naturally  become  most  marked  in  those 
portions  of  the  body  posterior  to  the  locality  in  the  cord  where 
the  chief  destruction  has  occurred.  The  symptoms  of  the  dis- 
turbances of  the  nervous  system  are  not  confined  to  any  portion 
of  the  body,  and  there  is  frequently  observed  a  paralysis  of  an 
ear  or  eyelid  or  of  the  lips  or  nose.  In  the  stallion  there  is  fre- 
quently a  well  marked  change  in  the  voice  so  that  he  can  not 
whinny  naturally. 

The  sexual  desire  may  remain  unaffected  throughout  the  dis- 
ea.se,  and,  in  many  stallions,  the  power  to  copulate  is  but  little 
impaired,  but  in  the  earlier  stages,  during  the  tumefaction  of  the 
prepuce  and  penis,  either  from  excessive  erection  or  other  cause, 
the  stallion  fails  in  many  cases,  to  effect  coition,  and,  late  in  the 
course  of  di.sea.se,  the  same  inability  may  arise  from  loss  of  power 
in  the  penis  or  from  extreme  paralysis  of  the  posterior  parts. 
6 


82  Veterinary  Obstetrics 

The  effect  of  tlie  disease  upon  the  powers  of  reproduction  is 
ver}'  profound.  In  the  earlier  stages,  the  stallion  may  be  capa- 
ble of  impregnating  mares  and,  failing  to  infect  them  with  the 
disease,  they  may  give  birth  to  healthy  foals.  As  the  disease 
progre.s.ses,  while  the  stallion  may  still  be  capable  of  copulating, 
he  is  usually  sterile.  The  mare  which  becomes  infected  does  not, 
generally,  conceive,  or,  if  so,  aborts  so  early  that  the  conception 
is  not  observed.  In  the  Illinois  outbreak,  it  could  not  be  deter- 
mined that  a  living  foal  had  been  born  among  loo  diseased  mares. 
vSome  writers  claim  that,  occasionally,  a  disea.sed  mare  will  pro- 
duce a  living  foal. 

Recovery  may,  and  does,  occur  even  after  extreme  emaciation, 
and  when  paralysis  has  been  .so  complete  that  the  animal  could 
not  ri.se  without  assistance. 

The  duration  of  the  disea.se  may  extend  from  three  months  to 
as  many  or  more  years,  and  recovery,  either  ai^jiarent  or  real, 
take  place  at  any  intervening  time. 

Pathological  Anatomy.  In  animals  which  have  succumbed 
to  the  malady  or  l^een  destroyed  in  its  last  stages,  there  is  seen, 
T|uite  uniformly,  an  evident  degree  of  anaemia  and  emaciation. 
Distributed  throughout  nearly  ever)'  tissue  in  the  body,  there  is 
found  a  characteristic  yellowi.sh  exudate  of  gelatinoid  appearance, 
especially  abundant  in  the  subcutaneous  and  intermu.scular  con- 
nective ti.ssue,  in  the  mesentery,  and  all  parts  rich  in  connective 
ti.ssue.  Nearly  every  organ  of  the  body  partakes  of  the  general 
yellowi.sh  tinge.  The  muscles,  especially'  tho.se  of  the  thigh  and 
croup,  are  pale  and  soft. 

The  intestines  are  pale,  and,  in  .some  cases,  show  signs  of 
previous  inflammation  on  their  peritoneal  surface.  The  mes- 
entery presents  a  pale  saffron  color,  thickened  by  a  gelatinous 
exudate.  The  mesenteric  lymphatics  are  enlarged,  pale  yellow 
and  friable.  The  spleen  is  pale,  small,  shriveled,  tough  and 
hard.  The  liver  is  .soft  and  filled  with  dark  blood.  The  kidneys 
are  usually  found  somewhat  enlarged,  very  pale  and  edematous. 

The  genital  organs  fail  to  exhibit  the  extraordinary  changes 
one  would  naturally  expect  to  find. 

Autopsies  made  by  us  on  several  .stallions,  all  di.seased  for  one 
and  one-half  to  over  two  years,  showed  the  general  conditions 
above  indicated,  while,  in  addition,  in  some  cases  the  genitals 
showed   marked  changes  and,  in  others,  there   were   only   very 


Dourhie  83 

slight  deviations  from  the  normal.  One  very  bad  case,  an  im- 
ported French  draft  stallion,  showed  very  great  enlargement  of 
the  scrotum,  which  was  hard  and  unyielding  to  the  touch.  The 
skin  of  the  scrotum  was  enormously  thickened  and  of  a  pale 
yellow  color.  The  inguinal  glands  of  the  right  side  were  the 
seat  of  an  extensive  abscess,  opening  at  the  upper  part  of  the 
scrotum.  A  large  abscess,  occupying  the  usual  position  of  the 
testicle,  was  filled  with  dark  yellow,  hard,  cheesy  pus,  which 
had  pushed  the  gland  from  its  place  up  into  the  inguinal  canal. 
The  testicle  was  small,  atrophied,  soft,  flabby  and  pale  yellow  in 
color,  witli  the  serous  covering  firmly  adherent  at  every  part. 
The  surface  of  the  penis  offered  no  evidence  of  disease.  The 
urethra  contained  a  small  amount  of  a  dirty,  purulent  secretion  ; 
the  lining  membrane  was  rough,  grayish-yellow  in  color,  with- 
out any  appearance  of  ulcers.  The  seminal  vesicles  and  enlarged 
portions  of  vasa  deferentia  contained  thin,  grayish,  purulent 
accumulations.  The  left  testicle  was  normal  in  size,  with  cover- 
ings firmly  adherent  at  every  part.  No  appearance  of  ulcers  was 
found  in  the  urethra  or  upon  the  penis  of  either  of  the  several 
stallions  examined. 

Investigators  have  observed  inconstant  changes  in  the  nervous 
system,  principally  of  injection  of  the  coverings  of  the  brain  and 
spinal  cord,  softening  of  the  lower  part  of  the  cord  and  occa- 
sional extravasation  of  fluid  into  the  ventricles  of  the  brain. 
Thanhoffer  describes  extensive  degeneration  of  the  nuclei  of  the 
nerve  cells  in  the  spinal  cord.  The  nasal  mucous  membrane 
usually  shows  catarrhal   inflammation. 

Differential  Diagnosis.  Few  contagious  diseases  of  animals 
have  been  so  confusedly  described  by  veterinary  writers.  At 
first  there  was  a  very  general  confusion  between  Doiirine  and 
Genital  Horse  Pox,  a  condition  which  still  continues  in  many 
descriptions  of  the  malady. 

According  to  our  observations,  the  most  reliable  local  S5'mp- 
toms  for  the  diognosis  of  Dourine  in  the  stallion  consists  of  the 
doughy,  elastic  swelling  of  the  prepuce,  with  varying  degrees  of 
penial  paralysis,  the  penis  hanging  somewhat  out  of  its  sheath, 
usually  retained  within  the  prepuce.  The  urethral  opening  is 
usually  inflamed  and,  from  it,  a  slight  discharge  escapes,  but 
there  is  nothing  visible  to  the  naked  eye  to  mark  this  as  differing 
from  lesions  of  these  parts  due  to  other  causes. 


84  Veterinary  Obstetrics 

Later  a  depigmentation  of  the  penis  and  prepuce  may  occur, 
not  in  small  circular  spots,  as  in  genital  horse  pox,  but  in  large, 
irregular  patches,  which  gradually  spread  from  the  periphery. 
In  the  mare,  the  most  important  local  symptoms  for  purposes  of 
diagnosis  consist  of  the  doughy,  edematous  swelling  of  the  vulvar 
lips,  the  enlargement  of  the  clitoris,  the  gaping  of  the  vulva  at 
its  inferior  commissure  and  the  depigmentation  of  the  clitoris, 
and  its  prepuce,  and  of  the  skin  of  the  vulva,  perineum  and  anus. 

Once  it  is  decided  that  an  equine  venereal  disease  exists  in  a 
stud,  the  presence  or  absence  of  specific  pustules  or  vesicles  may 
serve  largely  to  differentiate  between  the  two  maladies. 

Eruptions  upon  the  external  genitals  may,  of  course,  occur  in 
Dourine,  but  those  writers  who  have  mentioned  them  uniformly 
fail  to  de-scribe  them  in  a  manner  to  enable  one  to  differentiate 
those  of  Dourine  from  those  of  Genital  Horse  Pox,  and,  as  a 
rule,  it  might  well  be  suspected  that  such  descriptions  are  based 
upon  diagnostic  error.  In  some  cases,  doubtless,  erosions  or 
ulcers  have  appeared  as  the  result  of  irritation  from  ichorous  dis- 
charges or  from  the  accumulations  of  filth  about  the  genitals, 
accompanied  by  low  vitality  in  the  cutaneous  tissues  ;  but  such 
eruptions  are  devoid  of  diagnostic  value,  their  relation  to  the 
disease,  so  far  as  we  know,  being  quite  .secondary. 

Specific  eruptions  of  vesicles  or  pustules  upon  the  genitals  do  not 
occur.  When  abu)idant  and  specific  eruptions  occur  on  the  genitals 
of  the  horse,  they  indicate  Genital  Horse  Pox,  not  Dourine. 

Dourine  and  Genital  Horse  Pox  may  readily  coexist  and  thus 
add  confusion  in  diagnosis. 

In  the  outbreak  of  Dourine  in  Illinois  in  i8<S6-7,  we  were  in 
great  doubt  for  a  time  as  to  our  diagnosis  in  the  case  of  a  young 
stallion  showing  abundant  pustules  and  vesicles  on  the  penis, 
prepuce  and  sheath.  The  urethral  meatus  was  inflamed,  dark 
livid  in  color  ;  from  it  there  was  a  thin  grayish  discharge  ;  the 
prepuce  and  sheath  were  swollen.  Though  the  animal  was 
within  the  zone  of  infection,  no  exposure  could  be  traced.  He 
transmitted  Dourine  to  no  mares,  and  recovered  completely  and 
permanently  in  a  few  days.  Had  it  been  possible  to  connect  him 
in  any  way  with  the  outbreak,  it  would  have  been  difficult  to 
attribute  the  eruptions  to  anything  but  Dourine,  and,  had  he  been 
actually  affected  with  that  malady,  we  have  no  reason  to  believe 
that  it  would    have  prevented   his  becoming  simultaneously  in- 


Do  urine  85 

fected  with  the  far  more  common  Genital  Horse  Pox.  In  the 
table  on  page  <S8  this  animal  is  designated  as  No.  XI. 

Some  writers,  in  describing  Dourine,  accept  the  presence  of  de- 
pigmented areas  about  the  vulva  and  anus  as  conclusive  evidence 
of  precedent  ulceration,  but  depigmentation  of  the  skin  does  not 
necessarih'  follow  vesicular  or  pustular  eruptions  nor  does  its 
presence  indicate  that  eruptions  have  occurred.  We  had  excel- 
lent opportunity  for  ob.serving,  day  by  day  and  week  by  week, 
the  depigmentation  of  the  skin  of  the  vulva  and  anus  in  Dourine 
and  saw  it  begin  and  gradually  spread,  without  the  presence  of 
any  visible  vesicles,  papules  or  ulcers.  It  was  a  depigmentation 
^vithout  ulceration. 

Fleming,  (Veterinary  Sanitary  Science  and  Police);  Williams, 
(Principles  and  Practice  of  Veterinary  Medicine) ;  Law,  (Veter- 
inary Medicine);  Moore,  (Pathology  and  Diagnosis  of  Infectious 
Diseases)  and  numerous  other  writers  place  emphasis  upon  the 
presence  of  specific  eruptions  in  Dourine,  but  fail  to  describe  their 
characters,  and  do  not  intimate  that  they  have  personally  observed 
them.  The  only  definite  assertion  by  any  author, .so  far  as  we  have 
been  able  to  find,  that  he  has  personally  observed  ulcers,  papules 
or  vesicles  is  that  of  Thanhoffer,  who  records  instances  of  mares 
with  eruptions  about  the  perineum  and  in.side  the  thighs  and 
pre.sents  illustrations  of  ca.ses  ;  but  there  is  nothing  in  their  char- 
acter of  diagnostic  value  and  it  does  not  appear  that  the  diag- 
nosis in  these  cases  was  verified. 

In  the  extensive  Illinois  outbreak,  which  was  under  our  per- 
sonal charge,  among  more  than  100  cases  of  the  disease,  not  an 
instance  of  eruptions  was  observed  nor  could  the  most  diligent 
inquiry  among  owners  reveal  any  history  of  such  in  any  animal. 
In  this  outbreak,  the  cases  were  observed  daily  for  some  months, 
and  we  were  especially  careful  to  search  for  these  eruptions  in 
recent  and  old  cases  because,  relying  upon  the  descriptions  of  va- 
rious writers,  we  expected  to  find  them,  and  were  disappointed 
and  confused  when  we  did  not. 

European  writers  are  generally  inexact  in  reference  to  vesicu- 
lar and  pustular  eruptions  and  white  spots  upon  the  genital  or- 
gans. One  of  the  first  writers  to  point  out  the  distinction  be- 
tween Dourine  and  the  Genital  Horse  Pox  and  to  assert  that  the 
former  was  without  eruptions,  was  RodlofT.      Baldrey,  after  an 


86  Vctej'hiary  Obstetrics 

extensive  experience  with  the  malady  in  India,  fails  to  record 
the  occurrence  of  vesicles  and  pustules. 

In  the  United  States  of  America,  there  have  occurred  approxi- 
mately 300  cases  of  the  disease,  and  so  far  as  we  can  determine, 
no  vesicles  or  pustules  have  been  observed  in  any  instance. 
Hutyra  and  Marek  describe  eruptions  but,  on  page  464  of  their 
Spezielle  Pathologic  und  Therapie,  they  pre.sent  the  illustration, 
(Fig.  9),  of  a  mare  with  depigmentation  about  the  vulva,  which 
they  attribute  to  prior  ulceration,  but  they  do  not  illustrate  any 
of  these  ulcers  and  the  appearances  in  the  picture  are  identical 
with  the  depigmented  spots  observed  in  America,  which  occurred 
without  the  prior  existence  of  vesicles,  pustules,  ulcers  or  other 
visible  destructive  proce.s.ses  in  the  epithelial  surface  of  the  skin. 

In  the  Jahresbericht  for  1902,  de  Does  is  quoted  as  having 
observed  the  depigmentation  of  the  skin  of  the  external  genitals 
without  precedent  vesicles  or  pustules  and  regarded  this  loss  of 
pigment  as  a  marked  symptom  of  the  affection. 

It  seems  to  us  that  the  apparent  differences  in  observation  and 
view  in  reference  to  vesicles,  pustules  and  loss  of  pigment  is  due 
to  the  constant  confusion  of  the  two  wholly  distinct  venereal 
diseases  and  to  accepting  the  erroneous  conclusion  that  depig- 
mentation indicates  prior  pustular  or  vesicular  eruptions. 

It  should  be  further  remarked  in  reference  to  the  alleged  oc- 
currence of  eruptions  that  the  character  of  the  micro-organisms 
said  to  cause  the  disease  is  contradictory  to  the  appearance  of 
such  lesions.  Trypanosoma,  in  general,  have  little  or  no  tend- 
ency to  produce  eruptions  or  suppuration,  and  it  would  .seem 
unique  to  expect  that,  in  this  one  disea.se,  alone,  of  th-'s  great 
group,  there  should  occur  characteristic  vesicles  or  pustules. 

The  elliptical  .swellings  or  "  talerfiecke  "  in  the  skin  of  the 
flanks,  hips  and  other  parts  of  the  body  have  long  held  a  high 
place  in  diagnostic  value,  but  they  do  not  always  exist. 

In  the  Illinois  outbreak,  the  enlarged  and  pigmentless  clitoris 
con.stituted  a  noteworthy  and  highly  diagnostic  symptom  in  the 
mare,  persisting  for  at  least  two  years  after  all  other  ph\sical 
.signs  of  the  malady  had  di.sappeared. 

The  paresis  of  Dourine  is  fairly  characteri.stic  ;  accompanied 
by  other  lesions  and  symptoms  it  is  pathognomic,  while  the 
peculiar  jerky  movements  in  the  hind  limbs  during  progression. 


Dourine  87 

and  the  knuckling  over  at  the  hind  pasterns  are   rarely   seen  in 
other  forms  of  disease. 

In  addition,  there  is  the  clinical  histor}-  of  infection  by  coition, 
along  with  the  malignancy  of  the  malady. 

Finalh',  the  finding  of  the  trypanosoniiini  equiperdum  in  the 
blood  of  the  animal  serves  to  definitely  establish  the  diagnosis.  In 
many  cases  it  seems  to  be  very  difficult  to  find  the  parasite  in 
the  blood  of  the  animal  and,  consequently,  this  proof  of  the 
character  of  the  disease  is  not  always  readily  produced. 

The  Mortality  from  Dourine  is  very  great  and  the  loss  amounts, 
upon  the  whole,  to  far  more  than  the  total  value  of  the  diseased 
animals.  When  it  has  once  become  widely  disseminated  in  a 
breeding  district,  it  practically  ruins  the  industry  for  a  time  be- 
cau.se  its  character  is  so  insidious  that  it  is  exceedingly  difficult 
to  trace  in  it  all  its  ramifications.  The  mortality  among  the 
affected  animals  reaches  60  to  80  ^r.  which  places  it  among  the 
most  fatal  of  infectious  diseases.  Those  which  recover  do  so 
very  slowly  and  the  time  consumed  before  they  are  again  fit  for 
work  is  so  great  that  it  almost  destroys  their  value.  We  have 
no  data  to  show  that  an  animal  once  affected  can  ever  be  bred 
again  with  safety,  however  completely  they  may  have  apparently 
recovered  or  how  long  a  period  may  have  elap.sed. 

The  tabulated  list  on  next  page  of  affected  stallions  in  the  Illinois 
outbreak,  copied  from  the  author's  report  upon  the  disease,  is  of 
interest,  as  showing  the  transmissibility  and  mortality  of  the 
malad}-. 

Control  and  Eradication.  There  is  no  specific  treatment 
known  for  the  disease  and,  at  present,  the  most  that  can  be  done 
is  the  .securing  of  rest  with  favorable  food  and  environment. 
Complications  may  be  handled  according  to  circumstances.  Some 
investigators  have  obtained  apparently  favorable  results  from  the 
admini.stration  of  arsenic  and  other  antiseptics  but  there  is  no 
definite  evidence  of  specific  action  of  these,  though  they  are 
worthy  of  trial.  In  the  Illinois  outbreak,  some  animals  recovered 
their  general  health  after  having  been  so  completely  paralyzed 
that  they  constantly  required  assistance,  for  several  weeks,  in 
getting  up.  As  a  general  rule,  however,  animals  which  become 
so  weak  and  paralytic  as  to  be  unable  to  get  up  when  down, 
soon  succumb  to  the  di.sea.se. 


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The  plan  of  control  adopted  in  the  outbreak  in  Illinois  was  to 
make  a  rigid  inspection  of  every  breeding  stallion  within 
the  infected  zone  and  in  the  adjoining  territory  and  to  keep 
them  under  constant  observation.  In  the  case  of  each  stall- 
ion which  showed  symptoms  of  the  disease  or  which  had 
served  a  diseased  mare  or  a  mare  which  had  later  become  diseased 
Avithout  other  known  exposure,  his  breeding  record  was  examined 
in  detail  and  each  mare  which  had  been  bred  to  him  was  placed 
under  quarantine  and  subjected  to  repeated  observation.  All 
animals  which  were  found  diseased  were  either  destroyed  and 
the  owners  compensated,  or  they  were  placed  under  a  strict  quar- 
antine for  life,  by  the  terms  of  which  they  were  allowed  to  be 
worked,  but  not  to  be  bred,  sold  or  exchanged. 

Under  these  conditions,  almost  all  the  affected  mares  were 
killed  and  the  few  remaining  ones  were  closely  watched.  The 
affected  stallions  were  all  destroyed.  The  mares  which  had  been 
exposed  to  the  disease,  but  had  not  become  affected,  were  kept 
under  quarantine  for  a  year  or  more  and  subjected  to  rigid  in- 
spection from  time  to  time  and  were  finally  released  when  it 
seemed  perfectly  clear  that  they  were  not,  and  had  not  been,  dis- 
eased. The  effect  of  these  measures  has  been  highly  satisfac- 
tory and  no  recurrence  of  the  di.sease  has  come  to  light  during 
the  twenty  years  which  have  elapsed  since  the  outbreak.  At 
that  date  the  trypanosomum  equiperdum  was  unknown  and  its 
pre.sence  or  absence  could  not  enter  into  the  question  of  diag- 
nosis or  control,  physical  symptoms  alone  being  relied  upon. 

Upon  one  occa.sion,  during  the  early  stages  of  control  work, 
the  owner  of  a  stallion,  who  doubted  the  diseased  condition  of 
his  animal,  clandestinely  permitted  him  to  serve  a  mare,  which 
became  infected.  The  destruction  of  all  affected  stallions  shortly 
thereafter  put  a  stop  to  such  accidents. 

It  is  of  primary  importance  in  all  outbreaks  of  the  disease  to 
provide  early  for  the  entire  cessation  of  breeding,  or,  we  might 
more  strictly  say,  of  copulation  or  attempts  at  copulation  between 
animals.  In  this  respect,  it  is  important  that  colts  which  are 
reaching  the  breeding  age  should  be  properly  castrated  or  other- 
wise made  .secure.  Stallions  of  breeding  age,  which  have  become 
affected,  should  be  destroyed  promptly,  or  placed  under  safe 
quarantine,  since  they  constitute  the  greatest  source  of  danger. 
Destruction  of  the  affected  animal   is  highly  important,  since  in 


go  Veterinary   Obstetrics 

many  cases  the  owner  is  not  fully  convinced  of  the  dangers  from 
the  disease  and  may  carelessly  violate  any  quarantine  regulations- 
imposed. 

There  is  tlie  additional  danger  that  employees  of  the  owner,  or 
others,  may  violate  the  quarantine  without  his  knowledge  or  con- 
sent, and  thereby  start  the  disease  anew  in  a  way  which  may  be 
exceedingly  confusing,  or  might  work  serious  injustice  to  the 
owners  of  healthy  stallions.  The  feeling  between  competing- 
stallion  owners  in  a  community  is  not  always  of  the  best,  and 
they  may  seek  to  do  a  rival  a  very  great  injury. 

The  castration  of  stallions  does  not  insure  inability  to  spread 
the  disease.  It  is  a  well  known  fact  that  such  castrated  animals, 
which  have  previously  been  used  for  breeding  purpo.ses,  will  con- 
tinue to  copulate  with  mares  which  are  in  estrum  and  may, 
therelDy,  spread  the  di.sease.  It  has  been  recorded  that  geldings 
have  contracted  the  malady  and  it  is  perfectly  rea.sonable  to- 
suppose  that  the  accident  occurred  in  this  manner.  The  castra- 
tion of  stallions  is,  con.sequently.  not  wholly  safe  and,  if  it  is  at 
all  allowed,  it  should  be  accompanied  by  other  safeguards  which 
would  prevent  any  accident.  If  such  stallions  are  removed  from 
breeding  areas  to  city  stables,  where  they  are  put  to  work,  in  case 
they  have  sufficiently  recovered,  they  may  cea.se  to  be  dangerous- 
.so  long  as  they  are  under  reasonable  supervision 

The  castration  of  mares  has  not  been  largely  applied  to  the 
control  of  this  disease,  but  may  prove  of  important  police  value. 
If  a  mare  has  been  exposed,  but  apparently  not  infected,  there 
may  still  linger  a  question  of  her  safety,  even  though  she  has- 
not  shown  symptoms  of  the  disease  and,  unless  she  is  highly  val- 
uable for  breeding  purposes,  it  may  be  better,  in  some  cases,  to 
completely  exclude  her  from  breeding  by  causing  her  castration. 
Since  this  operation  is  comparatively  safe  upon  the  mare  and  is- 
readily  carried  out  by  an  ordinary  operator,  it  might  well  be 
largely  employed  in  these  outbreaks,  and  the  animal  then  jiut  to 
work. 

Diseased  mares  should,  in  the  present  state  of  our  knowledge, 
be  destroyed.  They  occasionally  recover  their  general  health 
and  ability  for  work  but,  as  already  stated,  we  have  no  data  ta 
show  that  such  mares  ever  become  entirely  .safe  as  breeding  ani. 
mals  and  the  danger  to  the  horse  breeding  industry,  as  compared 
o  the  small  value  of  the  few  apparently  recovered  mares,  is  so 


Doiirine  gr 

overwhelming  that  it  would  seem  poor  policy  to  take  the  risk  of 
a  violation  of  quarantine  regulations  and  the  breeding  of  these 
animals  by  the  owners.  In  the  Illinois  outbreak  the  opposite 
course  was  pursued  and  a  small  number  of  mares  was  allowed  to 
live  and  used  for  work  purposes  under  strict  quarantine  against 
breeding  or  disposal.  Though  the  plan  has  not  been  followed  by 
any  disaster,  it  was  unsafe  and  necessitated  prolonged  vigilance. 
In  the  community  where  the}-  were,  however,  each  neighbor 
knew  the  history  of  each  of  these  previously  diseased  mares  and 
would  probably  have  reported  any  open  violation  of  the  quaran- 
tine very  promptly.  It  is  needless  to  say  that  careful  watch 
should  be  kept  over  the  breeding  animals,  especially  the  stallions, 
in  the  infected  area  for  several  years  and  prompt  and  rigid  in- 
vestigations made  upon  the  slightest  suspicion  of  a  recurrence  of 
the  maladv. 


2.  GENITAL  HORSE  POX.     COITAL  EXANTHEM 
Eruptive  Venereal  Disease  of  the  Horse. 

Genital  Horse  Po.x  is  a  highly  contagious  disease,  which, 
under  ordinary  conditions,  is  transmitted  by  coition  only  and 
consists  of  a  local  infection  of  the  genital  organs.  It  is  far  more 
readily  transmitted  than  Dourine  and  has  a  shorter  period  of 
inculcation. 

Symptoms  After  a  period  of  two  to  five  days  sulxsequent 
to  exposure,  there  appears  in  the  mare  an  inflammation  of  the 
mucous  membrane  of  the  vulva  and  vagina,  in  which  tliere  ari.se 
small  reddish  papules,  which  .soon  become  vesicular  or  pustular 
and  rupture,  leaving  small  ero.sions  on  the  mucosa.  From  the 
vulva,  there  occurs  a  more  or  le.ss  copious,  muco-purulent  dis- 
charge, which  .soils  the  tail  and  neighboring  parts.  Urination  is 
somewhat  frequent  and  the  contact  of  the  urine  with  the  denuded 
muco.sa  irritates  that  membrane  and  causes  straining. 

At  the  same  time,  similar  eruptions,  appear  upon  the  externa 
surface  of  the  vulva,  anus,  perineum  and  surrounding  parts. 
They  behave  somewhat  similarly  to  tlie  eruptions  within  the 
vulva  and  vagina.  At  first,  a  small  papule  arises  in  the  skin, 
which  .soon  becomes  vesicular  and  this,  in  turn,  pustular  and 
a.ssumes  a  yellowish- white  color  ;  the.se  mature  quickh'  and  soon 
rupture,  to  be  followed  by  tough,  yellow  scabs,  ^/i  to  ^4  inch  in 
diameter.  After  a  few  days,  the  crusts  drop  off  and  leave  be- 
hind white  scars  very  slightly  depressed.  The.se  depigmented 
spots  are  circular  in  form  and,  in  very  .severe  ca.ses,  may  coalesce 
somewhat.  They  tend,  however,  to  remain  distinct  circular 
spots.  The  pigment  returns  after  two  or  three  weeks  and  no 
visible  .scar  remains.  The  vesicles  appear  in  continuous  crops 
over  a  period  of  one  to  three  weeks,  so  that,  at  a  given  examina- 
tion, there  may  be  eruptions  in  every  stage. 

Accompanying  the.se  eruptions,  there  is  swelling  of  the  vulva, 
with  .some  tenderness  of  the  parts.  Some  writers  have  described 
also  a  prurigo  or  intense  itching  of  the  parts,  causing  the  animal 
to  violently  rub  the  tail  and  vulva.  Although  we  have  personally 
observed  a  number  of  outbreaks,  we  have  not  seen  this  symp- 
tom in  any  case.  Neither  have  we  been  able  to  find  in  the 
literature  upon  the  subject  any  case  where  such  a  symptom  has 
been  recorded  as  a  personal  observation. 
92 


Genital  Horse  Pox  93 

In  the  stallion,  the  symptoms  are  virtually  parallel.  Erup- 
tions, of  the  same  character  as  described  upon  the  vulva  and  anus 
of  the  mare,  appear  upon  the  penis,  prepuce  and  sheath  of  the 
horse.  The  opening  of  the  urethra  is  swollen  and  congested 
and  from  it  there  is  a  muco-purulent  discharge.  There  is 
some  swelling  of  the  prepuce  and  po.ssibly,  to  a  less  degree,  of 
the  penis.  Ordinarily,  there  are  no  constitutional  symptoms  in 
either  animal,  there  is  no  loss  of  appetite  nor  appreciable  emacia- 
tion and  the  general  condition  of  the  animal  remains  undisturbed. 
In  one  case  observed  by  us,  there  remained  a  year  afterward  an 
extensive  chronic  inflammation  of  the  vagina  and  bladder,  which 
virtually  ruined  the  animal.  In  this  case,  the  mucous  membrane 
of  the  vulva  and  vagina  was  greatly  thickened,  corrugated, 
sensitive  and  bled  easily  upon  touch.  The  bladder  was  highly 
inflamed,  its  mucosa  greatly  thickened,  the  urinary  .salts  were 
deposited  over  its  inner  surface  and  its  cavity  was  largely  oblit- 
erated. The  meatus  urinarius  was  open  and  the  urine  dribbed 
away  involuntarily,  .so  that  the  tail  and  thighs  were  kept  con- 
stantl}-  befouled  and  presented  a  very  repulsive  appearance. 

The  course  of  the  di.sease  is  usually  mild  and  brief.  Most 
cases  recover  spontaneously  in  from  two  to  three  weeks  and, 
under  proper  handling,  recovery  is  hastened  and  rendered  in- 
crea.singly  certain. 

The  nature  of  the  disease  is  not  precisely  known.  A  given 
outbreak  is  not  usually  traceable  to  any  definite  source  of  origin, 
but  seems  to  become  established  in  a  community  without  having 
been  imported  by  a  diseased  animal.  Once  it  becomes  estab- 
lished, almost  every  mare  bred  to  an  affected  stallion  contracts 
the  disease  with  great  uniformit}'.  Presumably,  it  is  just  as 
transmissible  to  the  stallion,  but  this  is  not  so  often  observed, 
since  the  mares  are  not  usually  bred  to  different  males  during 
the  same  season.  Experiments  have  shown  that  the  vesicles  and 
pustules  contain  the  element  of  contagion  in  a  virulent  form. 

Handling.  The  handling  of  the  disease  depends  essentially 
upon  disinfection  and  a  temporary  cessation  of  breeding.  Any 
disinfectant  will  answer  the  purpose,  but  it  should  not  be  highly 
irritant,  since  the  parts  involved  are  very  sensitive. 

The  handling  of  the  stallion  is  most  urgent  so  that  he  may 
resume  service  as  promptly  and  safely  as  possible.  From  our 
experience  we  have  come   to  prefer  an  antiseptic  wash  composed 


94  Veteriyiary  Obstetrics 

of  about  I  ounce  of  carbolic  acid  with  2  ounces  of  tannin  and  6 
ounces  of  glycerine  in  i  gallon  of  warm  water.  After  washing 
the  penis  and  prepuce  thoroughly  with  soap  and  water,  this  solu- 
tion is  applied  freely  twice  daily  and  a  quantity  of  it  is  injected 
up  the  urethra  until  it  is  supposed  to  reach  nearly  to  the  bladder. 

The  extent  of  disease  in  the  urethra  has  not  been  investigated. 
We  only  know  that  there  is  a  urethral  inflammation  and  dis- 
charge and  that  it  is  infective.  The  mere  washing  of  the  penis 
and  prepuce  cannot,  therefore,  bring  about  effective  disinfection, 
but  the  urethra  needs  be  included.  The  urethral  injection  is 
best  made  by  means  of  a  rubber  bulb  syringe  or  a  gravity  ir- 
rigating apparatus.  The  syringe  or  irrigator  nozzle  is  insert- 
ed into  the  urethral  opening  and  retained  there  while  the  an- 
tiseptic solution  is  forced  upward  as  far  as  is  deemed  necessary. 
Should  some  of  the  fluid  reach  the  bladder,  it  will  not  prove 
dangerous  but  it  would  be  well  not  to  overfill  the  urethral  pass- 
age at  first  so  that  the  infective  discharges  ma}'  be  largelj^  ex- 
pelled before  taking  the  risk  of  forcing  them  up  into  the  bladder 
by  an  excess  of  the  solution.  The  external  ulcers  resulting  from 
the  pustules  may  be  touched  lightly  with  stick  nitrate  of  silver. 
The  animal  needs  be  kept  as  free  as  possible  from  .sexual  excite- 
ment, but  should  be  allowed  gentle  exercise,  along  with  a  re- 
stricted, laxative  diet.  The  stallion  may  be  returned  to  the  stud 
as  soon  as  all  evidences  of  disease  have  disappeared  but,  for  a 
time,  it  might  be  advisable  to  continue  the  disinfection,  especially 
after  each  .service. 

The  handling  of  the  mare  should  be  along  the  same  general 
line  and  should  be  persevered  in  until  all  symptoms  have  di.sap- 
peared.  As  a  general  rule,  she  will  recover  sufficiently  during 
the  interval  between  two  estrual  periods  that  she  may  again  be 
bred  at  the  first  return  of  estrum  since  the  contraction  of  the 
disease,  should  she  not  prove  to  be  in  foal. 

The  differentiation  of  this  affection  from  Dourine  is  highly 
important,  but  has  already  been  discussed  on  page  83. 

There  is  little  need  for  police  control  of  this  disea.se,  .since  its 
symptoms  are  so  prominent  that  laymen  promptly  note  it  and 
voluntarily  withdraw  the  affected  animal  from  breeding  until  re- 
covery has  occurred.  vShould  there  at  any  time  be  a  negligent 
tendency  shown,  the  affected  animals  should  be  promptly  quar- 
antined until  all  danger  has  passed. 


VENEREAL  DISEASES  OF  CATTLE 

I.  Vesicular  Exanthem.     Aphthous  Venereal  Disease. 

The  vesicular  venereal  disease  of  cattle  is  one  of  the  most  com- 
mon and  wide-spread  of  the  entire  group  of  venereal  diseases  of 
animals.  It  is  a  highly  contagious  malady,  transmitted  ordin- 
arily by  copulation. 

The  Symptoms  are  ver}-  similar  to  those  of  the  Genital  Horse 
Pox,  already  described.  The  first  evidence  of  the  disease  in  the 
cow  is  an  intense  vaginitis,  in  which  the  mucous  membrane  of 
the  vulva  and  vagina  become  greatly  injected  and  swollen,  soon 
followed  by  dark  red  points  or  petechiae,  which  quickly  develop 
into  vesicles  of  very  small  size.  These  are  at  first  transparent, 
but  may  later  become  pustular,  although  they  largely  rupture 
while  yet  in  the  vesicular  stage.  From  these,  very  shallow  ul- 
cers result  and  give  rise  to  a  muco-purulent  discharge,  which  col- 
lects upon  the  tail  and  neighboring  parts  m  the  form  of  dry 
crusts. 

In  severe  cases,  the  ulcers  may  acquire  considerable  depth, 
with  irregular  borders,  and,  in  healing,  may  temporarily  leave  a 
stellate  scar,  though  there  is  usually  no  prominent  mark.  In  any 
case,  they  tend  to  develop  completely  in  a  short  time.  The  cow 
expres.ses  pain  and  irritation  by  stepping  to  and  fro  with  the 
hind  feet  and  by  movements  of  the  tail.  The  act  of  urination  is 
painful  and  causes  straining  because  of  the  irritant  effect  of  the 
urine  upon  the  denuded  mucous  membrane.  In  some  instances 
there  seems  to  be  an  excessive  estrum. 

When  very  severe,  the  cow  may  show  some  difficulty  in  moving, 
owing  to  the  tenderness  of  the  inflamed  organs.  Manipulations 
of  the  swollen  vulva  cause  very  evident  pain  and  the  inflamed 
mucous  membrane  bleeds  very  readily.  The  discharge  from  the 
-vulva  is  somewhat  parallel  to  the  degree  of  ulceration  in  the  vulva 
and  vagina.  If  excessive,  it  may  become  irritant  and  cause  ex- 
coriation of  the  parts  with  which  it  comes  in  contact.  In  very 
severe  cases,  patches  of  the  mucosa  may  become  necrotic  and 
slough  away. 

The  infection  may  or  may  not  prevent  impregnation  and,  when 
affecting  a  pregnant  cow,  it  rarely  causes  abortion.     The  general 

95 


96  l^e/erhiarr  Obsh  tries 

functions  of  the  animal  are  not  usually  affected,  the  temperature 
and  appetite  remaining  very  nearly  or  quite  normal.  The  affec- 
tion may  lead  to  chronic  catarrh  of  the  vagina  ;  or  it  may  result 
in  adhesions  l^etween  the  walls  of  the  vagina,  more  or  less  com- 
pletely closing  that  canal. 

In  the  bull,  the  penis  and  sheath  are  inflamed,  swollen  and 
tender.  Eruptions  of  the  same  character  as  we  have  described 
in  the  cow  appear  also  upon  the  penis,  first  as  papules,  which 
develop  into  vesicles,  to  be  followed  by  ulcers.  The  urethra  is 
similarly  involved,  as  expressed  by  a  muco-purulent  discharge- 
This  is  further  shown  by  the  urine  being  frequently  voided  in 
small  amounts,  with  appearances  of  pain.  The  swelling  of  the 
penis  and  its  sheath  tends  to  produce  phimosis. 

Erection  of  the  penis  causes  bleeding  and  this  is  especially 
evident  immediately  after  copulation.  Kampmann  records  a 
case  of  extensive  necrosis  of  the  penis  with  a  permanent  de- 
formity. The  duration  of  the  disease  is  usually  brief  and  gener- 
ally ends  in  spontaneous  recovery  in  from  one  to  four  weeks. 
An  outbreak  in  a  stable  may  continue  for  a  long  time  by  being 
transmitted  first  to  one  and  then  to  another  animal.  One  attack 
apparently  confers  little  or  no  immunity  and,  when  an  animal 
has  almost  recovered,  the  di.sease  may  be  renewed  through 
copulation. 

This  affection  should  be  differentiated  from  the  granular  ven- 
ereal disease  of  cattle.  In  the  latter,  vesicles  and  pustules  are 
absent  throughout  and  it  runs  a  far  more  chronic  and  virulent 
course.  We  find  no  record  of  the  latter  affection  in  America, 
while  the  vesicular  venereal  disease  is  widely  distributed. 

The  prognosis  is  highly  favorable  and  it  is  only  rarely  that 
material  loss  follows. 

The  control  of  the  disease  must  rest  fundamentally  upon  the 
isolation  of  the  affected  animals.  It  is  highly  essential  that  the 
two  sexes  .should  be  kept  entirely  apart.  Even  steers  should  not 
be  allowed  in  an  enclosure  with  cows,  because  they  sometimes 
attempt  copulation  and  may  thereb)  serve  to  transmit  the 
di.sease.  A  diseased  cow  should  not  be  permitted  to  stand  in 
clo.se  proximity  to  healthy  ones  because  the  infection  may  be 
transmitted  from  one  animal  to  the  other  through  the  medium  of 
the  tail,  by  .soiled  bedding  or  other  means.  Affected  animals 
should  on  no  account  be  bred   until   thev   have   fullv    recovered. 


Granular    Venereal  Disease  of  Catlle  97 

Thorough  disinfection  of  the  stalls  and  of  the  diseased  and  soiled 
parts  of  the  animals  contributes  materiall)-  to  the  control  of  an 
outbreak  and  the  shortening  of  its  duration. 

The  treatment  consists  of  the  disinfection  of  the  copulatory 
organs  and  those  parts  which  become  soiled  from  the  discharges. 
The  choice  of  a  disinfectant  is  not  of  e.s.sential  importance. 
Thorough  mechanical  cleansing  by  washing  constitutes  a  highl)^ 
important  part  of  the  handling.  The  disinfectants  used  should 
constantly  be  of  such  a  character  as  to  cause  little  irriation  to 
the  highly  sen.sitive  parts.  One  of  the  chief  dangers  to  be  an- 
ticipated is  adhesions  between  contiguous  mucous  surfaces  of  the 
vagina  or  of  the  sheath  of  the  penis.  If  the  walls  of  the  vagina 
or  vulva  adhere,  because  of  the  denudation  of  epithelium,  breed- 
ing may  be  prevented,  owing  to  the  narrowing  of  the  canal  to 
such  an  extent  that  copulation  cannot  occur.  In  the  bull,  the 
penis  may  become  adherent  to  the  sheath  so  that  it  cannot  be 
protruded,  and  coition  thus  be  prevented. 

Such  untoward  results  may  be  best  anticipated,  and  recovery 
hastened  and  assured,  by  douching  thoroughl}'  with  such  mild 
disinfestants  as  yi'/c  solution  of  carbolic  acid,  \'/(  alum  solution 
or.  I  9^  permanganate  of  potash,  repeated  twice  daily.  The  so- 
lution should  be  used  at  about  the  body  temperature  and  intro- 
duced into  the  vagina  or  sheath  by  means  of  an  irrigator,  until 
the  cavity  is  well  distended,  when  it  should  be  allowed  to  escape. 
Should  the  patient  give  indications,  by  straining,  that  the  douche 
is  painful,  it  should  be  reduced  in  strength  until  it  is  well  borne. 

2.  Granular  Venereal  Disease  of  Cattle.     Infectious 
Vaginal  Catarrh.     Vaginitis  Verrucosa 

Bibliography:  Zschokke,  Die  L'nfruchtbarkeit  des  Riudes;  Hutyra 
und  Marek.j^Spezielle  Pathologie  und  Therapie  ;  Hess.  Schweitzer  Archives 
f.  Tierheilkunde,  Band  XLVIII,  S.  351  ;  Thorns,  Monatshefte  fur  Praktische 
Tierheilkunde,  B.  XVII,  vS.  193. 

In  many  portions  of  continental  Europe  there  exists  a  widely 
spread  and  highly  contagious  venereal  disease  of  cattle,  which 
causes  very  serious  losses  in  dairies.  So  far  as  known,  it  is  purely 
venereal,  transmitted  clinically,  generally,  if  not  always,  by  coi- 
tion, though  capable  of  being  transferred  by  other  means. 


98  l^eteriiiaty  Obstetrics 

W^e  have  seen  no  record  of  its  existence  in  America,  ])ut  its 
wide  dissemination  in  Europe,  the  chronic  and  somewhat  insid- 
ious course  of  the  disease,  which  may  render  it  difficult  of  detec- 
tion at  ports  of  entry,  render  it  possible  of  importation.  The 
want  of  any  record  of  its  presence,  in  this  country,  is  not  final 
proof  of  its  non-existence,  as  it  may  be  confused  with  the  far 
less  serious  eruptive  venereal  disorder  described  in  the  preceding 
chapter. 

The  malad)'  has  been  recognized  for  twenty  jears  and  has  been 
observed  and  described  by  numerous  veterinary  authors  in  Switz- 
erland, Germany,  Italy,  Denmark,  Austria  and  other  countries, 
from  some  of  which  America  imports  large  numbers  of  dairy 
cattle. 

While  not  of  importance,  as  related  to  the  lite  ot  the  affected 
animal,  it  becomes  in  other  respects  a  very  serious  malady  as 
affecting  the  dairying  interests.  It  is  highly  contagious,  involv- 
ing, in  the  infected  zones,  as  high  as  80  to  90'/  or  even  more  of 
the  total  number  of  cows.  Hutyra  und  Marek,  citing  Mueller, 
states  that  in  East  Prussia  alone  the  disease  involved  30,000 
dairy  cows,  while,  in  Switzerland  and  other  countries,  it  has  ac- 
quired a  similarly  extensive  dissemination. 

It  is  a  fertile  cause  of  enzootic  abortion.  Thoms  states  that 
more  than  50%  of  cows  affected  abort.  In  one  outbreak,  involv- 
ing 300  cows,  about  70"/  aborted  ;  in  another  group  of  296  cows 
there  were  48  live  calves.  After  the  malady  has  prevailed  in  a 
dairy  herd,  a  large  proportion  of  cows  become  sterile,  partly 
because  of  cystic  ovaries,  accompanied  by  nymphomania.  In 
fact,  this  malady  appears  to  be  one  of  the  common  exciting 
cau.ses  of  nymphomania  with  ovarian  cysts.  It  may  also  lead  to 
sterility  in  other  ways. 

During  the  course  of  the  malady  and  as  a  result  of  the  direct 
irritation  from  the  abortion  and  other  interruptions,  there  is  a 
great  lo.ss  of  milk.  Thoms  estimates  the  average  lo.sses  upon 
each  cow  at  30  M.  ($7.  o).  According  to  those  authors  who 
have  had  extensive  experience  with  the  malady,  it  deserves  to 
rank  amongst  the  most  serious  of  dairy  plagues. 

Etiology.  According  to  Ostertag  and  Hecker,  the  affection 
is  due  to  a  streptococcus  con.sisting  of  6-9  cocci,  which  are  held 
together  by  a  delicate  capsule. 


Granular    Venereal  Disease  of  Cattle  99 

In  artificial  cultures,  either  alkaline  or  acid,  and  at  the  body 
or  room  temperature,  the  organism  grows  vigorously.  It  does 
not  liquefy  coagulated  blood  serum  or  gelatin  nor  coagulate 
milk.     It  forms  neither  gas  nor  indol. 

The  disease  is  readily  induced  in  healthly  cows  b}'  vaginal  in- 
oculation with  pure  cultures  or  by  discharges  from  the  vagina 
of  a  diseased  animal. 

Attempts  at  experimental  transmission  to  other  species  of 
animals  have  resulted  negatively. 

Naturally,  the  infection  is  transmitted  almost  wholly  by  copu- 
lation, an  affected  bull  infecting  almost  all  the  cows  with  which  he 
copulates.  A  bull  which  has  recently  served  a  diseased  cow 
may  transmit  the  malady  to  a  sound  one  wathout  becoming  dis- 
eased him.self .  Sometimes  the  transmission  occurs  through  ordi- 
nary contact,  without  sexual  intercourse.  It  may  be  accidental!}' 
transmitted  to  heifers  or  calves. 

The  streptococci,  having  gained  the  vagina,  penetrate  the 
mucosa  and  are  found  between  the  epithelial  cells  and  deeply 
wathin  the  papillae.  The  organisms  have  also  been  identified  in 
nodules  in  the  uterus,  in  the  uterine  mucosa  and  in  the  ovaries 
which  have  undergone  C5'Stic  degeneration. 

In  this  w^ay,  apparently,  they  cause  the  very  frequent  sterility, 
while  the  wide  area  of  distribution  of  the  organisms  and  their 
depth  within  the  ti.ssues  render  disinfection  and  cure  a  complex 
and  difficult  problem. 

Symptoms.  According  to  Ostertag,  a  vaginal  catarrh  be- 
comes established  within  2-3  days  after  artificial  inoculation, 
while,  by  natural  or  coital  infection,  one  or  two  more  daj's  elapse 
before  the  catarrh  becomes  apparent.  Raebiger  observed  va- 
ginitis and  catarrh  in  24  hours. 

The  first  symptoms  of  the  malady  to  be  noted  consist  of  swell- 
ing of  the  labige  of  the  vulva  and  a  diffused  or  streaked  reddening 
and  swelling  of  the  vulvo- vaginal  mucosa,  with  tenderness  of  the 
parts.  The  inflamed  area  is  covered  somewhat  by  a  muco- 
purulent discharge. 

A  day  or  two  later  there  develop  in  the  vestibule  of  the  vulva 
along  the  floor  and  sides  about  the  clitoris  numerous  small  nodules 
^Jg-  to  |-  inch  in  diameter,  which  are  at  first  dark  red,  later  be- 
coming lighter  in  color.     These  nodules  are  smooth  and  of  very 


loo  Veterinary  Obstetrics 

firm  consistence  and  are  somewhat  reo;ularly  arran»;jed  in  parallel 
rows,  as  sliown^in  Fig.  lo. 


Fig.   io.     iNi-'KCTior-s  Gr.\nui..\r  Vagiitis. 

Mucosa  of  the  vestibule  after  three  months  duration  of  the  dis- 
ease. (Hutyra  and  Marek,  after  Ostertag.) 


Grmiular    \^enereal  Disease  of  Cattle  loi 

The  nodules  consist  essentially  of  hypertrophied  papillary 
bodies.  If  the  vulva  is  held  open  and  reflected  light  thrown  into 
the  cavity,  the  nodules  can  be  readil)^  distinguished  ;  they  are 
also  readily  recognizable  by  the  sense  of  touch. 

The  mucous  membrane  is  swollen,  r^  and  sensitive,  bleeds 
easily  upon  manipulation  and  is  covered  by  an  inodorous  mucous 
or  muco-purulent  secretion,  which,  flowing  from  the  vulva,  soils 
the  labiae,  tail  and  adjacent  parts,  where  it  dries  in  brown  crusts 
or,  if  in  larger  amounts,  may  flow  from  the  vulva  in  long,  ropy 
ma.sses.  The  denudation  of  the  mucosa  renders  it  quite  sensitive 
to  the  passage  of  urine  over  it,  and  the  pain  and  irritation  in  the 
part  tends  to  cause  urination  with  abnormal  frequency. 

When  the  disease  extends  into  the  cavity  of  the  gravid  uterus, 
which  appears  to  be  almost  the  rule,  abortion  occurs,  while,  in  the 
non-pregnant  cow,  nymphomania  and  sterility  are  common 
results. 

The  acute  stage  of  the  malady  continues  for  20  to  30  days,  when 
the  swelling  and  tenderness  abate  and  the  nodules  lose  their  red 
color  to  become  somewhat  j-ellowish  or  grayish,  perhaps  some- 
what transparent  ;  but  the  discharge  and  the  granules  persist  for 
90  to  100  daj's,  or  more. 

Vesicles,  pustules  or  ulcers  do  not  ordinarily  occur,  though  ul- 
cers and  phlegmon  have  been  very  rarely  recorded.  Bulls  show 
a  comparatively  high  resistance  to  the  infection,  and,  though 
they  constitute  the  chief  vehicle  for  the  contagion,  apparently 
suffer  slightly,  if  at  all,  in  most  cases. 

When  affected,  they  show  analogous  sj'mptoms  to  those  observed 
in  the  cow.  The  penis  is  studded  over  with  nodules,  like  those 
of  the  vagina,  which  are  easily  seen  when  the  organ  is  extruded. 
Erection,  copulation  or  manipulation  of  the  penis  cau.ses  bleeding. 
There  is  a  muco-purulent  discharge  from  the  sheath  of  the  penis, 
which  adheres  to  and  soils  the  parts. 

Treatment.  The  handling  of  the  malady  consists  essentially 
of  local  disinfection,  and,  as  in  other  localized  infections,  there 
should  be  a  thoroughness  in  application  conformable  to  the  in- 
tricacy. We  have  stated  above,  that  the  cocci  are  found  deeply 
insinuated  between  the  epithelial  cells,  and  yet  deeper  within 
the  papillary  bodies,  that  they  may  extend  to  the  muco.sa  of 
the  OS  uteri,  to  the  oviducts  and  even  to  the  ovaries.  Safe  recov- 
ery includes  the  successful   destruction    of  the  organisms  in  all 


I02  J^ctcrinary  Obstetrics 

these  organs  and  tissues.  The  disinfectants  used  must  not  be  too 
irritant  to  the  highly  sensitive  mucosa  of  the  genital  passages, 
since  they  induce  straining,  inflammation,  adhesions  and  other  dis- 
agreeable consequences.  Disinfecting  douches,  ointments,  pow- 
ders and  tampons  have  been  commended,  all  having  a  common 
aim.  Among  douches  there  have  been  suggested  2  to  2^2'/  solu- 
tionsof  ly.sol,  creolin  and  similar  drugs;  .5'/  silver  nitrate,  .  i '/ 
potassium  permanganate,  5'/  ichthyol,  etc.  Likewise,  with  pow- 
ders, a  wide  variation  is  available,  such  as  zinc  sulphate,  alum, 
tannin  and  others,  reduced  by  mixing  with  starch  or  other  inert 
powder.  In  this  group,  we  should  also  mention  iodoform,  be- 
cause of  its  local  anaesthetic  action,  its  weight,  which  would 
cause  it  to  drop  into  the  depressions  between  the  elevations  of 
the  mucosa,  and  its  comparative  insolubility,  causing  it  to  re- 
main in  position  for  24  and  more  hours,  presumably  to  be  slow- 
ly converted  into  iodine.  It  has  one  very  .serious  objection  in  the 
dairy,  its  odor,  which  is  at  all  times  liable  to  taint  the  milk.  If 
it  is  to  be  used,  great  care  should  be  taken  in  its  application, 
.some  penson  other  than  the  milker  applying  it,  .since  his  hands 
inevitably    become    .somewhat  saturated    with  the  drug. 

It  ma}'  be  best  introduced  by  means  of  a  gelatine  capsule,  to 
be  later  broken  and  the  powder  liberated.  Other  drugs,  like  lysol 
and  creolin,  require  cautious  handling  in  the  dairy,  to  avoid  the 
contamination  of  the  milk.  In  the  use  of  tampons,  the  vulvo- vagi- 
nal cavity  may  be  packed  with  gauze  or  cotton  saturated  with  a 
disinfectant.  Usually  animals  resist  the  presence  of  a  tampon  in 
the  vulva  or  vagina  and  tend  to  expel  it. 

Some  experienced  practitioners  praise  anti.septic  ointments  very 
highly.  They  may  vary  greatly  in  composition  and  con.sist  of 
well  nigh  any  disinfectant,  incorporated  with  a  heavy  fat,  like 
cocoa  butter,  wax  or  tallow.  The  latter  is  very  cheap  and  may 
have  added  to  it  a  little  wax  in  order  to  giv^e  it  the  proper  firm- 
ness. Along  with  the  desired  antiseptics,  the  mixture  may  be 
placed  over  a  fire  and  brought  to  the  melting  point,  when  all  in- 
gredients are  mixed,  and,  while  still  soft,  may  be  molded  into 
suppositories,  .say  in  form  of  a  candle,  about  one-half  to  one  inch 
thick  by  five  to  eight  inches  in  length.  Such  suppositories  are 
very  readily  introduced  through  the  vulva,  and,  unless  containing 
highly  irritant  antiseptics,  are  well  borne  bj'  the  patient. 


Granular    l^enereal  Disease  of  Cattle  103 

Affected  bulls  are  to  be  handled  along  the  same  general  lines 
as  described  for  cows. 

The  prophylaxis  and  control  of  the  maladj'  is  highly  impor- 
tant and,  in  a  general  way,  demands  the  enforcement  of  the  usual 
regulations  for  the  control  of  contagious  diseases.  Of  the  first 
importance  is  sexual  isolation  ;  coition  must  be  prohibited  until 
the  disease  has  wholly  disappeared  in  the  two  animals  to  be 
mated,  not  alone  because  a  diseased  animal  will  quite  surely 
transmit  it  by  copulating  with  a  sound  one,  but  because  coition 
tends  constantly  to  arouse  the  disease  to  new  and  increased  ac- 
tivity. In  addition  there  needs  be  general  isolation  of  the  dis- 
eased from  the  health}-,  with  thorough  and  efficient  disinfection 
of  the  stalls  and  all  portions  of  the  stable. 

In  a  suspected  herd,  the  penis  and  sheath  of  the  bull  should 
be  thoroughly  disinfected  by  means  of  a  reliable  douche,  both 
immediately  before  and  after  copulation.  This  is  easily  accom- 
plished by  placing  a  barrel  or  other  container,  filled  with  a  relia- 
ble antiseptic,  in  a  convenient  elevated  place,  from  which  the 
fluid  may  flow  by  gravity,  and  attaching  to  it,  by  means  of  a 
faucet,  a  piece  of  rubber  tubing  10  to  15  feet  long,  the  free  end 
of  which  ma}'  be  inserted  into  the  opening  of  the  sheath  and  the 
cavity  thoroughly  douched.  In  regions  where  the  malady  exists 
or  is  suspected,  efficient  quarantine  should  be  enforced  against 
the  entrance  into  the  herd  of  diseased  or  suspected  animals. 


VENEREAL  DISEASE  OF  THE    DOG.     VENEREAL 
GRANULAMOTA.   LYMPHOSARCOMA 

in  the  dog,  there  is  observed  a  sptcific  venereal  disease  con- 
sisting of  granulomata  upon  the  genital  mucosa.  The  disease  is 
somewhat  wide-spread  in  Great  Britain  and  continental  Europe. 
It  is  observed  in  various  portions  of  the  United  States,  largely  in 
dogs  recently  imported.  It  seems  most  common  in  large  cities. 
In  the  male  it  affects  chiefly  the  penis  and  prepuce  and  some- 
times invades  the  adjacent  tissues.  Metastatic  disease  of  the 
inguinal  glands  may  follow.  In  the  female  it  involves  primarily 
and  chiefl_v  the  vulva.  It  is  naturally  transmitted  by  copulation 
only,  but  may  be  otherwise  spread  by  artificial  or  accidental 
inoculation. 


Fig.  II.     Infectious  Vkxerkal  Gr.\nul()m.\  of  Dog.     (C.  A.White.) 

Symptoms.  The  first  symptom  usually  noted  is  a  bloody  dis- 
charge from  the  prepuce  or  vulva,  accompanied  by  tumefaction  of 
the  parts.  If  the  penis  is  exposed  at  this  time,  there  are  .seen  pink 
or  grayish  red  vegetations,  largely  upon  the  glans  or  at  the  ba.se 
of  the  penis  where  the  penial  mucosa  pas.ses  over  to  the  sheath  or, 
104 


Voiereal  Disease  of  the  Dog 


105 


at  times,  upon  other  parts  of  the  mucosa.  These  tumors  are  soft  and 
friable  and  bleed  freely  upon  being  touched.  They  may  be  sessile 
or  somewhat  pedunculated,  resembling  warts.  The  affection  is  of 
a  chronic  character  and  seems  to  have  no  definite  limitation,  the 
vegetations  continuing  to  increase  in   size  month  by  month  and 


"\ 


Fig.  12A.     iNFECTiors  Venerkai.  Granuloma  of  Bitch.     (C.  A.  White. ) 

finally  become  firm,  lobulated  mas.ses,  so  intensely  injected  that 
they  assume  a  dark  color. 

In  the  bitch,  the  symptoms  are  very  similar.  There  is  first  a 
bloody  discharge  from  the  vulva.  Examination  of  the  vulva  and 
vagina  reveals  vegetations  of  the  same  appearance  as  already 
noted  in  the  male.  These  appear  chiefly  along  the  floor  of  the 
vulva  and,  when  very  large,  may  protrude  externally.  The  dis- 
charge from  the  vulva  is  usually  fetid.     According  to  French, 


io6 


I'eicriuary  Obstetrics 

aversion    to    niatiti^    with    affected 


males   soiuetinies   show 
females. 

Beebe  and  Ewing  (Jour.  Med.  Re.search,  Sept.,  1906,  do.  A'et. 
Jour.,  July,  1907)  record  the  presence  in  the.se  tumors  of  spi- 
rochsete  in  one  out  of  a  .series  of  cases,  but  failed  to  connect  their 
presence  with  the  cau.se  of  the  malady. 


IT 


\ 


Fig.  12B.     iNKECTiois  Vknerk.\l  GR.\Nri.OM.\  01-  Bitch.     (C.  A.  White.) 

Later,  Mettam  (  Veterinary  Journal,  February,  1907)  records 
the  discovery  of  an  organism  in  this  di-sease  belonging  to  the 
group  of  spirochaete,  which  he  believes  to  be  the  .specific  cause. 

Histologically,  the  tumors  consist  of  large  round  or  polyg- 
onal cells,  which  multiply  rapidly  and  push  the  contiguous 
ti.ssues  aside  without  their  becoming  involved  in  inflammatory 
or  other  disease  changes. 

Thedisea.se  has  been  repeatedly  transmitted  experimentally  by 
inoculations  in  the  genital  muco.sa  and  other  tissues. 


Venereal  Disease  of  the  Dog  107 

In  clinical  and  experimental  cases  the  neoplasms  may  not  re- 
main confined  to  the  genital  organs,  but  may  involve  the  skin, 
the  lymphatic  glands  of  various  portions  of  the  body,  the  liver, 
spleen  and  other  glands, 

The  treatment  is  not  highly  satisfactory  unless  undertaken 
early.  It  consists  chiefly  in  excising  the  vegetations,  along  with 
a  small  area  of  the  healthy  mucosa,  after  which  the  edges  of  the 
wound  should  be  drawn  together  with  catgut. 

In  the  male,  it  may  be  necessary  to  divide  the  prepuce  and,  in 
the  female,  the  perineum,  in  order  to  reach  all  the  diseased  parts. 
Afterwards,  these  wounds  should  be  sutured.  It  is  well  to  place 
the  animal  under  general  anaesthesia  for  the  operation,  which 
should  be  repeated  within  one  to  three  weeks  if  necessary-,  and 
in  some  ca.ses,  cautery  may  be  resorted  to.  In  inveterate  cases 
it  may  be  necessary  to  amputate  the  penis  and  prepuce.  Hobday 
states  that  the  disease  may  be  favorably  affected   by  castration. 


VENEREAL  DISEASE  OF  SHEEP. 

Flook  (Jour.  Comp.  Path,  and  Ther.,  \'ol.  XVI,  p.  374)  records 
an  outbreak  of  a  venereal  di.sease  among  .sheep  which  came  under 
his  observation.  He  relates  that,  in  a  herd  of  fiftj^-two  yearling 
ewes  and  two  ram  lambs,  which  had  been  recently  purcha.sed,  it 
was  noted  that  one  of  the  rams  had  a  discharge  from  the  .sheath, 
while  the  other  had  extensive  eruptions  about  the  mouth  and 
no.se.  Nothing  was  .seen  amiss  with  the  ewes.  Soon  after  pur- 
cha.se,  the  two  rams  were  taken  from  the  band  with  which  they 
had  been  purchased  and  placed  with  a  small  flock  of  old  ewes. 
After  one  week  F.  found  nine  of  the  old  ewes  showing  great 
swelling  of  the  vulvae,  with  raw,  bleeding  sores  upon  the  mucous 
and  cutaneous  surfaces  of  the  lips  of  the  vulva.  An  examination 
of  the  rams  revealed  ulcerating  sores  in  the  sheath  of  one  and 
eruptions  upon  the  upper  lip  of  the  other.  The  general  health 
of  the  animals  was  not  apparently  disturbed. 

The  rams  had  been  marked  with  color  upon  the  breast  between 
the  forelegs  .so  that  each  ewe  which  was  .served  could  be  identified 
and,  by  this  means,  it  .seemed  to  be  determined  that  two  of  the 
latter  had  contracted  the  disea.se  without  coition.  F.  suggests 
that,  in  these  two,  the  disease  may  have  been  transmitted  b}-  the 
ram  which  had  the  eruptions  on  his  upper  lip,  through  smelling 
of  the  vulvae  of  these  two  animals,  or  that  it  might  have  been 
caused  by  flies  bearing  the  di.sease  from  one  animal  to  another, 
.since  the  affection  appeared  during  the  month  of  August.  The 
affected  ewes  were  isolated  and  the  sores  dressed  with  antiseptics. 
Gradually  they  all  recovered. 

On  the  following  page  of  the  same  journal,  vSir  John  McFad- 
yean  contributes  observations  made  by  himself  upon  an  out. 
break  which  he  considers  identical  with  that  described  by  F., 
which  he  also  ob.served.  He  saw  twelve  ewes  affected  in  one 
flock,  showing  intense  inflammation,  swelling  and  tenderness  of 
the  vulva.  The  vulvar  mucosa  was  inflamed  and  some  ulcers 
were  present,  both  on  the  mucous  membrane  and  the  skin. 
There  was  a  slight  purulent  discharge  from  the  vulva.  As  these 
ewes  had  been  .served  by  a  hired  ram,  which  had  been  returned 
to  his  owner  six  days  previously,  McFadyean  failed  to  .see  the 
108 


Venereal  Disease  of  Sheep  109 

animal.  McFadyean  attempted  to  produce  the  disease  experiment- 
ally b}-  collecting  the  discharges  upon  pledgets  of  cotton,  one  of 
which  was  introduced  into  the  vulva  of  a  ewe,  another  into  that 
of  a  cow  and  a  third  into  the  sheath  of  a  wether. 

Though  two  of  these  experiments  proved  negative,  in  the 
wether,  a  swelling  of  the  sheath  was  apparent  two  days  after  the 
inoculation.  This  was  still  further  increased  on  the  4th  day  and 
accompanied  b)'  a  slight  discharge.  The  swelling,  at  this  time, 
was  sufficient  to  make  the  exposure  of  the  penis  impossible. 
The  symptoms  continued  over  a  period  of  about  two  weeks.  On 
the  third  daj'  there  appeared  on  the  skin  near  the  opening  of  the 
sheath  a  small  sore,  which  was  covered  with  a  brownish  scab. 
This  sore  continued  to  spread  around  the  opening  of  the  sheath. 
On  the  fifteenth  day  after  inoculation,  two  small  abscesses  had 
formed  on  the  prepuce  near  the  primary  sore  ;  these  ruptured 
the  next  day,  leaving  shallow  ulcers.  At  this  time,  a  third  small 
abscess  had  formed.  All  the  ulcers  were  covered  later  with 
brownish  crusts,  after  which  they  began  to  heal.  Attempts  to 
artificially  transfer  the  disease  from  this  animal  to  another 
wether  and  ewe  failed.  McFadyean  did  not  succeed  in  isolating 
any  organism  which  he  believed  to  be  the  cause  of  the  disease. 
While  both  outbreaks  here  mentioned  have  been  comparativeh' 
mild  in  their  course,  McFadyean  remarks  that  it  is  worthy  of 
careful  observation  and  that  newly  purchased  rams  might  well 
be  examined  with  a  reference  to  this  affection  before  being  used 
for  breeding. 

G.  H.  Williams  (Vet.  Jour.  Vol.  XVII,  p.  64)  records  two  more 
outbreaks  of  this  disease.  In  his  first,  in  a  flock  of  eight  eweS 
and  one  ram,  two  ewes  and  the  ram  were  affected.  There  was 
balanitis  and  ulceration  of  the  penis.  He  used  chinosol  and  zinc 
sulphate,  in  solution,  to  the  parts  and  they  recovered  in  about 
two  weeks.  In  his  second  outbreak,  three  rams  and  forty  ewes, 
in  a  flock  of  fifty,  showed  the  same  symptoms  as  described  by 
Flock  and  M'Fadyean.  In  one  ewe,  eruptions  occurred  upon 
the  nostril.  In  some  of  his  cases,  the  vulva  was  greatly  swol- 
len and  distorted  and,  in  others,  there  were  exten.sive  granu- 
lations of  a  dark  color,  which  protruded  out  through  the  vulva. 
The  graulations  and  ulcers  were  penciled  with  silver  nitrate 
and  the  entire  parts  were  washed  with  a  solution  of  zinc  sulphate 
and  chinosol. 


no  I ^eterin ary  Obstetrics 

In  another  flock  of  ewes,  which  had  not  associated  with  this 
one,  except  that  one  of  the  rams  had  been  with  them,  it  was 
found  that  some  twelve  of  them  had  eruptions  about  the  lips  and 
and  noses,  but  no  genital  affection  was  present.  A  second  ram,  in 
this  lot,  escaped  the  disease,  so  far  as  seen.  In  the  larger  flock 
of  ewes,  the  rams  were  isolated  and  the  affected  ewes  removed 
immediately  from  the  herd.  Daily  inspection  was  made  of  the 
apparently  well  ewes,  and  any  which  developed  the  symptoms  of 
the  disease  were  promptly  separated.  A  few  weeks  later  breed- 
ing was  resumed  without  recurrence  of  the  di.sease,  and,  in  due 
time,  the  ewes  dropped  healthy  lambs. 

INFECTIOUS  VENEREAL  DISEASE  OF  RABBITS 

Friedberger  and  Frohner  (Spezielle  Pathologic  und  Therapie, 
1904,  page  501),  describe  an  infectious  disease  of  rabbits  which 
was  transmitted  chiefly,  or  wholly,  through  copulation.  The  af- 
fection appeared  in  an  extensive  breeding  establishment  of  rab- 
bits, and  consisted  of  an  inflammatory  disease  of  the  organs  of 
copulation.  It  was  transmitted  by  coition  from  buck  to  doe,  and 
vice  versa.  There  were  extensive  swellings  of  the  genital  or- 
gans in  both  sexes,  accompanied  by  a  muco-purulent  di.scharge. 
The  disease  was  finally  eradicated  by  injections  of  a  .solution  of 
sulphate  of  copper,  i  to  2  % ,  extending  over  a  period  of  some 
weeks. 

VENEREAL  DISEASES  OF  SWINE  AND  GOATS 

Hutyra  und  Marek  mention  the  occurrence  of  venereal  disease 
in  .swine,  and  Friedberger  und  Froehner  state  that  it  occurs  rarely 
in  swine  and  goats,  but  neither  of  these  authors  record  any  de- 
finite okservations  upon  either  malady. 


OTHER  INFECTIONS  OF   THE  GENITAL  ORGANS 
Bursattee  of  the  Penis  and  Prepuce. 

Genital  bursattee  presents  characters  suggesting,  to  the  inex- 
perienced, a  venereal  disorder,  and  constitutes  an  annoying  dis- 
ease in  breeding  stallions.  It  is  not  infrequent  in  those  countries 
where  this  malady  prevails  in  other  portions  of  the  body.  In  our 
experience,  bursattee  shows  a  distinct  tendency  to  attack  the 
penis  and  prepuce  of  breeding  stallions,  especially  of  heavy  draft 
animals.  The  infection  is,  persumably,  not  coital  but  is  trans- 
mitted by  other  means  :  accidental  wounds,  flies  or  other  carriers. 

The  usual  symptoms  of  penial  bursattee,  when  first  observed 
by  the  groom  or  owner,  is  the  presence  about  the  urethral  open- 
ing of  an  angry-looking  fungoid  growth,  which  bleeds  upon  the 
slightest  touch  and  is  generally  observed  to  bleed  immediately 
after  coition  ;  or,  during  erection,  blood  will  drip  from  the  tumor. 
Another  fungoid  mass  of  similar  appearance  exists  at  the  prepu- 
tial ring  upon  the  inferior  or  urethral  side  near  the  middle  of 
the  organ  when  erected  ;  that  point  where  the  urethral  opening 
rests  when  the  penis  is  fully  withdrawn  within  its  sheath.  When 
the  penis  is  at  rest,  therefore,  the  growths  about  the  urethral 
opening  and  on  the  preputial  ring  are  in  immediate  contact  ;  the 
preputial  growth  has  emanated  from  that  about  the  urethral 
opening,  as  a  consequence  of  contact. 

The  bursattic  growth  may  begin  at  other  points  or  may  ex- 
tend from  the  .seat  of  infection  to  neighboring  parts.  In  one 
instance,  we  ob.served  the  disease  beginning  upon  the  scrotimi. 

If  the  new  growth  is  closely  inspected,  it  is  usually  possible  to 
recognize  readily  with  the  naked  eye  the  small  yellow  concre- 
tions or  "  kunkurs "  characteristic  of  the  malady.  In  some 
cases,  the  penial  bur.sattee  is  accompanied  by  infections  upon  the 
feet  or  other  parts. 

So  far  as  we  have  observed,  the  di.sea.se  is  not  transmitted  to 
mares  through  copulation,  though,  clinically,  it  behaves  as  an 
infectious  malady  and  it  seems  not  impossible  that  danger  of 
transmission  to  the  mare  through  the  vagina  may  exist. 

The  micro-biology  of  the  disease  has  not  been  fully  deter- 
mined, some  attributing  it  to  nematode  worms,  others  to  the 
presence  of  a  fungus. 


112  Veterbiary   Obstetrics 

Like  biirsattee  of  other  parts,  it  is  active  in  temperate  coun- 
tries only  during  the  hot  season  and  undergoes  apparent  spon- 
taneous recovery  upon  the  advent  of  winter,  to  remain  dormant 
until  the  return  of  warm  weather.  It  thus  incidentally  assumes 
its  greatest  activity  during  the  breeding  season  and  interferes 
seriously  with  stud  duties.  Aside  from  the  remote  po.ssibility  of 
transmi.ssion,  it  is  very  noticeable, and  owners  of  mares  naturally 
do  not  care  to  breed  them  to  a  stallion  so  palpably  diseased. 
Furthermore,  the  sexual  excitement  incidental  to  breeding 
greatly  influences  the  disease  and  adds  to  its  virulence,  each 
erection  of  the  penis,  with  the  con.sequent  congestion  of  the 
organ,  causing  the  bur.sattee  growth  to  bleed. 

The  handling  of  the  disease  consists  of  the  destruction  or  re- 
moval of  all  infected  tissues  and  the  avoidance  of  venereal  excite- 
ment. If  undertaken  early,  the  disease  is  usually  confined  to 
the  urethral  tube,  filling  it  and  protruding  beyond  the  navicular 
fossa,  and  may  extend  up  higher  in  the  urethra.  Whatever  the 
extent,  the  diseased  tissues  are  to  be  excised  or  curetted  away 
and  the  parts  well  cauterized  with  silver  nitrate  or  the  thermo- 
cautery, after  which  the  wound  may  be  dressed  with  iodoform, 
which  apparently  exerts  a  very  beneficial  influence  upon  the 
course  of  the  disease,  should  any  remain. 

Before  operating,  it  is  well  to  apply  local  anaesthesia,  though 
the  sensitiveness  of  the  part  is  not  marked,  as  is  usually  the  case 
with  bursattic  growths.  Successful  handling  demands  the  with- 
drawal of  the  animal  from  the  stud  and  the  prevention  of  sex- 
ual excitement.  If  necessary,  erection  of  the  penis  should  be 
prevented  by  the  application  of  a  stallion  guard. 

At  the  preputial  ring,  at  that  point  where  the  opening  of  the 
urethral  tube  rests  when  the  penis  is  completely  withdrawn,  the 
secondary  bursattic  growth  is  more  amenable  to  management. 
Here  the  operator  can  freely  excise  the  diseased  tissue  without 
danger  of  unpleasant  deformity. 

After  excision  or  destruction  of  the  diseased  tissues,  the  parts 
should  be  kept  scrupulously  clean,  to  which  end  it  is  advisable  ta 
wash  the  penis,  prepuce  and  sheath  twice  daily,  with  soap  and 
water,  to  which  '4  (n  i '/(  of  carbolic  acid  may  be  advantageou.sly 
added.  After  cleansing,  the  parts  may  be  dressed  with  powdered 
iodoform,  or  iodoform  ointment.  Before  applying  the  iodoform^ 
any  suspicious  areas  may  be  cauterized  with  stick  nitrate  of  silver. 


Actinomycosis  of  Genital  Organs  113 

Actinomycosis  of  the  Genital  Organs. 

In  cattle,  actinom^'cosis  of  the  external  or  internal  genital  or- 
gans may  occur  in  such  a  manner  as  to  suggest  venereal  infec- 
tion or,  by  their  presence,  may  interfere  with  coition  or  fecund- 
tion. 

In  a  Gallowa}-  bull,  we  observed  an  actinomycotic  tumor  weigh- 
ing about  two  pounds,  which  was  located  in  the  elongated  naked 
prepuce  and  prevented  the  protrusion  of  the  penis.  There  were 
also  similar  actinomycotic  new-growths  present  in  the  inguinal 
lymphatic  glands.  In  another  case,  to  which  we  shall  again  have 
occasion  to  refer  when  considering  sterility,  actinomycotic  ab- 
cesses  occurred  in  the  broad  ligament  of  the  uterus,  without  ac- 
tinomycotic lesions  in  other  organs.  This  would  suggest  that 
the  infection  had  been  introduced  into  the  vagina  during  coition. 


MENSTRUATION 

In  all  domestic  mainmals,  there  occurs  in  those  females  of 
breeding  age,  at  the  time  of  estrum,  an  excitation  of  the  genital 
tract  with  increased  activity  of  the  mucous  glands,  especially  of 
the  vagina  and  vulva,  which  leads  to  a  more  or  less  pronounced 
discharge  of  mucus. 

In  addition  to  this  increased  production  of  mucus,  there  occurs 
in  some  animals,  during  or  immediately  subsequent  to  estrum, 
an  evident  discharge  of  blood  from  the  vulva,  which,  mixed  with 
mucus  and  epithelial  debris,  is  known  as  the  menstrual  fluid  ; 
the  process,  as  menstruation.  The  phenomenon  is  not  so  con- 
spicuous in  any  of  our  domestic  animals  as  is  ordinarily  observed 
in  woman,  and,  for  the  most  part,  usually  pa.sses  unobserved, 
if  present.  It  is  quite  commonly  noted  in  the  cow  and  bitch.  It 
has  been  recorded  in  the  mare  by  Fleming  (Veterinary  Obstet- 
rics) and  Kaiser  (Magazine,  1859).  Many  regard  estrum  and 
menstruation  as  synonymous.  While  they  are  intimately  re- 
lated, we  prefer  to  regard  them  as  two  .separate  phenomena,  as 
observed  among  domestic  animals. 

While  estrum  is  common  to  all  mammalian  animals  of  breed- 
ing age  at  the  breeding  period,  menstruation,  or  a  muco-sanguiu- 
ous  vaginal  discharge,  is  not  observable  in  most  species  at  all, 
and,  in  the  cow,  where  it  is  most  conspicuous,  it  ordinarily  does 
not  occur  during,  but  siibseqiumt  to,  her  very  brief  e.strual  period. 
In  the  bitch,  the  relation  is  not  so  well  determined,  the  e.strual 
and  menstrual  phenomena  being  of  greater  duration  and  over- 
lapping or  occurring  simultaneously.  In  the  cow,  there  is  very 
frequently  noted  at  or  near  the  close  of  the  period  of  sexual  de- 
sire a  well  marked  discharge  of  blood  from  the  vulva.  The 
amount  varies  greatly,  usually  being  limited  to  a  sufl&cient  quan- 
tity to  plainly  stain  the  tail  and  surrrounding  parts  so  that  they 
are  distinctly  bloody,  but  sometimes  there  is  a  large  amount  of 
blood  of  a  bright  red  color, mixed  with  raucus,seen  hanging  from 
the  inferior  vulvar  commissure.  In  a  few  cases  we  have  observed 
quite  a  voluminous  discharge  of  blood,  amounting  at  times  to 
several  ounces  and  accompanied  by  some  con.stitutional  disturb- 
ance, consisting  chiefly  of  decreased  appetite  and  a  loss  of  milk. 
This  sanious  discharge  in  the  cow  continues  usually  for  only  a 
114 


Fertilizatio7i  1 1 5 

very  brief  period  of  five  to  twelve  hours.  During  this  interval 
the  cow  may  copulate  but  estrum  is  not  well  marked.  In  the 
bitch  the  discharge  appears  during  estrum  and  continues  for  some 
days  without  usually  being  very  profuse. 

Fertilization. 

Fertilization  is  the  successful  union  of  the  male  generative  cell 
or  spermatozoon  with  the  female  egg  or  ovum,  by  which  the  re- 
sulting cell  acquires  the  power  of  .segmentation  and  is  enabled  to 
develop  into  an  embryo. 

According  to  Marshall  and  other  embryologists,  fertilization 
in  the  rabbit  occurs  in  from  eight  to  twelve  hours  after  copula- 
tion. This  interval  is  not  due  to  the  time  required  for  the  mi- 
gration of  the  spermatozoa  from  the  posterior  portion  of  the 
genital  canal  to  and  through  the  oviduct,  but  to  the  fact  that  the 
ova  are  not  discharged  from  the  ovary  until  eight  to  twelve  hours 
after  copulation.  In  the  rabbit,  the  spermatozoa  are  found  to 
travel  the  length  of  the  uterus  and  oviducts  in  from  fifteen 
minutes  to  two  hours  and,  in  the  ordinary  course  of  events,  are 
already  in  the  pavillion  of  the  tube,  awaiting  the  discharge  of 
the  ova.  The  doe  rabbit  copulates  with  the  buck  immediately 
after  giving  birth  to  young,  the  interval  between  estrual  periods 
being  the  same  as  the  duration  of  pregnancy. 

We  are  not  aware  that  any  exact  observations  have  been  made 
in  our  larger  domestic  animals  demonstrating  the  length  of  time 
elapsing  between  copulation  and  fertilization.  In  .spaying  cows, 
we  have  regularly  ob.served  that  one  which  is  in  estrum  has  ripe 
ovisacs,  which  generally  rupture  the  moment  the  ovary  is 
grasped.  If  the  cow  has  been  in  estrum  on  the  previous  day, 
we  have  found  the  Graafian  follicle  freshly  ruptured.  This 
would  indicate  to  us  that  in  the  cow,  as  in  the  rabbit,  ovulation 
occurs  late  in  the  estrual  period  or  just  at  its  close  so  that,  under 
normal  conditions,  copulation  would  precede  ovulation  and  hence 
that,  in  the  cow,  as  in  the  rabbit,  ovulation  and  fertilization 
occur  some  hours  after  the  act  of  coition.  In  the  rabbit,  fertili- 
zation usually  takes  place  immediately  after  the  eggs  enter  the 
oviduct,  which  is  probably  the  general  rule  in  mammalia. 

If  eggs  be  taken  from  the  upper  portion  of  the  oviduct,  sperm- 
atozoa will  usually  be   found   imbedded   in  the  zona  radiata   or 


ii6  Veterhiary  Obstetrics 

lying  in  the  space  between  the  vitelline  membrane  and  the  egg. 
The  exact  process  of  fertilization  has  not  been  fully  determined 
in  our  higher  animals.  It  is  generally  held  that  a  single  sperma- 
tozoon fuses  with  the  female  pronucleus. 

The  Relation  between  Estrum,  Ovulation,  Fertilization 
and  Menstruation. 

The  relationship  existing  between  the  phenomena  of  estrum, 
ovulation,  fertilization  and  menstruation  has  not  been  clearly 
determined.  Owing  to  the  very  brief  duration  of  estrum  in  the 
cow,  she  offers  a  specially  favorable  opportunity  for  study.  As 
already  related  in  our  personal  experience  in  the  spaying  of 
cows,  it  has  been  found  that  estrum  is  the  first  of  these  phenom- 
ena to  present  itself  and  that,  if  the  ovaries  be  examined  dur- 
ing the  estrual  period,  it  is  found  that  there  is  an  enlarged, 
mature  Graafian  follicle  ready  to  rupture  and  that  the  walls  give 
way  under  ordinary  manipulation  allowing  the  follicular  con- 
tents to  escape. 

If  the  ovaries  be  examined  during  menstruation,  it  is  found 
that  the  ovisac  has  ruptured  and  its  contents  have  escaped.  It 
seems,  therefore,  that,  in  the  cow  at  least,  the  chronologic  order 
of  these  phenomena  is  estrum,  ovulation  and  menstruation,  pro- 
vided that  this  cycle  is  not  interrupted  by  copulation  and  ferti- 
lization, when  the  order  would  be  estrum,  copulation,  ovulation, 
fertilization.  If  successful  copulation  ensues  early  in  estrum, 
it  is  the  general  observation  that  menstruation  does  not  occur. 
Thus,  its  advent  would  seem  to  indicate  the  death  and  expulsion 
of  the  ovum  along  with  some  of  the  epithelium  of  the  uterus, 
accompanied  by  hemorrhage  in  a  manner  to  correspond  in  a  way 
to  the  lochial  discharge  of  parturition. 

It  would  appear  that,  in  our  higher  animals,  the  phenomenon 
of  menstruation  is  analogous  in  a  way  to  parturition  itself.  In 
animals  having  a  duration  of  pregnancy  greater  than  the  in- 
terval between  two  estrual  periods,  estrum  becomes  interrupted 
during  gestation,  except  in  rare  pathologic  cases.  The  follow- 
ing table  by  Simons  (Graduation  Thesis,  Library  of  New 
York  State  Veterinary  College,  1903)  shows  some  interesting 
observations  in  reference  to  the  relationship  existing  between 
this  group  of  phenomenona  and  brings  out  especially  the  influ- 
ence of  impregnation  upon  the  occurrence  of   estrum.     In   those 


Relatio7i  betweeti  Estriim,  Ovulatioji,  Fertilization,  etc.       iij 

animals  where  menstruation  occurred,  it  is  indicated  by  +,  while, 
in  those  in  which  no  sanious  discharge  could  be  recognized,  the 
fact  is  indicated  by  — . 


Relationship  between  Estrum,  Ovulation,  Fertil- 
ization AND  Menstruation. 


s 

^ 

2g 

d 

'o 

1 

-o 

1 

5f  a 

^• 

2 

0  s 

> 
'Ji 

1 

3  M 

I 

8.00  A. 

6-14 

M. 

6.00  P. 
6-14 

M. 

10 

- 

0 

" 

'■n 

M. 

5.00  P. 
6-16 

M. 

12 

— 

0 

III 

3.00  p. 

6-16 

M. 

5.30  A. 
6-17 

M. 

15 

— 

0 

IV, 

8.00  A. 
6-17 

M. 

4.00  P. 
6-18 

M. 

32 

+ 

July  8 

V 

6.00  A. 
6-17 

M. 

6.00  P. 
6-17 

M. 

12 

— 

0 

VI 

12.00  A. 
6-20 

M. 

9.00  A 
6-21 

M. 

21 

+ 

July  12 

VII 

5.00  P. 
6-20 

M. 

5.00  A. 
6-21 

M. 

12 

— 

0 

VIII 

3.00  P. 
6-23 

M. 

9.00  P. 
6-25 

M. 

6 

— 

0 

IX 

11.00  A. 
6-25 

M. 

9.00  P. 
6-25 

M. 

II 

— 

0 

X 

5.00  P. 
6-27 

M. 

9.00  P. 
6-28 

M. 

4 

+ 

August  8 

XI 

4.00  P 
6-29 

M. 

8.00  A. 
6-30 

M. 

16 

— 

0 

XII 

6.30  P. 

6  29 

M. 

5-3°  A. 

6-30 

M. 

II 

— 

0 

XIII 

5.00  A. 

7-2 

M. 

6.00  A. 
7-2 

M. 

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0 

XIV 

12.00  A. 

7-5 

M. 

7.00  P. 

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0 

XV 

5.30  A. 

7-8 

M. 

6.00  P. 

7-8 

M. 

13 

— 

0 

XVI 

4.00  P. 
7-12 

M. 

9.00  P. 
7-12 

M. 

5 

— 

0 

XVII 

5-30  p. 

7-24 

M. 

7.00  A. 
7-25 

M. 

13 

— 

0 

XVIII 

5.00  A. 
7-13 

M. 

— 

34 

-h 

7-25 

XIX 

8.00  A. 

7-6 

M. 

— 

40 

+ 

7-27 

XX 

10.00  A. 
7-12 

M. 

— 

23 

+ 

7-31 

ii8  Veterinary  Obstetrics 

"  In  cases  IV  and  V,  two  heifers  subject  to  the  same  condi- 
tions, the  second  was  bred  earl}-  during  estrum,  while  the  other 
was  allowed  to  go  until  menstruation  was  well  established,  then 
served  and,  as  a  result,  was  not  fecundated.  Nos.  VI  and  X 
were  handled  in  the  same  way  as  No.  IV  and  they  also  failed  of 
fecundation.  These  cases  were  taken  from  a  number  for  the 
reason  that  they  were  the  most  typical.  They  show  that  after 
service,  which,  in  the  succe.ssful  cases,  occurred  before  menstrua- 
tion, the  latter  did  not  take  place.  Instead,  the  animal  quickly 
returned  to  its  normal  condition  and  continued  as  before  estrum 
was  present.  Ca.ses  Nos.  IV,  VI  and  X,  at  the  end  of  21  days  or 
thereabouts,  were  again  in  estrum  with  the  same  regularity 
as  though  they  had  not  been  bred,  when  they  again  were  served, 
but  this  time  before  menstruation  began,  and  became  fecundated. 

Some  observations  were  also  made  upon  the  length  of  time  be- 
tween successive  periods  of  estrum.  This  occurs  quite  regularly 
in  cycles  of  from  20  to  25  days,  usually  about  21  days  being 
given,  though  this  is,  of  course,  subject  to  variation." 

A  careful  study  of  this  table  would  indicate  that,  in  the  breed- 
ing of  cows,  it  should  be  the  constant  aim  to  cause  copulation  to 
occur  somewhat  early  during  the  period  of  estrum.  Whether  it 
is  possible  for  it  to  occur  too  early  after  the  establishment  of 
estrum  is  not  very  clearly  determined,  but  it  would  seem  that, 
ordinarily,  it  .should  take  place  in  the  cow  within  twelve  hours 
from  the  beginning  of  the  period.  In  the  twenty  ca.ses  observed 
by  Simons,  the  longest  duration  of  estrum  prior  to  successful 
copulation  was  sixteen  hours  in  case  XI. 

In  abnormal  or  pathologic  conditions  of  the  genital  organs, 
the.se  relations  become  somewhat  varied  and  unreliable.  In  a 
typical  instance  related  by  Simons  of  a  nymphomaniac  cow 
which  was  in  estrum  each  eight  to  twelve  days,  repeated  service 
was  ineffective.  The  removal  of  the  ovaries  showed  them  to  be 
about  double  the  normal  size  and  cystic.  This  cystic  condition 
prevented  alike  ovulation  and  impregnation.  Other  conditions 
serve  to  interrupt  the  normal  order  and  lead  to  variations  in  the 
cycle  of  estrum  and  menstruation. 

The.se  observations,  although  brief  and  fragmentary,  suggest 
that  successful  impregnation  prevents  the  occurrence  of  menstru- 
ation and  that,  con.sequently,  its  presence,  in  a  cow  after  breed- 
ing, may  be  accepted  as  important  evidence  that  fertilization  has 
not  taken  place. 


STERILITY 

Standing  at  the  threshold  of  success  in  livestock  breeding,  is 
the  question  of  the  capability  of  the  animal,  set  aside  chiefly  or 
wholly  for  the  purpose,  to  reproduce  living  young.  Without 
this  capacity,  pedigree  and  individual  excellence  count  for  noth- 
ing. From  a  practical  standpoint,  it  matters  little  to  us  whether 
the  failure  to  reproduce  its  kind  depends  upon  a  want  of  impreg- 
nation, a  failure  of  union  between  the  ovum  and  spermatozoon 
or  if  it  be  due  to  the  death  of  the  embryo  or  fetus  while  yet  in 
the  uterus,  or  even  to  its  premature  expulsion  from  the  uterus 
in  such  a  defective  state  of  health  or  development  that  it  cannot 
continue  to  live  ;  each  results  in  a  defeat  of  the  aim  of  the  breeder 
and  practically  constitutes  sterility. 

We  shall  here  limit  our  consideration  to  the  failure  of  the  ovum 
to  become  fertilized  by  a  spermatozoon.  The  question  of  the 
life  of  the  embryo  and  fetus  and  the  birth  of  the  latter  in  a  state 
which  will  favor  its  development  into  a  mature  animal,  we  shall 
consider  under  the  head  of  abortion  and  related  subjects. 

Great  variations  are  noted  in  reference  to  the  prevalence  of 
sterility  in  our  domestic  animals,  it  being,  apparently,  more  com- 
mon in  the  larger  species.  There  is  a  somewhat  general  belief 
also  that  it  is  more  common  in  high  bred  individuals  but  this  may 
be  largely  erroneous. 

It  certainly  increases  in  all  animals  as  domestication  and  clo.se 
confinement  increases,  so  that  it  is  most  common  in  those  animals 
which  are  kept  closely  housed  and,  in  this  way,  it  becomes  highly 
important  in  so  intensely  used  as  dairy  cows. 

With  many  of  our  domestic  animals,  sterility  does  not  attract 
much  attention,  especially  with  females,  because  it  makes  com- 
paratively little  difference  to  the  owner  whether  they  breed,  or 
go  to  the  butcher.  We  are,  therefore,  most  interested  in  steril- 
ity when  it  appears  among  animals  in  which  their  principal  or 
sole  value  depends  upon  their  reproductive  powers.  Among 
these,  failure  to  breed  may  prove  a  great  financial  disaster.  If 
a  large  harem  of  valuable  brood  mares,  kept  exclusively  for  breed- 
ing, is  mated  for  a  year  with  a  sterile  stallion,  no  foals  are  pro- 
duced the  following  season  and  a  total  loss  of  anticipated  income 
results.  In  addition  to  this  loss,  each  mare  has  deteriorated 
119 


I20  Veterinary  Obstetrics 

through  her  increase  in  age  and,  having  been  idle  for  a  year,  has, 
probably,  become  very  fat,  the  sexual  system  somewhat  weak- 
ened and  the  tendency  to  sterility  intensified. 

Jn  dairy  cows,  the  results  of  sterility  may  be  equally,  or  more, 
disastrous.  The  production  of  milk  is  an  essentially  .sexual  func- 
tion, enduring,  as  a  rule,  but  for  a  year  or  two,  when  it  may  be 
re-established  or  reinvigorated  only  by  bringing  forth  young. 
Hence,  in  a  dairying  establishment,  a  failure  to  breed  causes  not 
only  the  loss  of  the  value  of  the  young,  but,  generally  of  far  more 
importance,  a  .serious  diminution  in  the  amount,  or  total  loss  of 
the  milk.  The  sterility  of  a  large  part  of,  or  an  entire  herd,  is  a  not 
uncommon  ob.servation  in  the  experience  of  breeders  and  veter- 
inarians, and,  while  such  instances  are  very  impressive,  they  do 
not  equal  in  the  aggregate,  the  widely  di.sseminated  and  oft  re- 
peated individual  cases. 

If  a  highly  valuable  dairy  cow  fails  to  produce  a  calf  in  a  given 
year,  the  fact  is  somewhat  masked  by  the  success  with  other 
portions  of  the  herd,  but  the  lo.ss  occurs  and,  add  these  individ- 
ual instances  together,  the  total  cost  to  breeders  becomes  enor- 
mous. If  a  given  cow  fails  to  breed  for  .several  years  in  succes- 
sion, she  becomes  far  more  than  a  total  lo.ss,  becau.se  the  owner 
retains  her,  year  after  year,  in  the  hope  that  she  may  yet  breed 
before  he  .sends  her  to  the  butcher,  where,  at  best,  her  value  is 
usually  trivial. 

The  function  of  reproduction  being  exceedingly  complex,  the 
causes  leading  to  sterility  are  correspondingly  varied. 

In  higher  animals,  reproduction  can  only  occur  as  a  result  of 
union  under  favorable  conditions  of  a  spermatozoon,  or  male  cell, 
with  an  ovum,  or  female  pronucleus  ;  the  first  elaborated  by  the 
testicles  of  the  male,  the  second  by  the  ovaries  of  the  female. 
Anything  which  may  interrupt  normal  coition  of  the  two  sexes, 
or  the  physiologic  activity  of  either  male  or  female,  may  end  in 
sterility. 

We  consequently  meet  wath  sterility  in  both  sexes  but,  in  the 
female,  the  genital  apparatus  is  more  complex  and  sterility  more 
common  and  widely  diffused  though  intrinsically  of  no  greater 
importance  than  in  the  male.  The  function  of  the  male  parent 
ends  with  the  ejaculation  of  healthy  .semen  into  the  uterus  or 
vagina  of  the  female.  In  the  female,  there  is  still  to  occur  the 
migration  of  the  male  cells  through  the  uterus  and  oviducts  until 


sterility  of  the  Male  Animal  121 

they  meet  the  ovum  and,  after  the  fusion  of  these  two  cells  to 
constitute  fertilization,  the  female  organs  must  protect, and  afford 
nutrition  to,  the  embryo  for  a  long  period  of  time. 

While  there  are  certain  analogies  between  the  causes  and  nature 
of  sterility  in  the  two  sexes,  it  is  desirable  to  consider  them  sep- 
arately. 

A.  Sterility  of  the  Male  Animal. 

In  order  that  a  male  animal  shall  be  fertile,  it  is  essential  that 
living,  virile  spermatozoa  shall  be  secreted  and  that  the  animal 
be  competent  to  copulate  with  the  female  and  give  effective  emis- 
sion to  the  normal  semen. 

The  testicles  constitute  the  basis  of  the  male  genital  system, 
since  they  produce  the  male  cell  or  spermatozoon.  In  mammalia, 
the  testicles  are  two  in  number,  a  right  and  a  left,  variably 
located  according  to  species.  In  all  our  common  domestic  ani- 
mals they  are  normally  located  in  adult  life  outside  the  abdomen 
in  the  scrotum,  which  is  situated,  according  to  species,  in  the  in- 
guinal or  perineal  region,  the  testicles  passing  through  the 
inguinal  ring  in  order  to  reach  the  scrotal  sac.  In  the  elephant, 
the  testes  are  normally  retained  within  the  abdomen  throughout 
life. 

The  testes  vary  somewhat  in  form  and,  necessarilj-,  in  size  in 
the  different  species  and  present  some  marked  differences  in  their 
relations.  Their  general  form  is  oblong  or  spheroidal  and,  when 
they  come  to  rest  in  the  scrotum,  their  long  axes  may  be  perpen- 
dicular to  the  spinal  axis,  as  in  the  bull,  or  parallel,  as  in  the 
horse. 

In  addition  to  its  peritoneal  coverings,  the  testicle  consists  of 
its  fibrous  framework,  the  proper  or  secretory  tissue,  excretory 
ducts,  and  the  vessels  and  nerves. 

The  fibrous  framework  forms  externally  a  very  firm,  inelastic 
capsule,  the  tunica  albuginea.  This  serves  to  render  the  func- 
tioning testicle  one  of  the  most  dense,  incompressible  glands  in 
the  body,  the  very  firmness  of  which  bears  an  important  relation 
to  fertility,  since  any  di.sease  causing  swelling  of  the  gland 
tends  to  seriously  affect  the  proper  glandular  tissue  by  the  severe 
compression. 

From  the  tunica  albuginea,  fibrous  septa  pass  toward  the  center 
of  the  gland  and  divide  the  secretory  tissue  into  small  lobules. 


122  Ve/ermary  Obstetrics 

Somewhat  near  the  surface,  toward  the  epididymis,  the  connect- 
ive tissue  stroma  becomes  very  prominent  in  the  central  portion 
of  the  gland  to  constitute  the  corpus  Highmori. 

The  glandular  tissue  proper  consists  of  numerous  convoluted 
tubules,  tubiili  semcni/eri,  which,  commencing  in  a  cul  de  sac,, 
terminate  in  a  central  system  of  canals.  These,  passing  through 
the  corpus  Highmori  empty  into  the  vasa  elferentia,  which  fin- 
ally converge  to  form  the  vas  deferens. 

The  tubules  consist  of  a  ba.sement  membrane  lined  with  an 
epithelium  of  three  or  four  layers  of  cells.  The  deeper  ones  are 
polygonal  in  form  while,  more  superficially,  occur  the  spermatic 
cells  or  spermatoblasts,  from  which,  finally,  the  spermatozoa  are 
elaborated,  the  nucleus  constituting  the  head,  while  the  tail  con- 
sists of  protoplasm. 

The  interlobular  connective  tissue  stroma  affords  pa.s.sage  for 
the  ves.sels  and  nerves  to  every  portion  of  the  gland  and,  within 
it,  are  numerous  interlobular  cells,  which  are  believed  by  some  to 
serve  as  nutritive  agents  for  the  tubidi  seme^iiferi. 

The  seminal  canalculi  are  lined  with  ciliated  epithelium,  which 
disappears  in  t^ie  seminal  duct,  to  be  succeeded  by  a  single  layer 
of  epithelial  cells. 

The  vesiculse  seminales  of  the  stallion  consist  of  two  commo- 
dious pouches  situated  above  the  urinary  bladder  and  the  vasa 
efferentia,  communicating  with  the  latter.  They  have  been 
thought  by  some  to  act  as  .seminal  reservoirs.  Hence  their 
name.  However,  it  is  generally  considered  that  such  is  not  the 
case  and  that  their  sole  function  is  the  elaboration  of  a  mucoid 
or  watery  secretion,  which  becomes  mixed  with  the  .semen  while 
being  ejaculated.  Fleming  (Chauveau's  Anatomy)  as.serts  that 
they  serve  as  .seminal  rcsevoirs,  but  investigators,  apparently,  uni- 
formly fail  to  find  spermatozoa  in  them. 

The  .seminal  vesicles  of  the  bull  have  the  character  of  ordinary 
acinous  glands.  Zschokke  has  been  unable  to  find  spermatozoa 
in  them.     They  have  only  a  very  small  cavity. 

In  the  boar,  the  vcsiculse  seminales  are  very  large  acinous 
glands,  .secreting  a  watery  fluid  and  not  containing  spermatozoa. 
The  vesiculse  seminales  are  absent  in  the  dog  and  cat. 

The  prostate  glands  of  the  horse  are  situated  above  the  ure- 
thra, at  the  neck  of  the  bladder.  They  are  acinous  in  type,  and 
secrete  a    transparent    viscid    fluid,  which    becomes    mixed  with 


Sterility  of  the  Male  Animal  123 

the  secretions  of  the  other  glands.  In  the  pig,  there  are  two  pros- 
tates, while,  in  the  dog  and  cat,  there  is  one  large  gland  com- 
pletely surrounding  the  urethra. 

Cowper's  glands  are  also  acinous  in  character.  Chauveau  states 
they  are  absent  in  ruminants,  but  Zschokke  claims  they  are  pres- 
ent.    They  are  absent  in  the  dog,  but  present  in  the  cat. 

The  phy.sical  characters  of  the  secretions  from  the  seminal  ves- 
icles, prostate  and  Cowper's  glands  varies  somewhat,  is  chiefly 
of  a  clear,  watery  character,  that  from  the  Cowper's  glands  being 
somewhat  more  viscid.     They  are  neutral  in  reaction. 

The  function  of  the  .secretions  from  these  subsidiary  glands 
has  not  been  very  accurately  determined,  but  they  apparently 
serve  a  useful  purpose  as  lubricants  and,  still  more,  they  dilute 
the  secretions  from  the  testicles,  adding  volume  to  the  semen  and 
giving  a  wider  dissemination  to  the  spermatozoa.  Furthermore, 
it  is  believed  that  their  presence  invigorates  the  spermatozoa. 

The  .semen,  at  the  time  of  ejaculation,  consists  of  an  admixture 
of  the  secretions  from  these  acces.sory  glands,  with  the  spermato- 
zoa and  accompanying  fluids  from  the  testicles.  It  is  a  whitish, 
viscid  fluid  of  feeble  alkaline  reaction,  and  has  a  specific  odor. 

The  spermatozoa  in  this  fluid  show  very  vigorous  motion,  in- 
duced by  the  contractions  of  the  tail,  which  cause  a  progressive 
movement  comparable  to  that  of  a  fish  or  an  eel.  Hensen  states 
that  they  may  move  1.2  to  3.6  mm.  per  minute.  Their  vigor  is 
greatest  at  about  the  body  temperature  and  is  decreased  or  stop- 
ped by  heat  or  cold  or  by  the  addition  of  water,  acids,  metallic 
salts,  etc.,  while  the  vigor  of  the  movements  is  increa.sed  by  the 
addition  of  weak  alkalies,  blood  serum  and  estrual  di.scharges. 

The  commencement  of  the  secretion  of  spermatozoa  marks  the 
age  oi  puberty  in  the  male  and  is  expressed  by  the  appearance  of 
sexual  desire.  Its  advent  varies  greatly  according  to  species,  in 
the  horse  from  10  to  18  months,  in  the  bull  from  8  to  10  months 
and  in  most  other  species,  at  an  earlier  date. 

The  amount  of  semen  ejaculated  during  a  single  coition  has 
not  been  well  determined.  In  the  bull,  it  is  5-6  c  m.'  (Zschokke) 
and  contains  more  than  60,000  spermatozoa  per  mm.' 

In  order  that  successful  copulation  may  occur,  it  is  essential 
that  the  testicles,  excretory  ducts,  urethra,  penis  and  acce.s.sory 
glands  be  normal  in  structure  and  function,  and  that  the  locomo- 
tory  apparatus  be  sufficiently  normal  to  enable  the  male  to  mount 


I  24  Veterinary  Obstetrics 

the  female,  and  otherwise  to   perform  the   physiologic  essentials 
of  copulation. 

Sterility  of  the  male  may  be  outlined  as  follows  : 

I.  Azoospekmip:. 

a.    Congenital  Defects  of  Testes. 

1.  Anorchidy. 

2.  Congenital  Malformations  and  Tumors. 

3.  Cryptorchidy. 

4.  Hybrids. 

5.  Hermaphrodites. 

b.   Acquired  Diseases  of  the  Testes  and  Scrotum. 

1.  Tumors. 

2.  Orchitis  and  Epididymitis. 

3.  Spontaneous  Degeneration  of  Testicles. 

4.  Hydrocele. 

5.  Torsion  of  tlie  Testicles. 

c.   Azoospermie  from  Systemic  Disease  or  Debility. 

1.  Debilitating  Systemic  Diseases,  Overwork. 

2.  Idleness  and  Overfeeding. 

3.  Excessive  Sexual  Use. 

4.  Onanism  or  Masturbation. 

II.  Defective  Secretions  of  Accessory  Gl.\nds. 

III.  Inability  to  Properly  Copulate. 

1.  Arrested  Development  of  the  Peuis. 

2.  Tumors,  hernise,  etc.,  near  the  penis,  which  serve  to  mis- 
direct it  and  prevent  its  entering  the  vulva. 

3.  Tumors  of  the  Penis  and  Prepuce. 

4.  Penial  Paralysis. 

5.  Exces.sive  Erection.     Spasm  of  Penis. 

6.  Broken  or  Curved  Penis. 

7.  Inflammation  of  Penis. 

8.  Adhesions  of  the  Penis  to  the  Prepuce. 

9.  Constriction  of  the  Preputial  Opening.      Phymosis. 
10.    Paraph ymosis. 

J  I.   Lumbar  or  General  Paralysis. 

12.  Painful  Diseases  of  the  Posterior  Limbs  and  other  Parts. 

13.  Size  of  Male. 

14.  Age  of  Male. 

IV.  Infectious  Diseases. 


A  zoo  sperm  ie  125 

I.    AZOOSPERMIE. 

In  the  rearing  and  selection  of  male  breeding  animals,  it  be- 
comes of  importance  to  determine  at  the  earliest  possible  date 
whether  they  may  prove  efficient  sires  or  not  and  it  is  essential, 
first,  to  know  whether  they  possess  normal  testicles  capable  of 
producing  vigorous  spermatozoa. 

Although  these  organs,  derived  from  the  Wolffian  bodies,  are 
formed  in  the  sublumbar  region,  they  normally  descend  into  the 
scrotum  in  all  our  domestic  animals  except  the  elephant  and  are, 
consequently,  with  the  one  exception,  quite  freely  available  for 
physical  examination. 

In  our  large  herbivorous  animals,  these  organs  normally  de- 
scend into  the  scrotum  prior  to  birth,  so  that,  when  one  of  these 
is  born  without  this  having  occurred,  that  fact  may  well  become 
an  object  for  suspicion. 

1.  Anorchidy.  In  some  cases  these  organs  are  entirely  want- 
ing or  have  been  arrested  in  their  development  so  that  they  are 
wholly  insignificant  and  devoid  of  physiologic  power.  Such  ani- 
mals fail  to  develop  sexual  desire  in  the  least,  do  not  acquire  the 
usual  characters  of  the  male  in  conformation,  head,  neck,  horns, 
voice,  or  other  attributes,  but  remain  neuter  or  asexual  in  char- 
acter save  in  respect  to  the  penis  and  sheath  and  even  these  may 
be  defective.  No  testicles  are  pre.sent  in  the  scrotum  and  none 
are  distinguishable  by  rectal  exploration.  On  post-mortem  ex- 
amination, one  may  find  within  the  abdomen  a  ma.ss  of  tissue 
which,  by  its  attachments  and  relations,  is  identifiable  as  the  rep- 
resentative of  the  testicle,  but  devoid  of  any  tissue  of  a  true  geni- 
tal character.  Such  are  the  findings  in  some  twin  calves,  as 
well  as  in  some  single  births,  and  the  same  conditions  are  met, 
far  more  rarely,  among  other  animals. 

2.  Congenital  Tumors.  In  other  cases,  instead  of  the  normal 
glandular  tissue,  the  male  animal  is  born  with  a  tumor  represent- 
ing the  genital  gland,  which  may  be  either  teratologic  or  patho- 
logic. Among  the  teratologic,  the  most  common  are  dermoid 
cysts,  containing  hair,  teeth  and  epithelial  debris,  along  with 
more  or  less  fluid. 

A  possible  mode  of  origin  of  these  structures  has  already  been 
discussed  on  page  12. 

In  other  animals,  the  primitive  gland   may  become  the  .seat  of 


126  Veterinary  Obstetrics 

calcareous  deposits,  which  invade  the  entire  primitive  gland  and 
efface  every  trace  of  glandular  tissue,  inducing  a  state  equivalent 
to  anorchidy.  In  >et  other  instances  the  primitive  testicle  be- 
comes the  seat  of  a  malignant  neoplasm.  In  one  case,  we  ob- 
served in  a  cryptorchid  pig  a  testicle  which  was  the  seat  of  a  ma- 
lignant new-growth  which  had  contracted  firm  adhesions  with 
adjacent  loops  of  intestine.  Each  of  these  conditions  serves  or- 
dinarily to  prevent  the  descent  of  the  testicle  into  the  scrotum. 
The  affected  organs  are  necessarily  and  incurably  sterile.  Ex- 
cept in  cases  of  malignant  disease  of  the  glands,  castration  is  not 
ordinarilv  demanded. 


Fig.   13.     Dermoid  Cyst  ok  Testicle 
Showing  dental  tissues.     Horse.  (Hinebauch.) 

3.  Cryptorchidy  also  con.stitutes  a  uniform  cause  of  sterility 
when  both  testicles  are  retained  within  the  abdominal  cavity. 
We  .speak  of  abdominal  and  inguinal  cryptorchidy  but,  ordi- 
narily, only  the  former  may  exist  as  a  permanent  condition,  while 
the  latter  is  a  transitory  state,  in  which  the  gland  is  descending 
from  the  abdomen  into  the  .scrotum,  which  it  will  eventually 
reach.  It  is  only  very  rarely  that  inflammatory  adhesions  or 
other  conditions  may  permanently  arrest  a  testicle  in  the  inguinal 
region  during  its  descent. 

Typically,  cryptorchidy  is  an  arre.st  in  the  development  of  the 
testicle,  the  organ  being  small,  flaccid  and  soft.  Histologically, 
it  partakes  of  the  character  of  the  fetal  testicle  and  no  .sperma- 


Hybrids.     Hermaphrodites  127 

tozoa  are  formed  by  it.  If  such  a  testicle  descends  and  passes 
from  the  abdomen  through  the  internal  inguinal  ring,  it  tends  to 
at  once  develop  normally  and  become  fertile.  However,  it  is 
essential  that  the  gland  itself  shall  descend.  In  some  cases,  the 
epididymis  descends  into  the  scrotum,  while  the  gland  remains 
in  the  abdomen,  the  testicle  retaining  its  typical  cryptorchid 
character  and  remaining  sterile.  While  the  typical  abdominal 
croptorchid  testicle  is  regularly  sterile,  it  nevertheless  induces  a 
sexual  reflex,  causing  the  development  of  the  ordinary  male  at- 
tributes, such  as  the  characteristic  head,  neck,  horns  and  voice 
and  usually  a  sexual  desire  of  an  intense  and  more  or  less  per- 
verted character,  in  which  vice  assumes  a  prominent  role.  If 
only  one  testicle  is  retained  in  the  abdomen,  the  other  being 
normally  located  and  developed  or  even  having  undergone  com- 
pensatorial  hypertrophy,  the  animal  may  be  fertile,  that  is,  the 
normally  developed  gland  is  capable  of  performing  its  function 
regardless  of  the  presence  of  the  sterile  gland  within  the  abdo- 
men. The  perverted  sexual  desire,  akin  to  nymphomania  of  the 
female,  persists  so  long  as  one  testicle  is  in  the  abdomen,  even 
though  one  has  descended  into  the  scrotum,  and  functions.  The 
defect  is  of  further  interest  to  the  breeder  becau.se  of  it.--  perni- 
cious hereditary  transmi.ssion  from  parent  to  offspring.  The  con- 
dition is  beyond  practical  remedy.  While  it  is  surgically  possible 
to  procure  the  descent  of  the  testicle  into  the  scrotum  and  thereby 
cause  the  gland  to  so  develop  that  it  will  perform  its  normal 
function,  this  would  not  prevent  the  transmission  of  the  defect 
to  the  offspring. 

4.  Hybrids,  chiefly  the  mule,  are  regularl}-  sterile,  the  testi- 
cles partaking  of  the  fetal  type  histologically,  though  normal  in 
position,  form  and  volume.  In  this  animal,  the  sexual  de.sire  is 
well  developed.  In  rare  cases,  well  authenticated,  the  female  has 
bred,  but  we  do  not  recall  instances  of  recorded  fertility  in  the 
male,  although  they  probably  occur.  The  opportunity  for  the 
demonstration  of  such  power  in  the  male  is  generally  excluded 
b}'  castration. 

5.  Hermaphrodites.  In  all  species  of  domestic  animals  we 
meet,  occasionally,  with  hermaphroditism  in  which  the  two  sys- 
tems of  sexual  organs  are  each  found  more  or  less  developed  in 
the  same  animal.  They  incline  to  assume  a  prevailing  type  ac- 
cording to  species. 


128  Veferhiary  Obstetrics 

In  the  horse,  hemaphroditism  tends,  generally,  towards  the  de- 
velopment of  testicles,  which  are  largely  retained  within  the  ab- 
domen and  attached  and  located  the  same  as  the  ovaries,  but 
may  descend  into  an  imperfect  scrotum  ;  the  vulva,  vagina 
and  uterus  may  develop  almost  perfectly,  as  in  one  case  occuring 
in  the  clinic  of  this  college  (Fig.  54),  where  the  vulva  and 
vagina  were  sufficiently  developed  that  the  animal  was  castrated 
through  the  vagina  in  the  same  manner  as  mares  are  spayed. 
The  rudimentary  penis,  or  enlarged  clitoris,  usually  ends  either 
in  the  vulva  or  in  the  vicinity  of  the  ischial  arch,  with  the  urethal 
opening  directed  backwards.  In  other  cases,  this  organ  is  pro- 
longed down  between  the  thighs,  but,  still,  as  a  rule,  is  directed 
backwards  at  its  extremity.  The  niammse  are  usually  moderately 
developed  in  the.se  animals  and,  upon  casual  examination,  have 
the  appearance  of  the  mare,  although,  as  in  one  ca.se  operated 
upon  by  us,  there  were,  just  above  the.se  rudimentary  glands,  small 
scrotal  pouches  containing  the  imperfectly  developed  testes. 

These  animals  present  chiefly  the  sexual  characters  of  the  crypt- 
orchid  horse  with  all  his  deranged  .sexual  desire  and  tendency- 
to  viciousness.  In  the  case  illustrated  by  Fig.  54,  the  head, 
neck,  voice  and  disposition  were  those  of  a  cryptochid  horse,  and 
the  vulva,  vagina  and  uterus  were  those  of  a  normal  mare.  When 
castrating  the  animal,  the  vagina  underwent  the  customary  bal- 
looning, which  indicated  functional  activity.  The  erectile  organ 
occupied  a  middle  place  between  the  clitoris  of  the  mare  and  the 
penis  of  the  horse. 

In  Fig.  14  is  shown  the  generative  apparatus  of  a  pig,  in  which 
the  hermaphroditism  is  of  quite  a  different  character,  one  of  the 
glands  having  developed  into  a  typical  ovary,  the  other  a  testi- 
cle, the  two  sides  of  the  genital  apparatus  thus  representing  the 
two  sexes. 

Sections  of  the.se  genital  glands  show  one  to  be  a  typical  crypt- 
orchid  testicle  with  tubuli  semeniferi,  the  other  a  primitive 
,  ovary  with  scattering  Graafian  follicles  containing  ova.  The 
Muellerian  ducts  have  developed  into  typical  oviducts,  uterus 
and  vagina,  and,  from  the  Wolffian  ducts,  have  formed  typical 
vasa  deferentia  and  the  penis  is  normal  in  form  and  extent. 

We  have  found  no  records  of  fertility  in  hermaphrodites  of  the 
equine  or  other  species. 


Acqiiired  Diseases  of  the  Genital  Organs  129 


Fig,  t4.     Hermaphroditism. 
Pig. 
T,  Testicle.  (),   Ovary. 

P,   Penis.  CC.  Uterine  Cornua. 


B.  Acquired  Di.sp:ases  of  the  Testicles  and  Scroti'm. 

I.  Tumors.  We  have  already  referred  on  page  125  to  con- 
genital tumors  of  the  testicles. 

Malignant  tumors  of  the  testicles  are  occasionally  seen  in  the 
stallion  and  other  adult  male  breeding  animals.  When  the  tes- 
9 


130  Veterinary  Obstetrics 

tide  is  in  its  normal  position,  such  a  new  growth  reveals  itself 
as  a  very  tense  swelling,  inclined  to  be  more  or  less  nodular,  not 
very  painful,  but  does  not  tend  to  cause  any  marked  swelling  of 
the  surrounding  parts.  The  affected  gland  becomes  sterile  as 
soon  as  the  glandular  tissue  is  generally  invaded  and,  probably, 
in  a  large  proportion  of  cases,  as  soon  as  any  increased  pressure 
is  exerted  upon   the  parenchyma  of   the  gland. 

When  tumors  of  any  kind  involve  the  testicle  to  a  marked  de- 
gree and  determine  its  loss  of  function,  it  should  be  promptly 
removed  for  general  curative  reasons  as  well  as  to  anticipate 
any  unfavorable  influence  which  it  may  exert  upon  the  other 
gland. 

The  prognosis  in  case  of  maglinant  tumor  of  the  testicle  is 
good  if  the  gland  be  removed  early,  becau.se  the  disease  tends  to 
be  confined  closeh'  to  the  gland  itself  for  a  considerable  period 
of  time.  The  fertility  of  the  normal  gland  may  thus  be  pre- 
served for  an  indefinite  period. 

2.  Orchitis  and  Epididymitis  are  not  readily  distinguishable 
clinically  as  distinct  affections.  So  far  as  we  are  aware,  they 
are  due  to  essentially  the  same  causes,  present  similar  symptoms 
and  have  like  dangers  for  the  fertility  of  the  animal.  Judging 
from  the  standpoint  of  post-castration  observations,  it  would  ap- 
pear that,  in  the  stallion  at  least,  epididymitis  is  more  common 
than  orchitis.      (See  Fig.  15). 

Inflammations  of  the  testicle  and  epididymis  arise  from  a  great 
variety  of  causes.  In  all  animals,  external  wounds  are  liable  to 
cau.se  inflammations  of  the  gland  especially  when  occurring  dur- 
ing the  active  breeding  season.  Scrotal  wounds,  e.specially  tho.se 
penetrating  the  peritoneal  sac  of  the  testicle  are  very  liable  to 
terminate  in    an  inflammation  of    the    glandular  tissue. 

Contu.sions  of  the  testicles  without  wounds  of  the  skin  are 
more  or  less  common  in  domestic  animals  and  may  at  all  times 
lead  to  orchitis.  In  ruminants,  and  especially  in  the  ram,  where 
the  scrotum  is  sometimes  large  and  very  pendulous,  the  testicles 
are  brui.sed  by  coming  in  contact  with  obtacles  or  by  being 
violently  struck  by  one  of  the  hind  limbs  and  thence  thrown 
against  the  other  during  rapid  proge.s.sion  In  the  stallion,  es- 
pecially in  trotters  used  for  track  purposes,  there  is  a  well 
marked  tendency  for  contusion  of  the  testicles  to  occur  by  being 
thrown  from  one  thigh  to  the  other  when  the  animal  is  going  at 


Orchitis  and  Epididymitis 


131 


a  rapid  pace.  When  the  horse  is  employed  at  this  work,  the 
testicles  become  more  pendulous  than  when  used  for  breeding. 
Contusions  of  the  testicles  of  the  stallion,  and  of  a  very  danger- 
ous character,  also  occur  occasionally  from  kicks  by  the  mare  at 
time  of  service. 

Orchitis  and  Epididymitis  occur,  in  some  cases,  independent  of 
any  history  of  traumatism,  as  an  apparently  idiopathic  malady. 
By  .some,  this  is  ascribed  to  exce.s.sive  venery,  or  coition.  We 
have  no  definite  data  to  show  that  it  so  occurs.     It  is  not  improb- 


FiG.  15.     Epididymitis.     Stallion. 
T,  Testicle.  E,  Epididymis. 


132  Veterinarv  Obstetrics 

able  that  such  untraced  cases  are  due  to  infection  of  some  char- 
acter passing  through  the  vas  deferens  into  the  testicle,  as  sug- 
gested by  Zschokke.  This  may  be  favored  by  excessive  coition 
or  by  an}'  debilitating  influences. 

In  other  cases,  the  disease  is  directly  traceable  to  an  infectious 
malady.  In  the  stallion,  we  meet,  not  infrequently,  with  stran- 
gles abccsses  in  the  testicle  or  about  it.  In  these,  the  ordinary 
symptoms  of  strangles  are  usually  present  in  other  portions  of 
the  body,  such  as  intermaxillary  abcesses,  with  the  other  general 
symptoms.  In  the  contagious  cellulitis,  or  pink  eye,  as  we  have 
already  stated  on  page  68,  orchitis  is  the  rule.  Orchitis  in  the 
stallion  has  been  recorded  also  as  result  of  glanders. 

In  the  bull,  orchitis  occurs  as  a  result  of  tuberculosis.  Zschokke 
(Unfruchtbarkeit  des  Rindes)  records  tuberculous  orchitis  as  the 
most  common  form  of  inflammation  of  the  testicle  in  the  bull,  and 
has  ob-served  it  both  uni-  and  bilateral.  It  a.ssumes  a  chronic 
course.  The  tubercular  nodules  are  generally  dis.seminated 
throughout  the  glandular  tissue  and  may  extend  to  the  tunica 
albugiuea  and  to  the  .serous  membrane.  The  tubercles  present 
their  usual  characters,  with  an  increased  amount  of  connective 
tissue  and  greater  density  of  the  organ.  If  the  nodules  are  super- 
ficial, there  are  adhesions  between  the  two  serous  coverings. 
Tubercular  deposits  may  also  exist  in  the  epididymis  and 
spermatic  cord. 

The  clinical  diagnosis  of  the  tuburcular  orchitis  must  chiefly 
rest  upon  the  enlargement  and  hardening  of  the  testicle,  its  adhe- 
sions, thickening  of  the  spermatic  cord  and  tumefaction  of  the 
inguinal  glands.  Other  symptoms  of  tuberculosis  are  usually  pre- 
sent and  the  diagnosis  may  be  verified  by  the  tuberculin  test. 

While  the  sound  areas  of  tuberculous  -testicles  may  generate 
normal  spermatozoa,  it  should  be  remembered  that  the  .semen 
emanating  from  such  a  testicle  will,  probably,  also  carry  tubercle 
bacilli,  and  thus  be  capable  of  directly  tran.smitting  the  di.sease 
from  the  bull  to  the  cow. 

Ehrhardt  (Schweizer-Archiv  fur  Tierheilkunde,  Vol.  38,  p. 
79)  records  a  case  of  orchitis  in  a  bull  due  to  the  vesicular  vene- 
real disease  of  cattle. 

Wallruff  ( Reperotorium,  1846,  p.  206)  records  an  epizootic  of 
inflammation  of  the  testicles  in  horses,  cattle  and  goats,  accom- 
panied by  the  formation  of  ab.scesses.      Others  record  inflamma- 


Orchitis  avd  Epididymitis  i  ;3 

tion   of   the  testicles  as  a  result  of    the    presence  of   nematode 
parasites. 

The  anatoni}^  of  the  testicle  is  of  such  a  character  as  to  render 
acute  inflammation  ver)'  serious  for  its  functional  life.  The 
tunica  albuginea  constitutes  the  most  dense  and  inextensible 
capsule  possessed  by  any  gland  in  the  body.  When  the  volume 
of  the  contents  of  the  capsule  is  augmented  by  engorgement  or 
inflammation,  the  pressure  exerted  upon  the  encapsulated  gland 
tissue  is  very  great  and  at  once  threatens  its  functional  activity 
or  life.  It  is,  consequently,  very  common  for  orchitis  to  per- 
manently destroy  the  integrity  of  the  gland.  Sometimes,  the 
inflammation  ends  in  a  total  necrosis  of  the  organ. 

From  whatever  cause  orchitis  may  arise,  it  should  ahvays  be 
treated  as  a  very  .serious  di.sea.se,  in  so  far  as  the  reproductive 
powers  of  the  animal  are  concerned,  and  should  be  handled  with 
the  greatest  po.ssible  promptness  and  care.  As  with  all  di.sea.ses  of 
the  sexual  organs,  it  is  especially  true  of  those  of  the  te.sticles 
that  the  fundamental  principle  in  their  handling  should  be  the 
removal,  as  far  as  possible,  of  all  .sexual  excitement.  The  animal 
maybe  exercised  aid,  po.ssibly,  benefited  thereby,  but  it  should 
be  done  in  a  manner  to  avoid  any  sexual  stimulation.  In  most 
stallions  the  application  of  the  .stud  bridle  is  in  itself  a  sexual 
suggestion  because  the  animal  constantly  associates  it  with 
service. 

So  far  as  possible,  a  breeding  male  affected  with  di.sease  of  the 
genital  organs  should  be  removed  from  sight  or  sound  of  any 
female  of  his  kind,  especially  from  those  which  are  in  estrum 
Every  arousal  of  sexual  appetite  intensifies  any  exi.sting  irrita- 
tion or  disease  in  the  sexual  organs  and  successful  handling  of 
these  accidents  and  diseases  demands,  first  of  all,  sexual  quietude. 

Wounds  to  the  scrotum  of  male  breeding  animals  should  have 
very  careful  surgical  attention.  Strict  antiseptic  precautions 
should  be  taken  from  the  ver}^  out.set  and  continued  until  all 
danger  to  the  glands  has  been  safely  pas.sed.  If  the  wound  is 
penetrant,  infection  of  the  peritoneal  sac  is  to  be  very  carefully 
avoided  by  thorough  disinfection  and  clo.sing  of  the  wound.  If 
there  is  a  want  of  good  drainage,  this  should  be  freely  provided 
and  no  accumulation  of  wound  discharges  be  permitted.  The 
food  should  be  of  a  light,  laxative  character. 


134  Veterina)-}'  Obstetrics 

Contusions  of  the  testicles  should  be  avoided  by  the  removal 
of  the  causes.  Rams  with  very  large  and  pendulous  scroti  should 
be  confined  in  enclosures  free  from  rough  elevations  and  from 
obstacles  against  which  the  testes  may  strike  when  the  animal  is 
moving  about  and  should  be  guarded  against  being  chased  by 
dogs  or  otherwise  compelled  to  run.  Injuries  from  contusions  of 
the  testicles  of  trotting  or  pacing  stallions  are  effectively  obviated 
by  the  use  of  a  stallion  suspensorium.  The  protection  of  the 
testicles  of  the  stallion  against  kicks  or  other  contusions  during 
.service  has  already  been  considered  on  page  51. 

Purgatives  should  usually  be  administered  in  cases  of  ai.ute 
orchitis  unless  contra-indicated  by  some  general  systemic  disease 
like  pink  eye.  Even  then,  it  would  probably  be  desirable  to 
prescribe  such  hypodermic  cathartics  as  arecoline  or  eserine, 
combined  with  pilocarpine,  which  will  act  quickly  without  cans 
ing  any  great  depression  or  inducing  super-purgation.  They 
should  be  given  in  small  do.ses  and  may  be  repeated,  if  necessary, 
in  one  hour.  In  such  animals  as  have  pendant  testicles,  it  is 
advi.sable  to  apply  a  suspensory  bandage,  which  favors  the  circu- 
lation within  the  organs  and   tends  to  overcome  the  congestion. 

Locally,  cold  water  may  be  applied  to  the  testicles,  or,  when 
this  cannot  be  continued,  it  may  be  advantageous  to  use  an  oint- 
ment or  liniment  consisting  of  camphor,  belladonna  and  olive  oil, 
applied  with  abundant  and  repeated  nia.ssage. 

Febrifuges  may  be  used  to  lower  the  temperature  in  event  of 
fever,  but,  .since  any  elevation  of  temperature  will  usually  sug- 
gest, if  not  indicate,  the  presence  of  infection  in  the  gland,  in- 
ternal medication  should  be  chiefly  directed  toward  the  elimina- 
tion of  the  infecting  element  itself  or  of  the  products  of  infection. 
For  this  purpose,  e.serine  and  pilocarpine  and,  to  a  much  le.ss 
degree,  the  slower  acting  cathartics,  exert  a  beneficent  influence. 
Potassium  iodide  in  full  do.ses  not  only  .serves  to  favor  the  elimi- 
nation of  bacterial  products,  but  tends  to  exert  a  distinct  bacter- 
icidal action.  vSome  writers  advise  against  its  use  lest  it  cause 
atrophy  or  degeneration  of  the  testicles  but,  so  far  as  we  are 
aware,  there  is  no  evidence  of  such  action  of  the  drug  in  domestic 
animals. 

Hoffman  recommends  compression  of  the  testes  of  dogs  by 
means  of  strips  of  adhesive  plaster  over  the  scrotum,  thereby 
tending  to  support  the  circulation  in  the  part.      W'hen  absce.s.ses 


Spotita7ieous  Degeneration  of  the    Testicles  135 

occur  ii?  the  organ,  they  should  be  promptly  opened,  the  pus 
evacuated  and  the  cavity  treated  antiseptically. 

Castration  is  always  to  be  considered  in  case  of  orchitis,  whether 
acute  or  chronic.  In  cases  of  acute  orchitis  or  epididymitis  in- 
volving one  gland  only,  there  is  a  constant  tendency  for  the  other 
to  become  involved.  If  the  life  of  the  animal  is  threatened  by 
the  intensity  of  the  inflammation,  if  the  function  of  the  gland  is 
apparently  wholly  and  permanently  destroyed,  or  if  there  appears 
to  be  danger  of  the  sound  gland  becoming  involved,  the  removal 
of  the  affected  testicle  .should  occur  without  delay.  In  chronic 
recurrent  orchitis  of  both  testicles,  especially  if  examination  of 
the  semen  indicates  the  absence  of  spermatozoa  or  if  the  animal 
has  proven  sterile  in  the  stud,  total  castration  should  be  per- 
formed and  such  salvage  obtained  from  the  animal  as  conditions 
may  permit. 

In  animals  affected  with  acute  orchitis,  there  is  some  hesitancy 
at  times  about  castration  lest  the  patient  cannot  well  endure  the 
operation  but,  in  our  experience,  it  is  a  most  efficient  therapeutic 
agent  and  the  operation  at  once  improves  the  general  well-being 
of  the  animal.  When  orchitis  is  present  as  a  complication  of  an 
acute  infectious  fever,  like  "  Pink  Eye,"  we  should  regard  cas- 
tration as  un.safe,  until  the  acute  stage  of  the  malady  has  run  its 
cour.se  and  the  disea.se  has  become  chronic  and  located  chiefl}'  or 
wholly  in  the  testes.  Since,  in  orchitis,  there  are  usually  intimate 
and  exten.sive  adhesions  between  the  peritoneal  layers,  it  is  safer 
and  more  convenient  to  castrate  by  the  covered  operation.  The 
removal  of  one  of  the  testicles,  providing  the  other  is  sound,  does 
not  interfere  with  the  reproductive  power  of  the  animal. 

3.  Spontaneous  Degeneration  of  the  Testicles.  Zschokke  re- 
cords spontaneous  degeneration  of  the  testicles  as  a  not  uncommon 
cause  of  sterility.  He  attributes  it  largely  to  the  action  of  toxines 
upon  the  secretory  cells  of  the  organ,  thus  causing  their  destruc- 
tion. He  a.ssumes  that  these  toxines  reach  the  glands  through 
the  blood  or  lymph,  during  the  course  of  some  sy.stemic  di.sease, 
in  which  the  deleterious  poisons  are  generated,  and  that  the  effect 
of  these  to.xineswill  be  most  noticeable  upon  tho.se  tissues  which  are 
most  sen.sitive,  among  which  are  the  secretorj-  cells  of  the  testi- 
cles. When  these  toxines  act  upon  the  spermatoblasts,  their 
first  effect  is  the  destruction  of  their  physiologic  function.  If 
the  toxicity  is  slight  and  temporary,  the  cells  soon  recover  their 


136  \'eterinary  Obstetrics 

function,  but,  if  intense  and  continuous,  it  leads  to  disease  chancres 
and  death  of  the  cells. 

The  anatomical  changes  observed  by  Zschokke  under  these 
conditions  in  the  testicles  of  bulls,  without  apparent  external 
cause  or  symptoms,  accompanying  the  sterility,  were  now  and 
then,  sclerotic  connective  tissue  degeneration  ;  fatty  infiltration  ; 
and  the  formation  of  bone,  or  the  total  calcification  of  the  sem- 
inal tubules.  He  asserts  that  calcification  is  not  at  all  rare  and 
that  it  is  easily  recognized  upon  a  microscopic  examination  of 
the  excised  gland,  the  white,  calcified  tubules  being  easily  vi.si- 
ble  and  evident  to  the  touch.  The  diagnosis  of  this  condition 
cannot  be  made  by  palpation  in  the  living  animal  with  the  or- 
gans in  position,  or  by  other  means  than  histologic  examination 
of  the  excised  gland,  except  by  examining  the  semen  and  deter- 
mining the  al)sence  of  spermatozoa,  which  would  point  with  con- 
siderable certainty  to  a  degeneration  of  this  character.  It  is  evi- 
dent that  no  method  of  handling  can  result  in  any  restoration  of 
the  breeding  power,  under  such  conditions,  and  castration  is  in- 
dicated. 

4.  Hydrocele,  or  dropsy  of  the  scrotum,  in  which  there  is  an 
accumulation  of  fluid  in  the  scrotal  sac  between  the  two  peritoneal 
layers,  probably,  exerts  an  unfavorable  influence  upon  the  af- 
fected glands  and  tends  to  produce  sterility.  If  the  accumula- 
tion of  fluid  in  the  sac  is  the  result  of  a  general  dropsy  of  the 
peritoneal  cavity,  ascites,  the  systemic  debility  of  the  animal 
would  usually  determine  sterility.  When  the  affection  is  local, 
as  is  usually  the  case  in  the  stallion,  and  depends  upon  a  chronic 
inflammation  of  the  scrotal  peritoneum  with  the  accumulation  of 
the  .secreted  fluids  in  the  .sac  and  involves  but  one  organ,  it  may 
not  induce  complete  sterility,  but  affect  the  formation  of 
spermatozoa  in  the  di.sea.sed  testicle  only. 

The  symptoms  of  hydrocele  consist  of  a  painless  enlargement  of 
the  scrotum,  appearing  gradually  and  usually  without  recogiza- 
ble  cause.  The  general  health  of  the  animal  is  not  usually  in- 
volved. The  swelling  is  even,  soft  and  suggillating,  indicating  that 
it  consists  of  fluid.  It  is  to  be-  differentiated  from  tumors  and 
orchitis  by  the  firmness  of  the  latter  ;  it  may  be  distinguished 
from  hernia  by  rectal  exploration,  determining,  thereby,  the 
presence  or  ab.sence  of  a  .segment  of  the  bowel  in  the  internal  in- 
guinal ring.     Its  diagnosis  may  be  further  established  by  intro- 


Azoospennie  from  Systemic  Disease  137 

trodiicing  an  exploratory  trocar  and  withdrawing  a  portion  of 
the  contents. 

The  handling  of  hydrocele  is  not  usually  highly  successful. 
Sometimes  good  results  maj'  be  had  b}'  aspirating  the  fluid  and 
injecting  tincture  of  iodine  or  Lugol's  solution  into  the  cavity. 
When  these  measures  fail,  a  radical  cure  of  the  local  disease  may 
be  brought  about  by  castration,  the  covered  method  being  used. 
When  the  hydrocele  is  dependent  upon  a  general  constitutional 
malady,  with  dropsy  of  the  abdomen,  there  is,  usually,  no  suc- 
cessful method  of  treatment. 

5.  Torsion  of  the  testicles,  it  is  claimed,  operates  at  times  to 
cause  their  atrophy  and  inhibit  the  formation  of  spermatozoa 
because  of  interruption  of  their  nutritive  supply.  The  reversal 
of  the  testicle  of  the  stallion,  so  that  the  tail  of  the  epididymis 
is  turned  forward,  is  alleged  to  interfere  with  fertility.  Such  a 
result  from  this  slight  and  common  displacement  is,  probably, 
purely  mythical.  It  is  well  known  that  emasculation  can  be 
produced  in  ruminants  by  the  process  known  as  double  subcu- 
taneous torsion,  in  which  the  testicles  are  twisted  and  turned 
upside  down  in  a  manner  which  interrupts  their  vascular  supply 
and  induces  atrophy,  with  disappearance  of  sexual  desire  and 
power. 

C.    AZOOSPERMIE    FROM    Sy.STEMIC    DISEASE. 

I.  Debilitating  Diseases  and  Overwork.  Any  constitu- 
tional disease  which  produces  profound  depression  of  the  general 
system  is  usually  accompanied  by  suspension  of  the  powers  of 
reproduction.  Most  serious  constitutional  disorders  not  only  de- 
stroy the  sexual  desire  for  the  time  being,  but  also  prevent  the 
formation  of  spermatozoa  and  thus  lead  to  essential  sterility  dur- 
ing the  period  of  the  existence  of  the  disea.se.  In  some  acute 
fevers,  the  sexual  powers  are  not  in  complete  abeyance  and  male 
animals  affected  with  a  disease  accompanied  by  a  high  fever  may 
be  fertile.  In  one  ca.se,  we  observed  a,  stallion  affected  with 
brustseuche,  with  a  temperature  of  107°  F.,  which,  in  spite  of 
the  very  high  fever,  served  a  mare  and  successfully  impreg- 
nated her. 

In  chronic  debilitating  diseases,  there  is  sometimes  seen  a 
tendency  to  sterility,  especially   in   the   constitutional   bone  dis- 


138  Veterinary  Obstetrics 

eases,  like  osteoporosis,  rickets  and  in   other   chronic  disorders 
which  depress  the  general  vigor  of  the  animal. 

Overwork  serves  to  inhibit  the  breeding  functions,  so  that 
animals  subjected  to  severe  work  are  strongly  inclined  to  be 
sterile  for  the  time.  In  animals  which  are  severely,  but  not  over- 
worked, as  in  stallions  which  are  being  trained  for  the  turf, 
there  is  usually  a  temporary  sterility,  without  any  evidence  of 
disease  or  degeneration  of  the  glands.  The  resources  of  the 
animal  are  wholly  consumed  in  the  physical  work  which  is 
demanded  and  there  remains  no  reserve  force  to  provide  repro- 
ductive energy  during  this  period. 

Starvation  has  a  like  effect  upon  the  reproductive  powers  .so 
that  any  animal  which  does  not  receive  sufficient  food  to  main- 
tain the  general  vigor  of  the  system  and  afford  a  moderate  re- 
serve for  reproductive  energies  tends  to  become  sterile  during 
the  period  of  want. 

The  remedies  for  these  conditions  are  suggested  by  the  causes, 
they  are  usually  but  temporary  and  run  a  parallel  course  to  the 
cau.ses  them.selves.  Whenever  these  are  removed  or  naturally 
cease,  the  reproductive  powers  become   spontaneously   restored. 

2.  Idleness  and  Over-feeding.  Impotence  of  the  male  is 
frequently  expres.sed  chiefly  by  an  absence  of  sexual  desire, 
without  any  changes  of  the  sexual  organs  which  can  be  detected. 
The  male  shows  but  slight  .sexual  desire  or  none  at  all  in  the 
presence  of  females  which  are  properly  in  estrum.  At  one  time 
he  may  pay  some  attention  to  the  female,  with  a  more  or  less 
complete  erection  of  the  penis,  and  then  desist  in  his  attentions, 
and  turn  away.  When  the  next  female  is  presented,  he  may 
show  normal  sexual  vigor. 

In  .some  cases,  there  is  alleged  to  be  an  individual  psychic  in- 
fluence which  prevents  the  male  from  copulating  with  a  certain 
female.  This  is  alleged  to  be  especially  true  of  some  stallions, 
to  which  certain  mares  seem  to  be  repulsive,  and  they  refuse  to 
.serve  them.  The  presence  of  young  at  the  side  of  the  dam  is 
.sometimes  alleged  to  repress  the  .sexual  appetite  of  the  male.  This 
is  usually  seen,  however,  only  in  tho.se  males  depressed  in  their 
vitality  by  improper  handling.  It  is  almost,  if  not  always, 
erroneous  to  attribute  this  trouble  to  the  caprice  or  idiosyncracies 
of  the  male  by  which  a  female  of  a  certain  type  or  color  becomes 


Res2c/fs  of  Idleness  and  Overfeeding  139 

repulsive  to  him  and  fails  to  arouse  his  sexual  appetite  ;  the  real 
cause  lies  in  bad  management. 

In  some  cases,  there  is  a  general  depression  of  the  sexual  de- 
sire, especially  in  those  animals  which  are  lethargic  or  of  a 
phlegmatic  temperament.  In  very  active,  nervous  animals  this 
peculiarity  is  rarely  seen.  It  is  most  common  in  draft  .stallions, 
but  is  observed  in  bulls,  especially  of  the  beef  breeds,  and  in  all 
kinds  of  male  breeding  animals. 

The  tendency  to  loss  of  vigor  on  this  account  increases  with 
the  age  of  the  animal.  It  is  usually  not  noticeable  in  the  young, 
but,  as  soon  as  the  animal  has  become  mature  and  grown  quite 
fat,  the  disposition  becomes  marked.  This  form  of  impotence  is 
seen  almost  exclusivelj'  in  those  animals  which  are  closely  con- 
fined, highly  fed  and  not  properly  exercised.  It  tends  to  disappear 
promptly  upon  a  correction  of  the  method  of  keeping,  providing 
that  it  be  applied  sufficiently  early.  The  most  careful  .search 
fails  to  find  any  anatomical  reason  for  the  difficulty,  and  it  seems 
to  be  of  a  purely  functional  character.  The  difficulty  should  be 
prevented  by  not  forcing  the  young  male  designed  for  breeding 
purposes  too  rapidly  in  his  development,  but  by  allowing  him 
only  a  moderate  diet,  with  plenty  of  exercise  and  freedom,  and, 
whenever  practical,  permitting  him  to  consort  with  females  dur- 
ing his  period  of  growth. 

Upon  the  appearance  of  these  defects  in  the  mature  animal, 
much  can  be  done,  if  handled  opportunely,  by  restricting  the 
diet  and  causing  an  abundance  of  exercise.  In  our  experience, 
a  healthy  draft  stallion  refused  almost  wholly  to  .serve  mares.  He 
was  being  highly  fed  and  was  getting  a  very  limited  amount  of 
exerci.se,  at  a  slow  walk.  Being  appealed  to  for  advice,  we  re- 
duced his  food  ration  one-half  and  prescribed  eight  miles  exerci.se, 
daily,  at  a  brisk  walk.  Within  a  few  days,  his  sexual  desire  had 
fully  returned.  He  finished  his  season's  work  in  good  form, 
and  was  effective  as  a  sire.  The  same  general  principles  apply 
to  other  breeding  males.  In  countries  where  cattle  are  habit- 
ually worked,  the  bulls  are  largely  kept  in  breeding  condition  by 
moderate  draft  service.  It  might  be  well  to  imitate  this  plan  in 
America,  where  they  are  not  habitually  used  for  work  purposes, 
but  could  readily  render  considerable  service,  while  being  greatly 
benefited  by  the  vigorous  exercise  which  would  be  secured  in 
this  way.  Under  general  conditions,  it  is  perhaps  the  best  pos- 
sible and  most  economic  manner  in  which  we  can  insure  sufficient 


140  Veterinary  Obstetrics 

exercise  for  these  animals.  Incidentally,  it  should  be  noted  that 
such  exercise  or  work  tends  very  strongly  to  prevent  that  vicious- 
ness  in  bulls  and  other  breeding  males,  which  renders  them  dan- 
gerous to  their  keepers. 

Zschokke  emphasizes  the  value  of  the  proper  selection  of  food 
for  the  purpose  of  arousing  a  sexual  desire  and  especially  insists 
that  the  hay  should  be  of  an  aromatic  character,  as  should  also 
the  oats.  Not  only  should  they  be  well  cured  and  sweet  smelling, 
but  he  believes  that  the  admixture  of  certain  stimulants  like 
calamus,  pepper,  powdered  mustard,  and  even  powdered  canthar- 
cides,  are  advantageous.  He  recommends  that  these  remedies 
should  be  fed  with  cut  hay  and  should  be  allowed  for  two  or  three 
days  in  succession  and  then  omitted  for  a  like  period,  when  they 
may  be  given  again. 

We  doubt  very  greatly  the  value  of  aphrodisiacs,  or  sexual 
stimulants,  in  breeding  animals.  Sexual  instinct  is  so  normal  a 
phenomenon  and  so  universal  in  animals  of  breeding  age  and 
proper  health  that  we  fail  to  see  the  value  of  exciting  sexual  de- 
.sire  artificially.  The  function  belongs  normally  to  every  male  or 
female  of  breeding  age  and,  if  it  is  absent,  it  is  because  of  some 
depression  in  the  general  vigor  of  the  animal,  which  cannot  read- 
ily be  removed  by  aphrodisiacs.  It  has  not  been  shown  that  the 
arousal  of  sexual  appetite  by  means  of  these  drugs  insures  or  even 
favors  fertility.  A  constant  and  wide  distinction  must  be  drawn 
between  copulation  and  fecundation.  The  fundamental  function 
of  the  male  is  the  elaboration  of  virile  spermatozoa  or  male  cells, 
while  copulation  merely  serves  to  transfer  these  fecunding  cells 
from  the  testes  of  the  male  to  the  vagina  of  the  female.  Copu- 
lation is  in  vain  without  vigorous  spermatozoa  and  we  have  no 
data  to  show  or  suggest  that  any  drug  may  directly  cause  or  favor 
their  development. 

Certainly,  we  must  admit  that  tonics,  alteratives,  or  other 
drugs  which  are  capable  of  favorably  influencing  the  restoration 
of  a  diseased  animal  to  a  healthy  state  must  also  improve  its  re- 
productive powers  by  restoring  the  equilibrium  of  the  body  and 
enabling  it  to  better  perform  all  its  normal  functions,  among 
which  is  reproduction.  The  highest  state  of  the  general  vigor  of 
the  body  is,  consequently,  the  most  favorable  condition  for  the 
production  of  virile  spermatozoa,  which  constitute  the  first  essen- 
tial in  the  fertilitv  of  the  male  animal. 


Resulls  of  Idleiiess  and  Overivork  141 

Zschokke  further  remarks  that  there  is  sometimes  an  absence 
of  sexual  desire  in  young  bulls  which  have  not  previously  served 
cows.  This  seems  to  bean  absence  of  the  sexual  instinct  and  he 
suggests  that  such  animals  should  be  turned  loose  with  cows 
which  are  in  estrum.  Under  these  conditions,  they  soon  become 
sexually  awakened  and  learn  to  serve  females.  This  difficulty  is 
not  so  prominent  in  other  domestic  animals,  though  the  same 
condition  is  observed  to  some  extent  in  young  stallions.  Under 
normal  conditions  the  sexual  desire  of  healthy  young  animals  is 
awakened  and  intensified  by  the  presence  of  the  opposite  sex. 
Breeders  of  pedigreed  stock  recognize  this  fact  and  cautiously  keep 
young  males  of  some  .species  entirely  away  from  females  which 
may  be  in  estrum,  lest  their  mere  presence  awaken  the  .sexual 
desires  of  the  immature  male  and  thereby  interrupt  his  growth. 

The  preparation  of  breeding  animals  for  the  show  ring  is  always 
very  dangerous  for  the  sexual  vitalit}- of  the  individual.  In  order 
to  get  them  in  high  condition,  they  are  frequently  closely  con- 
fined in  the  stall  and  fed  in  such  a  manner  as  to  produce  the 
greatest  amount  of  fat,  in  order  that  they  may  make  a  better 
showing  and  more  certainly  win  a  prize.  It  is  an  unfortunate 
fact  that  many  of  our  most  richly  bred  animals,  which  are  de- 
signed for  breeding  purposes  and  which  capture  the  most  coveted 
prizes  at  the  livestock  fairs,  have  their  breeding  powers  either 
temporaril}'  or  permanently  destroyed  in  the  process  of  feeding 
them  for  the  show.  There  is  no  effective  method  for  overcoming 
this  except  by  the  exercise  of  greater  intelligence  on  the  part  of 
the  owners  of  show  animals,  which  maj^  be  furthered  b}'  judges 
in  livestock  exhibitions  paying  less  attention  to  the  amount  of 
fat  and  more  to  the  form  and  general  vigor  of  the  animal,  in  the 
allotment  of  premiums.  In  order  to  show  breeding  animals  with 
safety,  it  is  absolutely  essential  that  abundant  exerci.se  should 
accompany  the  preparing  process  if  the  .sexual  vigor  of  the  animal 
is  to  be  safely  preserved. 

The  result  is  not  the  same  with  all  individuals.  There  are 
some  which  can  withstand  almost  unlimited  abuse  in  this  direc- 
tion and  continue  to  breed  regularly,  while  others  are  very  sus- 
ceptible and  soon  become  temporarily  or  permanently  sterile. 
Once  this  sterility  is  established,  the  only  thing  that  can  be  done 
is  to  correct  errors  in  care  by  moderating  the  diet  and  enforcing 


142  I'e/er/fian'  Obstetrics 

vigorous  exercise,  which  will,  as  a  rule,  though  not  always,  re- 
store the  sexual  powers. 

In  a  general  way,  the  food  of  a  breeding  male  needs  be  rich  in 
protein,  as  compared  with  the  amount  of  hydrocarbons  and  car- 
bohydrates. The  most  common  foods,  when  well  grown  and 
cured,  are  the  best  for  the  breeding  animal,  such  as  bright,  aro- 
matic hay  and  clean,  well  developed  oats,  along  with  grass,  to 
which  may  be  added,  in  the  winter,  roots  and  tubers.  Rarely, 
if  ever,  is  it  necessary  or  even  advisable  or  permissible  to  add  to 
the  food  any  sexual  stimulant  like  pepper  or  mustard. 

3.  Excessive  Sexual  Use.  The  number  of  services  which 
a  male  animal  can  effectively  render  is  an  important  question  for 
the  breeder.  It  probably  varies  greatly  with  different  indi- 
viduals. Naturally,  the  power  of  a  male  does  not  rest  so  much 
upon  the  number  of  females  which  he  is  expected  to  serve  as 
upon  the  number  of  copulations  essential  to  cause  fertilization. 
It  has  been  determined  by  careful  investigation  that,  when  the 
number  of  copulations  during  a  given  day  is  increased,  the 
abundance  of  spermatozoa  in  the  semen  rapidly  decreases  and, 
if  this  service  is  pushed  too  far,  the  spermatozoa  fail  almost  en- 
tirely, causing  an  interruption  of  the  fertility  of  the  animal. 
Much  will  depend  upon  the  age  and  vigor  of  the  male  animal. 
Zschokke  states  that  80  to  100  cows  may  be  bred  to  a  single  bull 
when  the  animal  is  kept  confined  and  his  service  somewhat  regu- 
lated by  the  breeder  but,  if  allowed  to  consort  with  the  cows  at 
pasture,  not  more  than  50  should  be  allowed.  In  the  western 
range  country  of  America,  the  allowance  is  very  much  smaller 
and  it  is  considered  safer  that  there  be  one  bull  to  each  20  or  25 
cows.  This  is  necessitated  largely  by  the  fact  that,  during  the 
principal  breeding  .season,  the  bulls  have  not  yet  fully  recovered 
their  vigor  from  the  long  and  trying  winter  with  scant  food  sup- 
ply. Zschokke  further  holds  that  the  bull  should  not  be  allowed 
to  serve  more  than  three  cows  in  any  one  day  and  that,  under 
such  conditions,  there  should  be  one  or  two  days  per  week  of 
complete  rest. 

In  the  stallion,  similar  rules  as  to  numbers  and  conditions  are 
applicable.  The  total  number  of  females,  however,  may  be 
greatly  increased  over  that  suggested  by  Zschokke,  if  the  service 
is  distributed  throughout  the  year,  and  noted  .stallions  have  been 
known  to  .serve  successfully,  and    without   apparent    injury,  two 


Onaiiism  or  Mashirbation  143 

or  three  hundred  mares  during  the  year  but,  in  such  cases,  the 
service  was  evenl}-  distributed  over  the  entire  period. 

Zschokke  draws  attention  to  the  erroneous  behef  that  a  long 
abstinence  from  coition  serves  to  store  up  a  large  amount  of  se- 
men, which  will  answer  for  a  series  of  copulations.  There  is  no 
reservoir  in  the  animal  body  for  such  purpose,  and  all  semen 
which  may  be  secreted  and  not  used  in  copulation  soon  disinte- 
grates and  is  expelled  or  ab.sorbed.  On  the  other  hand,  he  points 
out  that,  perhaps,  the  glands  undergo  some  atrophy  from  long 
inactivity  and  that  their  function  is  best  preserved  by  moderate 
use. 

Excessive  sexual  use  is  largely  a  comparative  term  and  indica- 
tive rather  of  a  relative  over-use  under  surrounding  environment. 

There  is  no  question  that  a  breeding  male  may  be  readily  over- 
done, nor  that  such  is  not  a  frequent  occurrence,  but,  more  com- 
monly, the  use  becomes  excessive  under  bad  management,  where 
proper  handling  of  the  male  would  enable  him  to  make  the  num- 
ber of  services  demanded,  safely  and  efficiently. 

Zschokke  also  draws  attention  to  the  very  important  fact  that 
moderate  work  during  the  breeding  season  is  not  injurious,  but 
favorable,  to  fertility  and  that  permanent  confinement  in  the 
stall  tends  contantly  to  a  decreased  secretion  of  semen  and  con- 
sequent sterility.  It  is  a  constant  observation  that  a  male  breed- 
ing animal  which  is  regularly  exercised  is  capable  of  rendering  a 
greater  number  of  effective  .services  than  one  which  is  closely 
confined. 

The  feeding  has  much  to  do  with  the  breeding  capacity  of  the 
male.  In  quality,  some  writers  condemn  such  foods  as  oil  cake 
and  malted  grain  and  prefer  the  various  forms  of  grains  and,  es- 
pecially, of  oats,  barley,  peas  and  beans  in  moderate  quantit}'. 
To  these  should  be  added  hay  and  grass  in  sufficient  amount. 
Roots,  tubers,  meal  and  molasses  are  not  essential  as  a  part  of 
the  food  supply  for  breeding  males,  but  may  aid  in  maintaining 
a  good  state  of  digestion  and  thus  contribute  to  the  general  vigor. 

The  feeding  of  salt  has  long  been  regarded  as  important  in 
reference  to  fertility,  but  it  is  not  known  whether  it  acts  directly 
or  merely  serves  to  favor  fertility,  indirectly,  by  aiding  digestion 
and  assimilation. 

4.  Onanism  or  Masturbation.  Masturbation,  as  a  cau.se  of 
sterility,  is  observed  chiefly  in  the  stallion  and  bull.     It  is  very 


144  l^cterinary  Obstetrics 

common  in  improperly  kept  stallions.  Spinola  (Handbuch  der 
spec.  Pathol.  1858,  II  Bd.)  records  this  vice  in  the  bull. 

The  stallion  has  an  erection,  the  penis  is  moved  up  and  down, 
imitating  coitus,  until  finally  an  ejaculation  of  semen  occurs.  In 
the  bull,  the  ejaculation  is  induced  by  an  erection  and  the  alternate 
protrusion  and  withdrawal  of  the  penis.  This  is  largely  seen  in 
idle  males  which  are  closely  confined,  over  fed  and  sparingly  u.sed 
for  breeding  and  in  track  stallions  when  sexual  debility  is 
brought  about  by  hard  work.  It  is  a  question  whether  the 
Onanism  causes  the  impotence  or  the  .sexual  weaknesses  induces 
the  masturbation. 

Corrections  may  be  brought  about  by  such  feeding,  exercise  and 
other  care  as  will  maintain  the  general  vigor  of  the  animal  and, 
as  far  as  po.ssible,  he  should  have  something  to  divert  his  atten- 
tion and  exert  a  favorable  psychic  influence.  Moderate  work  or 
exercise  and  judicious  feeding,  or,  in  animals  which  cannot  be 
worked  or  artifically  exercised,  the  allowance  of  freedom  in  a 
commodious  paddock,  or,  still  better,  in  a  properly  enclosed  pa.st- 
ure,  and  especially  in  company  with  pregnant  females,  tends 
largely  to  prevent  or  cure  the  vice.  Once  the  habit  has  become 
fixed,  it  should  be  prevented  by  a  shield  so  arranged  as  to  cause 
pain  whenever  the  penis  is  protruded  and  thus  prohibit  erection. 
It  is  to  be  constantly  viewed  as  a  vice  of  idleness  and  debility, 
and  it  must  be  remembered  that  any  and  all  remedies  must  fail 
in  their  aim  until  the  return  to  normal  vigor  is  attained. 

II.  Defective  Secretions  of  the  Accessory  Glands. 

Bass  and  Furbinger  (Deutsche  Zeitschr.  f.  Th.  Med.  B.  XX. 
page  147)  claim  that  the  absence  of  the  prostate  secretions  leads 
to  an  immobility  and  loss  of  vigor  in  the  spermatozoa.  The  gen- 
eral belief  of  investigators  is  that  the  secretions  of  all  the  acces- 
sory glands — the  seminal  vesicles,  the  prostate  and  Covvper's 
glands — when  added  to  the  semen,  tend  to  stimulate  the  move- 
ments of  the  spermatozoa,  invigorating  them  and  prolonging  their 
life,  thus  acting  as  an  important  accessory  in  the  phenomenon  of 
fertilization.  How  often  .sterility  may  be  due  to  disea.se  or  im- 
proper function  of  these  glands  is  not  known. 

III.    Physical  Inability  to  Copulate. 
I.    Arrested  Development  of  the  Penis,  which  we  have  al- 


Tumors.     Paralysis  of  the  Penis  145 

ready  noted  on  page  127  as  occurring  frequently  in  hermaphro- 
ditic animals,  especially  in  the  horse,  is  not  rare  in  foals  which 
are  otherwise  apparently  normal,  and  similar  defects  may  occur 
in  other  animals.  In  these  animals,  copulation  may  be  impossible, 
either  from  the  smallness  of  the  organ  or  its  misdirection.  The 
defect  is  usually  not  subject  to  correction,  nor  is  it  desirable  to 
correct  it,  lest  the  malformation  prove  transmissible. 

2.  Tumors  or  Herniae  situated  about  the  opening  of  the 
sheath  may  tend  to  push  the  penis  aside  as  it  is  protruded  and 
thus  to  so  misdirect  the  organ  that  copulation  becomes  uncertain 
and  difficult,  if  not  impossible. 

3.  Tumors  of  the  Penis  or  Prepuce  in  male  breeding  ani- 
mals are  not  rare,  and  constantly  tend  to  interfere  with,  or  pre- 
vent, copulation. 

We  have  already,  on  page  104,  alluded  to  the  infectious gratutlo- 
mata  or  lynipho- sarcoma  upon  the  penis  of  the  dog  ;  on  page  112, 
to  bursattee  of  the  genitals  of  the  horse  and,  on  page  113,  \.o  actino- 
mycosis of  the  genitals  of  the  bull.  Various  types  of  tumors,  both 
benign  and  malignant,  involving  the  penis  or  prepuce,  are  not  rare 
in  the  stallion,  bull  and  other  males.  They  are  quite  largely  of 
papillomatous  type  and,  as  soon  as  they  attain  a  moderate  size, 
prevent  copulation.  Their  usual  seat  is  upon  the  glans  penis, 
where  they  are  easily  diagnosed  by  examining  the  exposed  organ. 

In  all  cases,  their  removal  should  occur  early,  ere  they  involve 
the  organ  to  such  a  degree  that  their  ablation  will  result  in  its 
serious  mutilation.  In  the  stallion,  the  glans  penis  may  be  am- 
putated and  the  copulatory  and  procreative  powers  fully  retained. 
In  the  bull,  with  the  long,  tapering  glans,  amputation  is  not 
practical,  since  copulation  is  thereby  rendered  difficult  or  impos- 
sible. In  breeding  males,  the  early  ablation  of  penial  tumors 
consequently  becomes  very  urgent,  if  their  breeding  powers  are 
to  be  retained. 

4.  Paralysis  of  the  Penis  occurs  in  all  animals,  but  espec- 
ially in  the  stallion.  It  is  usually  of  central  origin  and  frequently 
occurs  as  a  symptom  of  a  constitutional  affection,  like  the  .so- 
called  cerebro-spinal  meningitis,  dourine,  etc.,  and  is  a  common 
accompaniment  of  lumbar  paralysis,  or  of  injuries  to,  or  diseases 
of,  the  internal  pudic  or  great   sympathetic  nerves.     It  is  rarely 


146  Veterinary  Obstetrics 

remediable,  and  depends  for  its  recovery  upon  the  removal  of 
the  cause. 

In  other  cases,  the  paralysis  is  local  and  more  or  less  tem- 
porary in  character.  Any  injury  to  the  penis  which  causes  swel- 
ling and  inflammation  tends  to  induce  paralysis,  both  directly 
through  the  disea.se  of  the  tissues  and  indirectly  as  a  result  of 
the  dragging  on  the  organ  due  to  its  increased  weight.  Rough 
handling  by  the  groom  or  violent  strains  of  the  organ  during 
copulation  may  also  lead  to  paralysis.  Large  tumors  on  the 
penis,  by  their  weight,  tend  to  cau.se  paralysis  and  prolap.se  of 
the  organ.  In  penial  paraly.sis,  the  protruded  organ  is  further 
exposed  to  wounds,  abrasions  and,  in  cold  weather,  to  freezing. 

The  handling  of  penial  paralysis  in  breeding  males  should  be 
prompt  and  energetic.  The  paralyzed  organ  should  be  at  once 
supported,  in  order  to  overcome  the  injurious  results  of  pend- 
ency. In  recoverable  cases,  the  longer  the  penis  protrudes,  the 
greater  the  danger  that  the  prolap.se  itself  may  lead  to  permanent 
paralysis  of  the  organ. 

5.  Excessive  erection  of  the  Penis  (Spasm)  sometimes 
occurs  in  the  .stallion  and  possibly  in  other  animals.  It  is  ac- 
companied by  a  peculiar  interruption  of  copulatory  power,  closely 
analogous  to  the  vagijtisjmis  of  the  female.  We  have  personally 
ob-served  one  case  in  the  stallion  and  have  known  of  a  second, 
both  imported  French  draft  horses.  These  stallions  were  very 
amorous  and  would  quickly  get  an  erection,  the  glans  penis  becom- 
ing excessively  large.  They  would  promptly  mount  mares,  intro- 
duce the  penis  momentarily  into  the  vulva  for  a  short  distance, 
suddenly  withdraw  it  and  dismount  with  the  penis  still  fully 
erected  and  without  the  ejaculation  of  semen  having  occurred. 
Repeated  efforts  were  unavailing  and  constant  and  prolonged 
failure  to  copulate  resulted.  Zschokke  records  the  ca.se  of  a  bull 
(Unfruchtbarkeit  des  Rindes,  page  58)  in  which  the  symptoms 
were  somewhat  similar. 

Careful  examination  fails  to  reveal  any  anatomical  defect 
or  pathologic  changes.  The  difficulty  appears  to  be  wholly 
functional. 

No  remedy  is  certainly  known.  Vigorous  work  on  a  light, 
laxative  diet  may  be  tried.  We  attempted  to  overcome  the 
nervous  irritability  by  means  of  potassium  bromide,  but  failed. 
Possibly  we  did  not  give  a  sufficient  quantity.     The  hor.se  passed 


Broke7i  Penis.     InfIam?natio?i  of  the  Penis  147 

from  our  observation  before   we   had    an   opportunity    to    fully 
investigate. 

6.  "Broken  Penis."  When  the  penis  becomes  violently 
and  abruptly  bent  while  erected,  the  tissues  at  the  point  of  cur- 
vature become  severely  injured,  inflammation  and  swelling  occur, 
the  erectile  ti.ssues  become  infiltrated  and  undergo  sclerosis. 
After  a  tardy  recovery,  distortion  remains  ;  the  penis  is  bent  or 
curved.  In  addition  to  the  deformity,  there  is  sometimes  an  in- 
terruption of  the  vascular  or  nerve  supply  to  the  portion  of  the 
penis  distal  to  the  seat  of  the  injury  and,  in  this  part,  erection 
may  be  wholly  wanting,  while  normal  in  the  proximal  portion  of 
the  organ.  The  deformity  and  want  of  erection  in  the  distal 
portion  serves  to  prevent  copulation. 

Treatment  is  usually  impracticable.  The  defects  cannot,  as 
a  rule,  be  remedied  and  generally  occur  too  high  to  permit  of 
successful  amputation  from  a  breeding  standpoint.  In  some 
cases  of  broken  or  curved  penis,  where  copulation  was  still  pos- 
sible, sterility  is  claimed  to  have  resulted  because  the  semen 
ejaculated  from  the  bent  organ  was  thrown  laterally  against  the 
side  of  the  vagina  instead  of  forwards  against  the  os  uteri  and 
the  spermatozoa  failed  to  enter.  The  difficulty  in  such  ca.ses 
was  apparently  overcome  by  artificial  insemination,  the  semen 
being  collected  from  the  posterior  portions  of  the  vagina  and 
introduced  into  the  os  uteri. 

7.  Inflammation  of  the  Penis  may  arise  in  a  variety  of 
ways.  We  have  already  referred  to  the  Venereal  Infections 
which  generally  lead  to  more  or  less  inflammatory  disease  of  this 
organ. 

In  addition,  inflammation  occasionally  results  from  physical 
injuries  during  coition,  from  kicks  in  stallions,  from  lacerations 
when  breaking  from  enclosures  while  the  penis  is  erected,  from 
the  tail  hairs  of  the  mare  becoming  caught  by  the  penis  and 
cutting  it,  by  the  "  hanging  fast  "  of  the  dog  during  copulation 
and  in  many  other  ways. 

The  effects  of  inflammation  of  the  penis  upon  copulatory 
powers  varies  greatly.  Some  males,  like  the  bull,  affected  with 
one  of  the  venereal  diseases,  may  copulate  in  spite  of  the  fact 
that  the  process  causes  profuse  hemorrhage  from  the  penis,  which 
must  be  accompanied  by  pain.  The  stallion  with  bursattee  of 
the  urethra  proceeds  to  copulate   regularly,  although   he  bleeds 


148  \''eterinary  Obstetrics 

freely  after  each  service.  In  this  case,  as  in  bursattee  of  other 
parts,  there  is  usually,  no  evidence  of  pain.  At  other  times, 
moderate  inflammation  of  the  penis  may  cause  a  male  to  desist 
from  coition,  although  the  sexual  appetite  is  unimpaired  and 
erection  occurs  ;  in  others,  the  inflammation  inhibits  erection. 

Inflammation  of  the  penis  should  be  promptly  and  energet- 
ically handled,  not  only  that  we  may  thereby  cause  its  eventual 
subsidence,  but  also  to  anticipate  and  avoid  deformities  and  par- 
alysis. In  general,  the  handling  is  to  be  based  upon  antisep.sis, 
combined  with  astringents  and  cold,  not  neglecting  to  effectively 
support  the  organ,  retaining  it  within  the  sheath  if  possible. 
The  patient  should  be  removed  from  sexual  excitement  and  any 
internal  medication  which  conditions  suggest  applied.  Should 
the  inflammation  be  acute  and  the  swelling  great,  no  time  should 
be  lost  in  inducing  prompt  catharsis  by  means  of  eserine,  areco- 
line  or  other  drugs  of  this  group  ;  delay  in  awaiting  the  action  of 
aloes  or  oil  may  prove  serious. 

8.  Adhesions  between  the  Penis  and  Prepuce  are 
especially  liable  to  occur  in  the  bull  and  other  male  ruminants, 
and  constitute  very  serious  obstacles  to  copulation.  Resulting 
usually  from  some  chronic  inflammation  of  the  penis  and  prepuce, 
the  contiguous  mucous  layers,  their  protective  epithelium  having 
been  destroyed,  adhere  in  such  a  manner  as  to  prevent  protrusion 
of  the  penis.  We  have  observed  such  a  case  in  a  valuable  bull. 
Where  possible,  the  adhesions  should  be  surgically  overcome  and 
their  recurrence  prevented  but,  as  a  rule,  they  are  not  subject  to 
remedy. 

9.  Phymosis  occurs  in  various  animals  as  a  result  either  of 
tumors  or  enlargements  of  the  glans  penis,  which  prevent  its 
pa.ssage  through  the  normal  preputial  opening  ;  more  generally, 
the  preputial  opening  becomes  narrowed  by  inflammatory  pro- 
cesses, possibly  intensified  by  the  deposit  of  urinary  salts  and 
epithelial  debris.  Naturally,  it  is  most  liable  to  occur  in  the 
ruminant  and  the  dog,  with  narrow  preputial  openings.  It  is 
rare  in  the  horse,  where  the  opening  is  very  ample. 

In  the  bull,  it  is  liable  to  ensue  from  the  deposit  of  urinary 
concretions  in  the  sheath,  as  a  complication  of  intense  preputial 
inflammation,  with  great  swelling.  It  is  readily  recognized  by 
the  pain,  heat  and  swelling  of  the  parts,  and  the  very  fetid  pre- 
putial discharge. 


Paraphymosis.      Lumbar  or  General  Phymosis  149 

The  handling  of  phymosis  consists  essentially  of  the  control  of 
the  infection  which  has  caused  it.  The  prepuce  and  sheath  need 
be  thoroughly  and  repeatedly  douched  with  a  warm  antiseptic 
solution,  not  too  powerfully  irritant,  such  as  a  ^  %  solution  of 
potassium  permanganate,  or  a  i  %  solution  of  carbolic  acid  or 
creolin.  The  solution  should  be  used  in  large  volume  so  that 
the  sheath  and  prepuce  are  repeatedly  filled  until  the  entire 
cavity  is  thoroughly  cleansed  and  disinfected.  In  the  bull,  the 
preputial  tuft  of  hairs  should  be  removed  in  order  to  facilitate 
cleansing. 

When  the  preputial  opening  is  too  greatly  constricted,  espe- 
ciall}^  in  the  bull,  so  that  cleansing  the  cavity  through  the  normal 
opening  is  difficult  or  impracticable,  the  sheath  is  to  be  freely 
opened,  either  by  surgical  enlargement  of  the  preputial  opening 
or  by  a  perforating  incision  through  the  inferior  wall  of  the 
sheath  at  its  posterior  extremity.  The  latter  method  affords  ex- 
cellent facility  for  thoroughly  cleansing  the  narrow,  elongated 
sheath  of  the  bull.  With  the  latter  plan,  the  antiseptic  fluid 
can  be  injected  through  the  preputial  opening  and  allowed  to 
escape  through  the  incision  at  the  posterior  extremity  of  the 
sheath. 

10.  Paraphymosis,  or  the  protrusion  of  the  penis  through  an 
incarcerating  preputial  opening,  interferes  with  normal  erection 
and  copulatory  power.  The  incarcerated  glans  penis  becomes  en- 
gorged, swollen  and  inflamed  so  that  it  is  too  painful  to  permit  of 
copulation,  and  functionally  incompetent. 

Observed  chiefly  in  the  dog,  it  more  frequently  follows  than 
prevents  copulation,  but,  having  occurred,  prevents  coition  until 
remedied.  It  is  to  be  remedied  by  a  reduction  of  the  paraphy- 
mosis. The  incarcerated  glans  penis  is,  usually,  greatly  swollen 
and  exceedingly  painful  and  cannot  be  readily  returned  to  its 
position.  After  cleansing  with  tepid  water,  to  which  a  little 
lysol  or  soda  bicarbonate  has  been  added  to  render  the  parts  unc- 
tuous, the  enlarged  glans  is  to  be  decrea.sed  in  volume  by  digital 
compression  and  finalh^  pressed  back  through  the  preputial  ring. 
Failing  in  this,  the  preputial  opening  needs  be  dilated  by  a  small 
incision  with  a  probe-pointed  bistoury,  enlarging  the  opening 
just  sufficiently  to  permit  the  return  of  the  glans.  This  may  be 
followed  by  antiseptic  dressing. 

11.  Lumbar  or  General  Paralysis,  as  a  bar  to  copulation. 


150  Veterhiary  Obstetrics 

is  most  frequent  in  the  stallion,  hut  is  possihle  in  all  males.  We 
have  already  referred  to  the  paresis  of  Dourine  as  rendering  the 
stallion  unable  to  mount  the  mare. 

Usualh',  when  any  marked  lumbar  or  general  paralysis  is  pres- 
ent, the  male  is  unable  to  mount  the  female  and,  hence,  fails  to 
copulate.  In  many  cases,  paralysis  of  the  penis,  to  which  we 
have  already  referred,  accompanies  these  affections  and  also 
serves  to  inhibit  copulation,  even  if  the  animal  be  able  to  mount 
the  female. 

Usually  this  group  of  affections  is  not  subject  to  cure  or  allevia- 
tion and  can  be  successfully  handled  only  in  those  extremely  rare 
ca.ses  where  the  cause  is  removable. 

1  J.  Painful  Diseases  of  the  Feet  and  Limbs  or  of  other 
parts,  which  may  cause  great  suffering  during  coition,  serve  to 
render  copulation  uncertain  or  to  prevent  it.  Disea.ses  of  the 
bones,  like  osteoporosis,  spavin,  ringbone,  or  painful  diseases  of 
the  hind  feet,  such  as  wounds,  quittor  and  others,  serve  to  cause 
great  and  even  unendurable  pain  when  a  male,  like  the  stallion, 
is  compelled  to  bear  his  chief  weight  on  the  two  posterior  mem- 
bers while  mounting  the  female.  A.side  from  this  difficulty,  in 
some  of  these  there  is  a  decreased  formation  of  spermatozoa  as 
well,  owing  to  constitutional  disturbances  and  loss  of  general 
vigor. 

13.  Diseases  or  injuries  along  the  inferior  part  of  the  chest 
or  abdomen,  so  situated  that  they  come  in  contact  with  the  fe- 
male during  the  act  in  a  way  to  cause  great  pain  to  the  male, 
tend  to  cau.se  him  to  desist  from  attempts  at  copulation. 

Their  prognosis  will  vary  greatly  according  to  cause,  being 
favorable  where  the  latter  can  be  removed,  unfavorable  and  per- 
manent where  the  causes  are  fixed. 

The  handling  is  along  general  surgical  lines  according  to  con- 
ditions. 

14.  Over  Size  of  the  male  apparently  acts  as  a  bar  to  copula- 
tion in  some  cases.  An  old  bull  may  become  so  heavy  and  fat 
that  it  becomes  difficult  for  him  to  mount  cows.  Zschokke  also 
suggests  that  overfilling  of  the  rumen  may  so  weight  a  bull  as  to 
render  his  mounting  a  cow  exceedingly  difficult.  The  nature  of 
the  condition,  itself,  indicates   the   rational  method  of  handling. 

15.  The  Age  of  the  male,  especially  as  related  to  size  and 
maturity,  may  affect  his  ability  to   copulate.      We   have  already 


hifedious  Diseases.     Examinatioii  of  the  Male  151 

referred  to  the  danger  to  small  or  young  bulls  in  attempting  to 
serve  mature  cows  of  large  size.  If  this  disparity  in  size  be  too 
great,  copulation  may  be  not  only  unsafe  but  even  impossible. 

With  an  undersized  young  male,  care  should  be  taken  to  give 
him  an  advantage  in  the  breeding  place.  The  hind  feet  of  the 
cow  should  rest  upon  lower  ground  than  that  upon  which  the 
bull  stands  and  the  ground  should  be  dry  and  of  a  character  to 
afford  secure  footing.  The  breeding  stocks  recommended  by 
Zschokke  and  briefly  described  on  page  61  may  here  be  used 
with  benefit. 

IV.  Infectious  Diseases. 

In  describing  the  venereal  diseases,  (page  73)  we  have  already 
recorded  their  tendency  to  the  production  of  sterility,  especially 
in  the  dourine  of  the  stallion  and  infectious  granular  venereal 
disease  of  cattle.  On  page  68  we  have  alluded  to  the  tendencj^ 
of  epizootic  cellulitis,  or  pinkeye,  to  cause  sterility  in  the  stallion. 

The  Ex.\mination  of  the  Male  in  relation  to 
Sexual  Efficiency. 

The  ultimate  test  of  sexual  efficiency  in  the  male  is  the  regu- 
lar production  of  young.  This  test  is  not  always  before  us  nor 
is  it  always  essential.  Such  conditions  as  abdominal  cryptor- 
chidy,  chronic  orchitis  with  enlargement  and  induration  of  the 
testicles  and  numerous  other  conditions,  require  no  physiologic 
test,  but  the  anatomical  conditions  alone  warrant  a  verdict  of 
sterility  of  an  incurable  kind.  ,  When  he  fails  in  the  test,  the 
question  ari.ses  as  to  the  cau.se  of  sterility,  its  prognosis  and 
handling. 

i\n  animal  may  be  highly  fertile  at  a  given  time,  be  fatted  for 
the  show^  ring  or  sale  and,  a  few  montlis  later,  may  prove  to  be 
wholly  and  irrecoverably  sterile.  In  our  examination,  we  need 
first  secure  from  the  owner  or  caretaker  a  history  of  the  animal 
as  a  breeder,  the  breeding  anamnesis.  The  veterinarian  should 
determine  the  presence  or  ab.sence  of  .sexual  desire  by  bringing 
the  male  into  the  presence  of  a  .strange  female  and  ob-serving  his 
actions.  A  careful  distinction  should  be  made  between  an  ab- 
sence of  sexual  desire  and  a  failure  of  erection  of  the  penis. 

In  the  presence  of  sexual  desire,  his  ability  to  mount  the  fe- 
male and   copulate  should  be   tested.     It  should  be  determined 


152  Veterinary  Obstetrics 

whether  ejaculation  occurs  or  not.  The  act  of  ejaculation  may 
be  observed  b}-  watching  over  the  course  of  the  urethra  for  the 
wave-like  movements  caused  by  the  propulsion  of  the  fluid 
through  the  channel.  If  ejaculation  has  not  occurred,  when  the 
male  dismounts,  the  penis  is  still  erected,  probably  more  than  at 
the  commencement  of  the  effort.  This  is  especially  notable  in 
the  stallion. 

In  some  animals,  especialh'  the  mare,  a  large  portion  of  the 
semen  is  at  once  expelled  from  the  vagina  and  may  thus  or  other- 
wise be  readily  secured  for  further  observation. 

The  manual  exploration  of  the  .sexual  organs  needs  be  careful 
and  complete.  The  testicles  should  be  normal  in  size,  form, 
location  and  density  and  free  from  adhesions.  Their  surfaces 
should  be  smooth  and  even  and  the  spermatic  cords  normal  in 
size,  soft,  movable  and  regular.  The  acces.sory  glands — vesiculae 
seminales,  Cowper'sand  prostate — and  the  vasadeferentia  may  be 
examined  manually  in  the  larger  males  and  digitally  in  the 
smaller,  and  any  disease  or  marked  abnormality  noted.  For  this 
purpose,  the  veterinarian  in  a  breeding  district  should  make  him- 
self expert  in  the  palpation  of  the  internal  genital  organs  by  rec- 
tal exploration.  The  novice  can  draw  no  .safe  conclusions  by 
rectal  palpations,  which  acquire  diagnostic  value  only  by  re- 
peated application  in  practice. 

The  penis  needs  be  completely  exposed  for  proper  examina- 
tion, when  diseases  and  deformities  may  be  readily  detected. 
The  urethral  opening  should  be  carefully  inspected  and,  if  neces- 
sary, explored  to  any  desired  distance  with  a  sound   or  catheter. 

The  quantity  and  quality  of  food  should  be  carefully  deter- 
mined and  the  amount  of  exercise  or  work  permitted  or  enforced 
should  be  learned. 

Finally,  much  may  be  learned,  if  the  animal  copulates,  by  an 
examination  of  the  .semen.  While  the  seminal  fluid  can  be  pre- 
served for  hours  and  carried  a  long  distance,  it  is  preferable  to 
examine  it  at  the  breeding  place.  Immediately  after  service  by 
the  male,  semen  should  be  taken  from  the  vagina  and  placed  in 
a  watch  crystal  or  on  a  slide  with  a  cover  glass  and  examined 
under  a  low  power  microscope. 

If  this  is  not  practicable  and  it  is  desired  to  make  the  examina- 
tion at  a  point  distant  from  the  breeding  place,  freshly  ejaculated 
semen  may  be  placed   in   a  flask,  which    should  be  immersed  in 


Sterility  of  the  Female  153 

water  at  about  100°  F.  and  maintained  at  this  temperature  until 
the  examination  can  be  made.  This  should  be  done  with  as 
little  delay  as  practicable. 

The  spermatozoa  should  be  abundant  and  show  ver}'  vigorous 
movements.  Even  then,  it  is  at  times  difficult  to  judge  exactly. 
We  have  examined  semen  from  stallions  of  very  low  fertility, 
which  contained  abundant  motile  spermatozoa.  The  low  fertility 
apparentl}^  depended  upon  a  want  of  vigor  or  virilitj'  in  the  sper- 
matozoa, not  distinguishable  under  the  microscope.  But  the 
presence  of  abundant  living  spermatozoa  leads  to  the  valuable 
conclusion  that  the  glands  are  functioning  and  that  the  fertility 
may  be  heightened  or  perfected  by  bringing  about  a  higher  de- 
gree of  bodily  vigor  of  the  male  through  properly  regulated  food, 
work  and  other  agents  and  the  virility  and  fecundating  power  of 
the  spermatozoa  themselves  raised  thereby  to  the  normal. 

B.  Sterility  of  the  Female. 

The  consideration  of  sterility  in  the  female  may  be  outlined  as 
follows  : 

I.  Diseases  and  Defects  of  the  Ovaries. 

1.  Congenital  Defects. 

2.  Oophoritis. 

3.  Tuberculosis. 

4.  Tumors. 

5.  Edema. 

6.  Cystic  and  Fibrous  Degeneration  of  the  Ovaries.  Nym- 
phomania. 

7.  Persistence  and  Hypertrophy  of  the  Corpus  Luteum. 

8.  Senile  Atrophy. 

9.  Debilitating  Diseases,  Emaciation,  Overwork. 

II.  Defects  and  Diseases  of  the  Oviducts,  Uterus, 

Vagina  and  Vulva. 

1.  Arrests  in  Development. 

2.  Salpingitis  and  Occlusion  of  the  Oviducts. 

3.  Metritis. 

4.  Edema  of  the  Uterine  Walls. 

5.  Tumors  of  the  Genital  Tract  and  of  the  Broad  Ligaments. 


154  Veterinary  Obste tries 

6.  Occlusion  of  the  Os  Uteri. 

7.  Atony  and  Dilation  of  the  Cervix  Uteri. 

8.  L0.S.S  of  Cotyledon.s. 

9.  Vaginitis. 

10.  Persistent  Hymen. 

11.  \'ulvo- Vaginal  Adhesions,  and  Constrictions. 

12.  Horizontal  Vulvar  Opening. 

13.  Rupture  of  the  Perinaeuni  and   Recto-vaginal  Fistula. 

III.  Impediments  to  Copul.vtiox  and  Fecuxdatiox  refer- 

AHLE  TO  Nervous  Disorders. 

1.  Excitability. 

2.  \'aginismus. 

3.  Violent  Expulsive  Efforts  following  Coitus. 

IV.  Extreme  Variatioxs   ix    vSize  of  Male  axd  Female. 

V.   IxFECTious  Diseases. 


I.   DEFECTS  AND  DISEASES  OF  THE  OVARIES 
I.   Congenital  Defects  of  the  Ovaries. 

The  fundamental  basis  of  fertility  in  the  female  is  the  living, 
fertilizable  ovum,  which  must  be  elaborated  by  the  ovary,  dis- 
charged therefrom,  caught  up  by  the  pavillion  of  the  oviduct, 
met  and  fertilized  by  the  spermatozoa  of  the  male  and,  migrating 
along  the  oviduct,  reach  the  uterine  cavity  and  establish  intimate 
relations  with  the  uterine  walls,  by  which  it  may  secure  nourish- 
ment. 

The  function  of  the  ovary  is  fundamental  in  character,  elabo- 
rating the  ovum  and  discharging  it  when  the  ovisac  ruptures. 
This  completed,  the  direct  function  of  the  ovary  ceases  and  its 
relation  to  fertilization  and  the  maturation  of  the  fetus  is  chiefly 
at  an  end.  Still,  it  exerts  an  influence.  If  the  ovaries  of  a 
pregnant  animal  are  removed,  there  is  a  definite  tendency  toward 
abortion  and  it  seems  that  it  is  not  the  ovaries  as  a  whole  which 
exert  this  influence  upon  the  fetus,  but  the  corpus  luteum,  which 
remains  at  the  seat  of  the  ruptured  ovisac,  from  which  the  im- 
pregnation has  resulted.  According  to  Hess,  if  the  corpus 
luteum  is  forced  from  the  ovary  of  a  pregnant  cow,  she  will 
abort.  Very  rarely  also  the  fertilization  of  the  ovum  occurs 
while  it  is  yet  in  the  ovisac,  but  presumably  only  after  its  rup- 
ture, while  the  egg  remains  adherent  to  the  walls.  Eventually 
this  cau.ses  the  exceedingly  rare  phenomenon  of  ovarian  preg- 
nancy. The  completed  function,  therefore,  of  the  ovary  includes 
ovulation,  since  it  is  immaterial  how  many  ova  the- gland  con- 
tains until,  by  discharge,  they  become  available  for  fertilization. 

The  causes  of  non-ovulation  are  numerous  and  mas^  consist 
either  in  the  failure  of  the  ovaries  to  produce  mature  ova  or  of 
the  intervention  of  some  obstacle  to  the  rupture  of  the  ovisac  and 
escape  of  the  egg. 

Arrest  in  development  or  ab.sence  of  the  ovaries  occurs  with 
approximately  the  same  frequency  as  the  analogous  condition  of 
the  testicles,  with  the  exception  that  the  female  gland  does  not 
fail  to  attain  functional  maturity  because  of  defective  location, 
its  normal  adult  position  being  within  the  abdomen,  not  widely 
separated  from  the  point  of  embryonic  origin. 
155 


156  Veterinary  Obstetrics 

In  rare  cases,  the  ovaries  are  displaced  by  passing  beyond  their 
normal  adult  position  and,  escaping  through  the  abdominal  ring, 
come  to  rest  in  the  region  corresponding  to  the  scrotum  of  the 
male.  However,  this  false  position  does  not  interfere  with  their 
function,  like  the  abdominal  retention  of  the  testicles. 

Freemartins.  In  bovine  twins,  we  meet,  frequentlv,  with  an 
interruption  in  the  .sexual  development  of  one  of  the  pair,  which 
is  generally  known  by  the  term  "  freemartin."  The  general  be- 
lief among  breeders  is  that  when  both  twins  are  of  the  .same  sex 
they  are  normally  developed  but  that,  when  one  is  a  male  and  the 
other  a  female,  the  latter  undergoes  an  arrest  in  development  aud 
becomes  a  freemartin.  As  a  matter  of  fact,  this  is  not  always 
true  and  a  pair  of  twins  representing  both  sexes  may  be  com- 
pletely developed  and  capable  of  breeding,  but  very  largely  the 
rule  holds  that  a  freemartin  is  one  of  a  pair  of  twins,  the 
other  of  which  is  a  perfect  male. 

The  origin  of  this  peculiarity  has  not  been  well  determined. 
While  similar  arrests  in  development  are  .seen  occasionally  in  all 
species  of  animals,  whether  twins  or  not,  there  is  no  other  in- 
stance where  such  a  condition  is  expected  with  such  regularity. 
It  is  a  quite  possible  that  the  defect  is  due  to  the  fact  that,  in 
such  ca.ses,  we  have  to  do  with  homologous  twins  which  have 
originated  from  the  division  of  a  single  ovum,  after  impregnation, 
and  that  one  of  the.se  has  suffered  from  an  arrest  in  .sexual  devel- 
ment.  Why  the  other  should  be  always,  or  usually,  a  male  has 
not  been  discovered. 

The  character  of  these  animals  is  generally  quite  uniform  In 
form,  voice,  behavior  and  other  attributes  they  are  frequently 
asexual.  The  head  and  neck  partake  neither  of  the  character  of 
the  cow  nor  bull,  but  remind  one  more  of  an  animal  which  has 
been  castrated  very  young  and  has  developed  no  sexual  charac- 
teristics. The  horns  are  fine,  usually  straight  and  not  very 
large.  The  head  and  neck  are  fine.  They  behave  and  feed  like 
castrated  animals,  and  usually  show  no  trace  of  sexual  desire. 

Examined  externally,  they  usually  show  at  the  ordinary  loca- 
tion of  the  vulva  a  small  urethral  opening,  having  the  general 
appearance  of  that  organ,  though  very  diminutive. 

Examined  internally,  the  genital  organs  are  generally  found 
to  have  been  arrested  in  the  indifferent  stage  of  development 
where  the  sexual  characters  are  not  yet  far  enough   advanced   to 


Co7igenital  Defects  of  the  Ovaries  157 

state  whether  it  be  male  or  female.  The  vagina  and  uterus  may 
be  somewhat  developed  but  are  ver}'  rudimentary,  while  the  es- 
sential glands  may  resemble  more  or  less  the  testicle  or  the  ovary 
but,  as  a  rule,  can  scarcely  be  classified  as  either  but  simply  as  a 
genital  gland  in  the  indifferent  state. 

Freemartins  are  frequently  spoken  of  as  hermaphrodites  and, 
in  a  certain  sense,  they  may  be  so  regarded  but,  since  they  fre- 
quently have  neither  sexual  desire,  character,  nor  power,  it  would 
be  better  to  speak  of  such  as  neuters. 

It  is  sometimes  important  that  it  be  determined  as  early  as 
possible  after  the  birth  of  twin  calves  if  one  of  the  pair  is  a  free- 
martin  or  not.  At  an  early  age  the  question  may  sometimes  be 
satisfactorily  answered  by  observing  the  size  and  form  of  the 
vulva,  especially  by  comparing  it  with  a  normal  calf  of  similar  age 
and  size.  If  the  vulva  is  normal,  it  is  probably  a  normal  heifer  ; 
if  small,  it  is  probably  a  freemartin.  In  a  freemartin,  the  cavity 
of  the  vagina  is  frequently  absent,  which  may  be  recognized  by 
the  inability  to  introduce  a  sound  or  a  finger  beyond  the  meatus 
urinarius.  As  the  age  of  puberty  approaches,  the  differentiation 
between  heifers  and  freemartins  becomes  greatly  facilitated. 
The  vulva  does  not  grow  or  it  might  better  be  said  that  a  vulva 
does  not  exist,  but  rather  a  urethral  opening  in  the  perineal 
region,  very  narrow,  constricted  and  scarcely  admitting  of  the 
insertion  of  a  man's  finger.  No  clitoris  is  recognizable.  The 
animal  fails  to  develop  .sexual  characters  in  form,  voice  or  be- 
havior. In  some  cases  there  is  pre.sent  a  definite  vulva  into 
which  two,  three  or  more  fingers  may  be  passed.  Rectal  explor- 
ation may  reveal  ovaries  and  uterus  or  cornua  in  varying  degrees 
of  perfection  and  estrum  may  occur. 

Hermaphroditism  habitually  leads  to  an  arrest  in  the  devel- 
opment of  the  ovary,  by  which  it  retains  more  or  less  of  its  fetal 
character  and  fails  to  function. 

In  mules  and  other  hybrids  the  ovaries  fail  to  produce  fer- 
tilizable  ova  as  a  rule,  to  which  there  are  rare  exceptions.  In 
these  animals  there  is  usually  a  well  marked  or  even  exaggerated 
sexual  desire,  presumably  due  to  the  development  of  imperfect 
ova,  followed  by  ovulation. 

Like  the  testicles,  the  ovaries  are  sometimes  the  seat  of  der- 
moid cysts,  which  may  contain  hair  or  teeth.  They  are  neces- 
sarily congenital  and  may  attain  indefinite  size.     Usually  involv- 


158  Veterinary  Obstetrics 

ing  the  gland  to  such  a  degree  as  to  compromise  the  formation 
or  persistence  of  normal  ovarian  parenchyma,  ovulation  from  the 
affected  gland  does  not  appear  and  sexual  desire  is  not  induced 
by  the  presence  of  such  glands,  though,  if  one  be  normal  and 
the  other  has  undergone  aberration,  estruni  and  even  fertiliza- 
tion may  result  from  the  presence  of  the  one  normal  ovary. 

Calcareous  degeneration  of  the  ovaries  may  occur  as  a  con- 
genital defect,  the  gland  assuming  a  variable  form  and  size  and 
consisting  essentially  of  a  mass  of  calcareous  matter  devoid  of 
proper  ovarian  tissue.  The  condition  leads  to  sterility  and  ab- 
sence of  sexual  de.sire. 

In  many  cases  of  arrested  development  of  the  ovaries,  the  sex- 
ual desire  and  attributes  are  wholly  absent.  In  most  instances 
of  the  undeveloped  ovaries,  except  in  hybrids,  the  condition  may 
be  suspected  by  the  diminutive  .size  of  the  vulva.  In  ca.ses  of 
dermoid  cysts  and  congenital  calcification  of  the  ovaries,  the  con- 
dition may,  usually,  be  determined  by  rectal  or  vaginal  explora- 
tion. 

This  group  of  affections  is  essentially  incurable,  from  a  breed- 
ing .standpoint.  When  the  ovaries  are  so  defective  that  they  in- 
duce no  .sexual  desire  and  cau.se  no  inconvenience  to  the  patient, 
no  interference  is  demanded.  When  dermoid  cysts  or  other  de- 
fects induce  undesirable  conditions,  the  removal  of  the  involved 
gland  is  indicated.  In  all  these  cases  where  nymphomania,  or 
perverted  .sexual  desire,  is  present,  castration  is  indicated. 

Oophoritis.  Inflammation  of  the  ovaries  is  rare  in  the  domestic 
animals  and  the  symptoms  are,  usually,  not  recognized  during 
life.  Upon  post-mortem  examination,  it  is  not  rare  to  find  the 
ovaries,  especially  of  cows,  studded  over  with  fibrous  tufts,  point- 
ing to  an  inflammatory  origin,  or  the  glands  adherent  to  the  pavi- 
lion of  the  oviduct.  Adhesions  of  the  ovary  to  the  pavilion  of 
the  oviduct  is  sometimes  recognizable  by  manual  exploration  per 
rectum,  but  the  condition  is  not  subject  to  remedy,  so  far  as 
breeding  is  concerned.  Such  animals  may  be  castrated  and  pre- 
pared for  the  butcher. 

3.  Tuberculosis  of  the  Ovaries  is  observed  in  cows  as  a  cause 
of  chronic  oophoritis  and  sterility  and  may  occur,  more  rarely, 
in  other  animals.  Zschokke  denies  that  tubercular  ovaries  consti- 
tute a  common  cause  of  .sterility,  and  records  that  among  no 
sterile  cows  but  2  %  were  referable  to  ovarian  tuberculosis. 


Tumors  of  the  Ovaries  159 

According  to  this  authorit}',  ovarian  tuberculosis  does  not,  as 
a  rule,  cause  nymphomania  or  produce  other  symptoms  during 
life  beyond  sterility,  which  may  be  further  identified  by  palpa- 
tion of  the  glands,  when  they  may  be  found  enlarged  and  nodu- 
lar. A  further  aid  in  diagnosis  may  be  secured  by  the  tuber- 
culin test.     The  affection  is  beyond  remedy. 

4.  Tumors  of  the  Ovaries  are  somewhat  rare  in  domestic 
animals  but  are  found,  occasionally,  in  all  species. 

They  may  be  malignant  in  character  and  tend  to  acquire  large 
size  before  their  presence  is  suspected  or  discovered.  There  are 
sometimes  seen  adenoid  tumors  of  great  size.  In  the  museum  of 
the  New  York  State  Veterinary  College  is  an  adenoid  ovarian 
tumor  from  a  sow,  weighing  38  pounds.  Becoming  sterile,  she 
was  fatted  and  upon  slaughter  the  immense  tumor  was  dis- 
covered. Cystic  tumors  are  occasionally  seen  of  immense  size, 
especially  in  the  mare. 

Ovarian  tumors  tend  constantly  to  cau.se  sterility  with  or  with- 
out nymphomania.  A  tumor  of  one  ovary  constantly  tends  to 
inhibit  ovulation  from  the  other  gland.  It  is  usually  either  the 
sterility  or  accompanying  nymphomania  which  attracts  attention 
to  the  animal  and  leads  to  an  examination  per  rectum  or  vagi- 
nam,  which  discloses  the  presence  of  the  tumor. 

Tumors  of  the  ovary  are  to  be  identified  by  their  location,  the 
absence  of  the  normal  ovaries  and  the  presence  of  the  tumors  to 
which  the  corresponding  uterine  cornua  lead  and  are  attached. 
The  ovarian  tumor  may  contract  extensive  and  firm  adhesions 
with  the  walls  or  viscera  of  the  abdomen  or  pelvis  and  thus  com- 
plicate the  question  of  diagnosis.  Its  true  character  is  then  to 
be  determined  by  tracing  along  the  uterus,  cornu  and  oviduct  to 
the  ovary  and  thus  indentifying  it  by  its  relation  to  the  uterus. 
We  have  observed  the  tumor  displaced  by  such  adhesions,  .so 
that  it  occupied  a  quite  abnormal  location.  If  essential  to  a  cor- 
rect diagnosis,  an  exploratory  incision  may  be  made  through  the 
vaginal  walls  in  the  mare  or  cow  or  through  the  abdominal  walls 
in  the  smaller  animals.  If  discovered  while  it  is  of  operable 
.size,  it  should  be  promptly  removed.  When  involving  one 
ovary  only,  the  successful  removal  of  the  tumor  will  usually  re- 
store to  functional  activity  the  remaining  normal  gland. 


i6o  Veterina}-y   Obstetrics 

5.  Edema  of  the  Ovaries  is  described  by  Zschokke  as  occur- 
ring, in  his  experience,  in  old,  nymphomaniac  cows.  The  ovaries 
are  somewhat  enlarged  and  contain  a  few  small  follicles  but  no 
corpora  lutea.  Upon  incision,  the  dropsical  fluid  is  easily  pressed 
out  from  the  cut  surface.  The  cut  surface  is  grayish  red  in  color 
and  shows  the  usual  characters  of  edema,  w^hich  is  confined  to 
the  gland  itself. 

The  abnormality  is  to  be  differentiated  chiefly  from  cystic  ova- 
ries and  persistent  corpora  lutea.  Examining  the  glands  care- 
fully per  rectum,  the  touch  reveals  the  somewhat  large,  soft, 
5delding  ovary  in  contrast  to  the  firm  fluctuating  and  sharply 
defined  cysts  of  cystic  degeneration  or  the  prominently  enlarged 
and  comparatively  firm,  non-fluctuating  persistent  yellow  body. 

The  dependent  sterility  is  usually  beyond  remedy  and,  in  case 
of  nymphomania,  ovariotomy  should  be  performed  in  order  to 
cure  the  vice  and  permit  the  cow  to  be  fatted  for  the  butcher. 


CYSTIC  AND  CYSTO-FIBROUS  DEGENERATION  OF 
THE  OVARIES  OF  COWS.     NYMPHOMANIA' 

The  most  frequent  and  important  disease  of  the  ovaries  is 
cystic  degeneration,  to  which  Zangger  was  the  first  to  draw  at- 
tention, in  the  Schweitzer  Archiv.  fiir  Tierheilkunde,  Volume 
XXII,  1859,  page  280. 

It  is  essential  to  a  proper  comprehension  of  the  subject  that  we 
have  in  mind  a  brief  outline  of  the  formation,  rupture  and  oblit- 
eration, or  astresia,  of  the  Graafian  follicles  and  that  we  recog- 
nize the  significance  of  the  formation  and  degeneration  of  the 
corpus  luteum  for  the  further  deyelopment  of  ovisacs  and  the 
origin  of  ovarian  cysts,  in  which  we  follow  the  highly  scientific 
and  meritorious  investigations  and  contributions  of  our  anato- 
mist. Professor  Doctor  Rubeli. 

It  is  known  that  the  reproductive  cells  originate  from  the  gerniiiial  epi- 
thelium, which  sinks  down  into  the  stroma  of  the  ovary  in  the  form  of  cell 
tubes.  The  formation  of  ova  in  hoofed  animals  is  generally  completed  at 
the  time  of  birth.  According  to  Bonnet,  there  may,  in  exceptional  cases, 
be  a  possibility  of  a  new  invagination  of  the  germinal  epithelium  upon  the 
margin  of  a  ruptured  ovisac. 

The  primitive  ova  in  the  young  ovary  either  lie  somewhat  scattered,  as  in 
ruminants  and  swine,  or  arranged  in  groups  in  the  peripheral  layer  of  the 
ovary.  When  the  germinal  epithelium  has  ceased  its  invagination,  the  hoi  tea 
albtigiiiea  is  formed  as  the  outermost  zone  of  the  stroma,  over  which  the 
ovarian  epithelium  extends.  The  primary  eggs  then  become  s  parated  from 
each  other  by  the  ingrowth  between  them  of  the  ovarian  stroma,  which 
pushes  in  between  the  cells  and  leaves  each  ovum  surrounded  by  a  single 
layer  of  smooth  cells,  constituting  the  primary  follicular  epithelium.  Heitz 
(Archives  fiir  Wissensch.  u.  Prakt.  Tierheilkunde,  Vol.  32,  1906)  recog- 
nizes that,  in  the  ovaries  of  calves,  the  epithelium  may  consist  of  a  single 

'  In  the  following  pages,  (161-234)  so  far  as  they  deal  with  sterility  and 
nymphomania  due  to  cystic  or  cysto-fibrous  degeneration  of  the  ovaries,  to 
persistent  corpora  Itiiea,  or  to  pj-ometra  in  cows,  we  have,  with  his  permis- 
sion, inserted,  essentially  entire,  the  admirable  report  of  Prof.  Dr.  E.  Hess 
of  the  Bern  veterinary  school,  entitled  "The  Sterility  of  Cows  ",  presented 
at  the  Annual  Convention  of  Swiss  Veterinarians  at  Freiburg  the  19th  of 
October,  1905,  and  appearing  in  the  Schweizer  Archiv.  fiir  Tierheilkunde, 
No.  6,  1906,  page  351.  The  illustrations  and  some  brief  additions,  in  [  ] 
are  our  own. 

II  161 


1 62  Veferinary  Obstetrics 

layer  of  endothelium-like  cells  or  of  a  concentrically  arranged  double  layer. 
From  the  primary  follicular  epithelium  there  develops  from  the  cells  a  cy- 
lindrical epithelium,  which  thus  forms  several  layers.  Regardin<.(  the  origin 
of  the  follicular  cells,  opinions  var}-.  While,  in  the  lower  vertebrates,  these 
cells  certainlv  originate  from  the  germinal  epithelium  and  this  source  for 
the  mammalia  is  accepted  by  many  investigators,  Kcilliker,  Rouget  and 
Biihler  believe  that,  in  the  formation  of  the  follicular  epithelium,  the  me- 
dullarv  fibres,  or  genital  portions  of  the  Wolffian  bodies,  play  an  important 
part,  or,  indeed,  in  the  case  of  the  dog,  cat  and  fox,  constitute  the  exclusive 
source  of  these  cells.  Heitz  observed  in  the  calf,  in  the  neighborhood  of 
an  ovum  surrounded  by  so-called  primitive  follicular  epithelium,  a  group 
of  granulation  cells,  which  so  increased  at  that  point  where  the  ovum  w-as 
located  that  an  excavation  took  place  and,  thereby,  completely  encom- 
passed it.  The  granulation  mass  either  already  contained  the  ovum  before 
the  development  of  a  follicular  cavity  or  else  accjuired  this  cavity  after  the 
egg  was  completely  surrounded.  One  of  the  foregoing  conditions  appears, 
from  these  observations,  to  be  the  ordinary  course  in  the  calf. 

As  soon  as  the  follicle  has  acquired  a  certain  size,  it  ruptures  and  dis- 
charges the  egg  and  the  follicular  fluid.  There  is  still  a  division  of  opinion 
as  to  the  cause  of  the  rupture  of  the  follicle.  It  is  highly  probable  that 
there  occurs  a  sudden  augmentation  of  follicular  liquid  owing  to  vasomotor 
irritation  of  the  nerves  and,  consequently,  a  greater  pressure  on  the  part  of 
this  fluid,  along  with  .'■imultaneous  thinning  of  the  follicular  walls  at  that 
part  of  the  vesicle  where  it  is  to  rupture.  Holzl,  on  the  other  hand,  com- 
pares the  rupture  with  that  of  the  formation  of  an  abcess,  in  that,  between 
the  granular  membrane  and  the  thecafol  iculi  there  occurs  an  important  ac- 
cumulation of  migratory  cells  which  form  the  so-called  theca  folliculi  interna. 

Under  the  pressure  of  this  infiltrated  cell  mass,  the  contents  of  the  follicle 
are  expelled  in  the  direction  of  least  resistance,  that  is,  upon  the  external 
surface.  Zschokke  holds  a  similar  view,  though  he  does  not  attribute  the 
rupture  to  the  infiltration  of  the  migratory  cells,  but  to  the  multiplication 
of  the  cells  of  the  theca  itself  at  the  base  of  the  follicle.  From  the 
view-point  of  these  two  investigators,  the  thickening  of  the  theca  interna 
at  the  base  of  the  follicle  and  the  thinning  of  the  wall  upon  the  surface  of 
the  ovary  has  a  special  importance.  However,  it  is  essential  to  remember 
that  the  unequal  thickness  of  this  membrane  must  be  referred  to  the  con- 
dition of  the  blood  supply  since,  indeed,  the  vessels  become  atrophied 
in  that  part  of  the  follicle  where  the  rupture  is  to  occur,  and,  hence,  the 
nutrition  of  this  part  of  the  theca  becomes  deficient.  If  now  the  mem- 
brane increases  in  thickness  on  one  .side  and  decreases  on  the  other,  so  will 
the  follicular  contents  be  massed  against  the  thin  portion  of  the  w-all.  The 
rupture  of  the  follicle,  consequently,  does  not  become  inevitable  except 
there  occurs  a  simultaneous  increase  of  the  intra-follicular  pressure  and  an 
atrophy  of  the  wall  at  the  most  prominent  point,  where  it  is  to  be  ruptured. 
If  the  latter  were  not  the  case,  there  would  necessarily  occur  more  or  less 
hemorrhage  when  the  follicle  breaks,  which,  however,  Zschokke  himself 
denies  for  the  cow. 

Against  the  Holzl-Zschokke  view  there  is,  first  of  all,  the  occurrence  of 


Cystic  Degeneration  of  the  Ovaries  163 

atresia  of  the  follicle,  since,  in  this  case,  indeed,  the  theca  interna  becomes 
extraordinarily  thickened  yet  does  not  lead  to  rupture  of  the  follicle  be- 
cause, in  that  case,  the  follicular  fluid  becomes  decreased  and  the  pressure, 
as  a  consequence,  is  lessened. 

Zschokke  believes  that  a  simple  increase  of  the  follicular  fluid  can  not 
occur  through  hyperaemia  because  artificial  or  inflammatory  hyperaemia 
does  not  cause  ovulation  ;  on  the  contrary,  it  is  to  be  observed  that  a  local 
hyperaemia  which  afi^ects  the  theca  folliculi  alone  evidently  exerts  a  differ- 
ent influence  from  an  artificial  or  inflammatory  hyperaemia  which  involves 
the  entire  ovary.  It  is,  moreover,  to  be  remarked  that  the  pressure  of  the 
follicular  fluid  in  follicles  of  different  sizes  is  variable  in  degree  because  the 
amount  of  fluid  evidently  varies  with  the  size  of  the  follicle,  whereas  the 
intrafoUicular  pressure  alone  can  have  the  power  to  rupture  the  follicle. 

Zschokke  believes  also,  a  conclusion  based  upon  personal  observation- 
that  ovulation  often  occurs  in  the  beginning  of  estrum  and  that  it  is,  conse- 
quently, to  be  held  that  the  rupture  of  the  follicle  occurs,  in  some  cases, 
l9efore  estnmi  has  reached  its  zenith.  We  hold,  on  the  one  hand,  from 
facts  known  for  many  decades,  that  ovulation,  which  is  to  be  regarded  as 
the  manifestation  of  vaso-dilation,  ushers  in  estrum  ;  we  might  however, 
on  the  other  hand,  emphasize  the  fact  that  the  most  evident  normal  clinical 
symptoms  of  estrum  are  not  to  be  regarded  as  occurring  at  the  same  moment 
as  the  highest  degree  of  ovarian  hyperaemia.  It  seems  to  us  far  more 
probable  that  hyperaemia  of  the  ovary  precedes  that  of  the  uterus  and 
vagina  and  that  such  a  view  is  more  plausible  and  correct.  One  argument 
for  this  view  lies  in  the  fact  that,  when  cows,  especially  those  in  pasture, 
are  bred  at  the  beginning  of  estrum,  they  become  pregnant. 

In  regard  to  ovarian  cysts,  we  have  found  small  c\-stic  follicles  in  ovaries 
of  calves,  ten  to  twelve  days  old,  which  were  investigated  by  Heitz.  These 
investigations  showed  that  80  ',■  of  the  ovaries  of  cows  contained  cysts  at 
least  3  mm.  in  diameter.  In  numerous  cases,  the  cysts  had  a  diameter  of 
over  10  mm.  and  four  times  they  reached  13  mm.  Often  there  occurred  in 
certain  of  these  ovaries  one  or  more  cvsts  so  greatly  developed  that  the 
proper  tis.sue  of  the  ovary  appeared  as  an  unimportant  appendix.  By  micro- 
scopical examination  these  were  recognizable  as  internal  follicles.  The 
granulosa  exhibited  no  marked  changes,  whereas  degenerative  processes 
existed  in  the  egg.  These  follicles  do  not  rupture  spontaneously,  since 
nowhere  could  there  be  seen  yellow  bodies  or  other  evidences,  like  scars  or 
fibrous  tufts,  which  indicated  ruptured  follicles.  Many  of  these  follicles 
retrograde,  many,  perhaps,  become  cysts,  because  they  show  absolutely  no 
decrease  in  size,  in  spite  of  the  fact  that  the  egg  has  already  undergone 
serious  degeneration.  Cysts  are  not  infrequently  observed  even  before  the 
first  pregnancy. 

Also,  in  new-born  calves  and  heifers,  one  meets,  according  to  Waldeyeri 
and  others,  with  follicles  as  large  as  peas,  containing  normally  developed 
ova.      The  same  is  true  for   various   other  species   of   animals.       On  the 

'Waldeyerin  Hertwig's  Handbuch  der    Entwicklungsgeschichte,  p.  374. 


164  I'etcrijiary  Obstetrics 

whole,  these  are  rare  exceptions  in  other  animals,  while,  in  the  calf,  they 
are  extraordinarily  common. 

It  is  readily  understood  that  the  prematurely  appearing  follicles  do  not 
rupture,  for  there  is  wanting,  at  this  time,  the  hyperaemia  of  estruni, 
through  which,  after  the  advent  of  puberty,  the  intrafoUicular  pressure  in 
adults  becomes  increased. 

Heitz  could  further  determine  that  all  follicles  existing  in  calf  ovaries  had 
emanated  from  simple  primordial  follicles  and  had  no  relation  to  sheath 
follicles  or  ovarial  adenoma. 

According  to  Simon  '  the  large,  distended,  degenerated  granular  cells 
appearing  so  numerously,  lying  in  the  inner  zone  against  the  inner  walls  of 
the  cyst,  play  an  important  role  in  the  genesis  of  these  cystic  follicles. 

The  most  convincing  argument  of  all  would  be  the  recognition  of  an  ovum 
in  such  cvsts.  This  evidence  it  has  thus  far  been  impossible  for  us  to 
adduce,  since  the  cysts,  in  the  preparation  of  the  material,  were  incised  or 
ruptured,  permitting  most  of  the  contents  to  escape.  Zschokke  has  searched 
many  cysts  for  ova  but  was  unable,  in  a  single  case,  to  detect  any.  Accord- 
ing to  this  author,  it  is  well  nigh  impossible  to  secure  the  entire  follicular 
contents  and  adequately  search  them  microscopically.  The  exact  contents 
of  these  follicles  in  the  cow  need  be  fully  determined. 

I  believe  it  is  possible  to  explain  the  cause  of  the  e<istence  of  cysts  directly 
by  the  structure  of  their  walls,  without  taking  into  consideration  the  forma- 
tion or  nonfonnation  of  the  corpora  lutea,  which  view,  however,  as  is  made 
clear  by  the  preceding  quotations,  is  by  no  means  established  in  a  manner 
free  from  objection.  * 

If  we  study  the  delicate  tissues  which  make  up  the  Graafian  follicles  of 
the  ovary,  we  are  at  once  impres.sed  with  the  thought  that  the  least  general 
or  local  pathologic  changes  must  serve  to  interfere  with  the  nutritive  pro- 
cesses in  them. 

If  the  contents  of  such  a  follicle  perish  as  a  result  of  these  changes,  the 
theca,  which  no  longer  receive  adequate  nutrition,  cannot  fill  the  cavity 
and  thus  obliterate  the  existing  defect.  This  may  be  seen  in  follicular 
atresia,  in  which  a  fine-meshed  connective  tissue  network  grows  out  into 
the  follicular  cavity  from  the  theca  interna.  Through  transudation  from  the 
few  existing  vsesels,  the  liquor  folticuli  becomes  increased  and  the  follicular 
capsule  then  surrounds  a  cavity  filled  with  a  fluid  poor  in  cell  contents. 

Contemporary  with  the  destruction  of  the  follicular  contents,  there  occur 
changes  in  the  follicular  wall.  It  becomes  markedly  poor  in  cells  and  ves- 
sels. The  previously  round  cells  assume  a  polygonal  form  and  show  polar 
outgrowths,  which  establish  connections  with  neighboring  cells.  There  are 
now  observed,  in  relatively  large  numbers,  round  cells  appearing  scatter- 
ingly  amongst  the  polygonal  ones.  The  inter-cellular  .substance,  at  first 
fibrous,  becomes  more  homogeneous  in  the  outermost  zone,  which  is  al- 
most wholly  devoid  of  cells,  and  stains  intensively  with  eosin.     The  vessels 

'A.  vSimon,  Anatomisch-histologische  Untersuchungen  der  Ovarien  von  95 
Kastrirten  Kiihen,  Berner  Inaugural-Dissertation,  1904. 


Cystic  Degeneration  of  the  Ovaries  165 

ultimately  atrophy  completely,  except  upon  the  margin  of  the  external  zone, 
where  there  are  still  seen  a  few  vessels. 

It  is  precisely  this  non-vascularity  which  is  generally  typical  of  the  cyst 
walls  investigated  by  us  and,  according  to  our  view,  constitutes  the  best  in- 
dication for  the  explanation  of  the  development  of  cysts  from  Graafian  fol- 
licles. 

After  the  follicle  has  ruptured  there  occurs,  in  its  place,  the  residual  body, 
corpus  luteum.  It  is  a  more  or  less  spheroidal  body,  attaining  a  variable 
size,  according  to  whether  impregnation  has  occurred  or  not.  In  the  first  in- 
stance, it  becomes  extraordinarily  large.  It  may  exceed  by  several  times  the 
volume  of  the  gland  itself  and  persists  throughout  the  period  of  pregnancy, 
to  disappear  only  after  birth.  We  have  in  this  instance  to  deal  with  the  cor- 
pus  liiteuin  vera,  or  the  yellow  body  of  pregnancy.  In  the  latter  instance,  it 
remains  smaller  and  disappears  a  few  weeks  later ;  here  we  have  to  do  with 
a  corpus  liitea  spuriutn,  or  the  yellow  body  of  estrum. 

Among  the  alleged  causes  of  the  formation  of  these  larger  corpora  lutea 
and  their  longer  duration,  are  increased  or  decreased  blood  supply  to  the 
ovary  during  the  period  of  pregnancy.  Schulin  sees  the  cause  for  the 
greater  growth  of  the  true  corpus  luteum  in  the  decreased  supply  of  nutri- 
ment to  the  ovary.  In  this  connection,  from  observations  made  in  path- 
ology, he  emphasizes  the  fact  that  soft  granulation  masses  persist,  not  in 
vigorous,  but  only  in  feeble,  sickly  men.  Bonnet  states  explicitly  that  the 
disappearance  of  the  yellow  body  is  delayed  because  the  ovary  becomes 
anaemic  owing  to  the  fact  that,  during  pregnancy,  the  hypertemia  of  estrum 
becomes  stable  in  the  uterus,  vagina,  etc.,  as  he  has  been  able  repeatedly 
to  demonstrate  to  his  personal  satisfaction.  Holzl  takes  directly  the  oppo- 
site view.  According  to  him,  the  ovaries  should  receive  a  larger  amount  of 
nutrition  during  pregnancy  owing  to  the  increased  flow  of  blood  to  the 
genitals.  He  believes  that,  during  pregnane}',  the  ovaries  hypertrophy, 
whereas  a  badly  nourished  organ  does  not.  According  to  his  view,  the  true 
corpus  luteum  persists  for  a  longer  period  because,  during  pregnancy,  there 
is  a  regular  diapedesis  and  hemorrhage  into  the  yellow  body  so  that  one 
finds,  in  gravid  animals  and  those  in  the  puerperal  state,  yellow  bodies, 
which  are  greatly  enlarged  as  a  consequence  of  hemorrhages  into  them  and 
have  in  their  center  a  well-defined  blood  clot,  completely  enclosed.  Similar 
observations  have  not  yet  been  made  in  the  cow  since,  in  this  animal, 
hemorrhage  into  the  follicular  cavities  is  unimportant  or  wholly  absent. 
Hence  the  alleged  causes  for  the  longer  continuation  of  the  yellow  bodies 
which  have  been  oV)served  in  woman  are  not  present  in  cattle. 

The  corpus  luteion  consists  of  a  brownish-yellow  or  ochre-yellow  capsular 
layer,  which  contains  lutein  cells,  and  a  soft,  gray,  transparent  nucleus, 
which  consists  of  newly  formed  connective  tissue  containing  few  cells  and 
supplied  with  blood  ves.sels ;  sometimes  there  exists  blood  debris  derived 
from  cells  which  have  undergone  disintegration  or  fatty  degeneration,  per- 
haps mixed  with  cells,  connective  tissue  fibres,  etc.  As  the  yellow  body 
undergoes  retrograde  changes,  there  develops  a  form  of  connective  tissue, 
which  contracts  to  constitute  the  corpus  fibrosum  albicans.  The  remnant 
then  represents  merely  the  contracted   nucleus  of  the  yellow  body,  corpus 


1 66  Veterinary  Obstetrics 

fibrosuni  simplex;  or  it  may  contain  a  large  amount  of  blood  pigment, 
corpus  nigrum. 

Regarding  the  formation  of  the  yellow  body,  there  is  still  much  difference 
of  opinion.  According  to  Bischoff,  Schron,  Pfliiger  and  others,  this  struc- 
ture emanates  from  the  inctiibraiia  granulosa;  von  Baer,  Kolliker,  His, 
Spiegelberg,  Paladino  and  others  consider  that  it  is  formed  from  the  tunica 
interna  folliculi.  Large  spheroidal,  polygonal  lutein  cells  occur  wiihin  the 
fine  fibrous  connective  tissue  stroma  of  the  yellow  capsule  wall  and  contain 
large  spherical  nuclei,  nucleoli,  nuclear  debris  and  a  finely  granular  pig- 
ment ( lutein  lipochrome )  permeating  the  protoplasm.  According  to  Sabotta, 
in  the  mouse  and  rabbit,  and  to  van  Beneden  and  Honor^,  in  rabbits,  these 
certainly  ari.se  from  the  membrana  granulosa.  The  same  origin  holds  good, 
according  to  Giacomini,  and  also  Mingazzini,  for  reptiles  and  birds.  Van 
der  Stricht  saw  these  cells  derived,  in  part,  at  least,  from  the  granulosa  in 
vesperugo  noctula.  On  the  other  hand,  Clark,  Xagel,  Biihler  and  vStcikel 
are  of  the  opinion  that  the  lutein  cells  are  derived  from  the  cells  of  the 
tunica  interna  folliculi.  Zschokke  speaks  in  much  the  same  way  of  the 
origin  of  the  yellow  body  in  cattle.  He  says,  "  I  have  for  a  long  time  thor- 
oughly studied  and  sectioned  dozens  of  ovaries  of  various  animals  and  am 
fully  convinced  that  they  are  derived  from  the  tunica  interna."'  He  found 
a  distinction  in  the  nuclear  staining  of  the  granulo.sa  cells  and  those  of  the 
tunica ;  the  first  >vas  more  intense.  He  further  observed  that  the  debris  of 
the  granulo.sa  could  bs  differentiated  by  their  form  from  the  growths  ema- 
nating from  the  tunica  interna.  It  is  impossible,  however,  for  one  to  deter- 
mine the.se  differences  in  the  illustrations  in  Zschokke's  work  and  to 
recognize  which  tissue  one  is  observing  because  the  magnification  is  too 
feeble. 

The  de-stinv  of  the  yellow  bodies  is  chiefly  that  they  shall  occupy  the 
cavity  which  occurs  as  a  result  of  the  rupture  of  the  follicles. 

According  to  Bohn,  who  agrees  with  Frankel  and  Cohn,  the  yellow  body 
consists  of  a  substance  secreted  by  the  system,  being  derived  from  the  blood 
through  the  influence  of  the  attachment  of  the  egg  to  the  uterus. 
Closelv  allied  to  this,  also,  is  the  view  that  the  yellow  bodies,  through 
these  secretions,  exert  a  restraining  influence  in  a  certain  way  upon 
the  ovary  and  the  further  development  of  follicles.  In  relation  to  the  latter 
point,  perhaps,  the  simple  pressure  of  the  yellow  body  upon  the  ovary  is 
partly  responsible  for  the  result.  Zschokke  asserts  that,  where  large  cor- 
pora lutea  exist,  as  a  general  rule,  large,  ripe  follicles  are  wanting,  while,  at 
the  same  time,  in  these  animals,  estrum  is  usually  absent.  Other  veteri. 
narianshave,  on  the  other  hand,  observed  that  the  existence  of  yellow  bodies 
does  not  always  prevent  the  occurrence  of  estrum. 

In  reference  to  the  number  of  ovarian  cyst.s  occurring  in  one 
animal,  we  have  found  in  ovaries  secured  by  castration  or  after 
slaughter  that  one  gland  may  be  normal  while  the  other  has  un- 
dergone cystic  degeneration  in  an  extremely  variable  degree.  Very 
frequently    both    ovaries  suffer,  sometimes  equally,  but  far  more 


Cystic  Degeneration  of  the  Ovaries 


167 


commonh-  iu  a  different  degree.  Not  infrequently  one  observes  in 
an  ovary,  both  superficially  and  deeply,  one  to  four  cysts  ;  in  other 
cases,  one  large  cyst.  Ovaries  containing  two  to  three  large  and 
two  to  four  small  cysts  are  by  no  means  rare.  While,  under 
normal  conditions,  the  ovary  of  the  cow  varies  in  size  between  a 
bean  and  a  large  hazelnut,  the  gland  which  is  affected  with  cystic 
degeneration  shows,  upon  its  nodular  surface,  varying  numbers 
of  stellate,  radiating  or  linear  scars.  The  special  position  of  the 
cysts,  which  always  develop  from  the  follicles,  is  the  stratum  par- 
enchymatosnvi  and  especially  the  stratum  vasculosiun.  In  the 
former,  the  location  of  the  cyst  is  more  superficial  or  peripheral, 
while,  in  the  latter,  it  is  central,  The  cysts,  usually  with  smooth 
walls,  are  found  located,  as  a  rule,  at  the  inferior  or  superior 
pole  of  the  ovary  or  occur  simultaneously  in  both  positions,  and, 
generally  3  mm.  from  the  mesovarian  or  ligamentous  border  and 
i-io  mm.  from  the  free  border.  Cysts  also  occur  imediately  upon 
the  free  border^  especially  in  the  middle  of  the  organ.  It  is, 
moreover,  quite  common  to  find  in  the  center  of  the  ovary,  one 


Fig.  16.     Normal  and  Cvstic  Ovaries  of  Cow. 


A.  B,  B',  Cystic  ovaries. 

B',  Section  of  B.  showing  it  to  consist  of  two  large  cysts  and  one 

corpus  luteuui  with  no  visible  ovarian  tissue. 
C,  Section  of  the  normal  ovary,  D,  showing  ovisacs  and  one  corpus 

luteum.     One-half  size. 


1 68  Veieri7iary  Obstetrics 

to  four  follicles  of  the  size  of  a  pea  or  small  hazlenut.  These  do 
not  project  beyond  the  surface  of  the  gland,  but  occupy  the  place 
of  the  vascular  stratum,  around  which  the  external  part  of  the 
ovary  continues  to  form  a  tissue  capsule  3-8  mm.  in  diameter. 
In  isolated  instances,  also,  the  ovary  ma}'  undergo  atrophy  because 
of  the  formation  of  abnormal  follicles,  until  it  becomes  merely  a 
remnant,  in  which  only  a  few  small  follicles  can  be  distinguished. 
Many  times,  in  the  sound  portion  of  the  surface  of  the  ovary, 
there  are  observed  numerous  follicles. 

In  regard  to  the  extremely  variable  thickness  of  the  walls  of 
peripheral  cysts,  it  is  to  be  emphasized  that,  in  many  cases,  their 
walls  are  as  thin  as  paper,  consisting  of  a  very  delicate  cuticle, 
which  is  easily  ruptured  upon  pressure  ;  in  other  cases,  on  the 
contrary,  there  is  a  thickness  of  6-8  mm.,  which  explains  the 
fact  that  spontaneous  rupture  of  the  cyst  may  occur  or  that  a 
variable  degree  of  force  may  be  necessary  in  order  to  crush  it. 

Analogous  to  the  variations  in  the  strength  of  the  exterior 
walls,  there  are  also  differences  in  the  thickness  of  the  sheath 
walls  of  the  ovarian  tissue  of  the  cyst  in  one  and  the  same  ovary, 
ranging  from  1-8  mm. 

According  to  the  anatomo-histologic  investigations  of  Simon, 
already  quoted,  under  the  direction  of  our  esteemed  colleague, 
Rubeli,  in  the  Veterinary  Anatomy  Institute  of  this  college,  the 
average  volume  and  weight  of  the  ovaries  of  95  castrated  cows 

was  as  follows : 

Right  Ovary.  Left  Ovary. 

Maximum  weight.   __   25.4     gr 20.3     gr. 

Medium  weight 14-33  gr \o.\\  gr. 

Minimum  weight. 6.8     gr_ 5.2     gr. 

Maximum  length 7.0   cm 5.1     cm. 

Medium  length 4.3    cm 3.71   cm. 

Minimum   length i.o   cm 2.1     cm. 

Maximum  width 4.0   cm 3.8     cm. 

Medium  width 2.8    cm 2.36  cm. 

Minimum   width 1.7    cm 1.6     cm. 

Maximum   thicknes.s 3.9   cm_ 3.9     cm. 

Medium  thickness 2.53  cm 2.15  cm. 

Minimum  thickne.ss 1.3   cm 1.3     cm. 

According  to  these  tables  the  right  ovaries  are,  on  the  aver- 
age, greater  than  the  left,  both  in  weight  and  volume,  a  fact 
which,  concerning  the  size,  can  be  readily  determined  by  rectal 


Cystic  Degeneratio7i  of  the  Ovaries  169 

exploration.  This  indicates  a  probable  greater  functional  ac- 
tivity of  the  right  organ. 

According  to  Zschokke,  the  ovaries  of  medium  sized  animals 
weigh  approximately  14-19  gr.  The  dimensions  of  the  ovaries 
of  healthy  cows  vary  between  42  and  47  mm.  in  their  greater,  or 
longitudinal  axes,  and  12-15  "i^-  i"  their  transverse  diame- 
ters; in  heifers  they  are  approximately  23-27  mm.  and  in  aged 
cows  31-36  mm. 

It  is  to  be  observed  that  the  weight  and  size  of  the  ovaries  is, 
in  a  large  measure,  dependent  upon  prior  physiologic  occur- 
rences, such  as  estrum,  conception,  etc. 

There  is  frequently  observed  upon  the  surface  of  the  ovary 
linear  or  stellate  scars,  the  most  prominent  linear  scars  of  which 
we  attribute  to  the  rupture  of  cysts  because  these  occur  especially 
in  those  ovaries  in  which  we  have  crushed  various  cysts.  The 
stellate  scars  are  referred  by  Zschokke  and  Simon  to  the  rupture 
of  follicles  in  which  the  corpus  luteum  does  not,  as  is  the  case  in 
most  instances,  project  beyond  the  surface. 

Aside  from  these  cicatrices,  there  is  often  found  upon  the  sur- 
faces of  many  ovaries  fibrous  tufts  as  much  as  r.6  mm.  long 
which  possess  no  clinical  importance,  and  which,  according  to 
Simon,  consist  of  numerous  capillaries  and  embryonal  wavy, 
connective  tissue  fibres  with  a  few  .small  spindle  cells  and  elastic 
fibres  and  often  arise  from  the  margins  of  old  yellow  bodies. 

We  have  personally  found  that  in  cases  of  cysto-fibrous  de- 
generated ovaries,  which  had  been  vigorou.sly  crushed  two  or 
three  times  within  a  few  weeks  in  consequence  of  cystic  degen- 
eration in  the  deeper  parts  of  the  organ,  not  only  an  evident 
enlargement  of  the  gland,  but  that,  after  castration  or  slaughter, 
there  was  present  on  the  surface  of  such  ovaries  a  great  number 
of  intensely  red,  fresh,  thick  tufts,  partly  in  sheet-like  groups, 
partly  as  solitary  projections. 

ETIOLOGY. 

According  to  the  teachings  of  our  extensive  statistics,  here 
omitted  in  order  to  save  space,  cystic  degeneration  occurs  most 
frequently  in  highly  bred,  early  maturing  valuable  breeding  and 
milch  cows  of  from  five  to  eight  years  of  age  and  in  well  kept 
heifers  of  \}i  to  3  j-ears.  However,  ovarian  cysts,  in  young 
calves  and  in  aged  animals,  are  not  at   all   rare.     We  have  also 


170  I'ctcrinary   Obstetrics 

observed  ovarian  cysts  in  mares,  sheep,  goats  and  swine,  always 
in  the  latter  animals  without  nymphomaniac  symptoms.  (  vid. 
Post  Mortem  Findings  7  and  8),  [We  have  operated  for  nympho- 
mania due  to  ovarian  cysts  in  the  bitch.] 

In  regions  with  very  intensively  forced  cattle-breeding  and 
dairying,  upon  estates  where  large  quantities  of  artificial  ferti- 
lizers are  used,  artificial  foods  are  employed,  and  where  pedi- 
greed breeding  animals  are  overfed,  especially  on  rye,  distiller's 
grains,  malt  and,  in  addition,  are  constantly  stabled,  the  disease 
is  indigenous,  while,  in  animals  more  naturally  and  moderately 
fed  and  kept  much  at  pasture,  the  disease  is  far  more  rare. 

Aside  from  the  fact  that  nymphomania  is  especially  common 
in  highly  fed,  stabled  cows  and  in  certain  establishments  it  is 
also  apparent  that  there  is  a  casual  connection  in  the  frequency 
of  its  appearance  according  to  the  character  of  the  .season,  the 
change  from  grass  to  hay  feeding  and  in  conn^ection  with 
parturition. 

On  the  other  hand,  there  is  not  sufficient  evidence  to  warrant 
the  conclusion  that  ovarian  cysts  are  directly  inherited,  although, 
in  some  cases  found  among  cows  of  the  same  family.  Neverthe- 
less, we  believe  that  the  disposition  to  the  formation  of  cysts  is 
hereditary  and  that  this  tendency  becomes  emphasized  through 
intensive  feeding,  constant  stabling,  deep  milking,  frequent 
breeding  and  through  attacks  of  the  nodular  venereal  di.sea.se. 
The  tendency  to  cystic  degeneration  may  al.so  be  favored  by  all 
conditions  by  which  certain  uses,  like  milking  or  breeding,  be- 
come hereditarily  emphasized,  or  the  vital  energy  is  greatly 
depressed,  that  is,  a  predi.spo.sition  is  established  for  di.sea.ses  of 
the  milk  glands,  ovaries  and  uterus. 

The  primary  causes  of  the  formation  of  cysts  are,  as  yet,  un- 
known. Among  other  causes  which  have  been  suggested,  we 
may  mention  that  proposed  b}'  Giovanoli,'  who  believes  that  it 
may  be  due  to  cerebral  disease.  According  to  the  investigations 
of  Simon,  the  occurrence  of  ovarian  cysts  cannot  be  referred  to  a 
chronic  oophoritis  with  secondary  thickening  of  the  albuginea 
because  he  failed  to  find  in  anj^  such  ovaries  a  thickening  of  this 
tunic,  although  they  were  generally  cystic  in  a  high  degree. 


Giovanoli.     Schweizer-Archiv.  fur  Tierheilkunde,  1S97,  page  77. 


Cystic  Degeneration  of  the  Ovaries  171 

In  how  far  the  frequently  occurring  ovarian  cysts  in  new  born 
calves  and  the  presence,  in  ovarian  follicles,  of  the  coccidiiun  ovi- 
formce,  first  recognized  by  Professors  Rubeli  and  Guillebeau  and 
Dr.  Simon,  exert  an  influence  upon  the  cystic  degeneration  of 
the  ovary,  requires  further  investigation. 

A  disease  which,  according  to  our  view,  certainly  possesses 
great  etiologic  importance  is  the  granulat  venereal  disease  {va- 
ginitis et  metritis  follicidaris  infectnosa)  because  the  relative  fre- 
quenc}'  of  diseases  of  the  ovary  and  uterus  is  much  greater  after 
the  appearance  of  that  plague  than  before  ;  likewise,  one  finds,  in 
cows  and  heifers  affected  with  diseases  of  the  ovaries,  extraordi- 
narily severe  symptoms  of  vaginitis  et  metritis  follieularis 
infectuosa . 

In  one  case  we  observed  primarih',  in  a  cow,  a  prolapse  of  the 
vaginal  portion  of  the  uterus  and,  four  weeks  later,  a  large  cyst 
in  each  of  tlie  ovaries. 

Undoubtedly,  also,  the  normal  occurrence  of  birth  and  unilat- 
eral castration  exerts  an  important  influence  upon  the  formation 
of  ovarian  cysts. 

It  is  highly  interesting  to  note  that  the  data  drawn  from  over 
200  nymphomaniac  animals  observed  by  us  during  the  year  1905, 
among  which  were  three  heifers,  show  that  92^  were  aff'ected 
with  cystic  ovaries  and,  among  these,  were  found  4  head  which 
had  aborted  and  later  suffered  from  retention  of  the  placenta, 
while  all  the  others,  aside  from  the  3  heifers,  had  completed  the 
normal  duration  of  pregnancy. 

Of  the  92  f/(  above  mentioned,  5  cows  had  suffered  from  de- 
layed expulsion  of  the  after  birth  and  secondary  septic  endome- 
tritis, 4  from  torsion  of  the  gravid  uterus  and  7  from  parturient 
paresis.  So  far  as  we  could  determine,  these  cows,  which  later 
became  nymphomaniac  had  given  birth  to  approximately  the 
same  number  of  male  and  female  young. 

It  is  worthy  of  record,  also,  that,  in  one  ca.se,  there  was  found 
a  follicle  as  large  as  a  hazelnut  in  the  left  ovary  of  a  cow  which 
had  been  slaughtered  during  the  sixth  month  of  pregnancy  be- 
cau.se  of  agalactia,  she  being  fat. 

vSVMPTOMS. 

For  decades  past,  the  symptoms  induced  by  ovarian  cysts  have 
been  designated  by  the  terms  bulling  or  nymphomania.     In   the 


172  Veterinayy  Obstetrics 

latter  term,  we  recognize  a  true  or  erethetic  nyniphomania  and 
the  so-called  dumb  estrum  (stillochsigkeit),  in  which  latter,  re- 
gardless of  the  existence  of  the  sinking  of  the  great  sciatic  liga- 
ments, symptoms  of  estrum  are  either  entirely  wanting  or  are 
only  of  a  very  feeble  cliaracter. 

A.   Nymphomania. 

General  Symptoms. 

Under  normal  conditions  in  non-pregnant  cows,  estrum  occurs 
ev-ery  three  weeks  and,  if  the  milk  secretion  is  not  too  intense,  it 
begins  from  6-8  weeka  post  part ufn.  Vascillations  of  the  estrual 
periods  between  21-28  days  must  still  be  regarded  as  normal, 
while  less  than  21  or  more  than  28  days,  as  for  example,  estrual 
periods  of  6-9  weeks,  according  to  our  statistical  observations  ex- 
tending over  several  years,  can  no  longer  be  viewed  as  normal 
because  experience  teaches  that  animals  with  reduced  or  pro- 
longed estrual  periods  either  fail  to  conceive,  or  do  so  only  with 
difficult}'.  On  the  whole,  we  have  observed  that  the  normal 
duration  of  estrum  in  the  cow  is  15-24  hours  and  that  its  pro- 
longation to  30-;,6-48  hours,  progressively  diminishes  the  proba- 
bility of  conception. 

The  probability  of  conception  is  also  decreased  if  the  duration 
of  estrum  is  very  brief  or  if  it  is  excessively  intense  or  goes  to 
the  opposite  extreme  and  is  very  weak,  as  well  as  when  there  is 
a  marked  or  abundant  sanguineo-mucous  vaginal  discharge  after 
the  cessation  of  estrum.  Only  in  exceptional  cases  have  we  ob- 
served conception  to  occur  at  the  first  service  in  well  nourished 
cows,  which,  at  times,  remain  in  vigorous  heat  for  fully  48  hours. 

All  the  varied  deviations  from  the  above  described  normal 
estrum  fall  within  the  designation  of  "  bulling  "  or  of  "dumb 
estrum"  and  especially  do  we  designate  as  nymphomania  those 
cases  in  which  the  estrum  is  excessive  and  irregular  or  is  of  too 
permanent  a  character. 

In  reference  to  the  relation  ])etween  estrum  appearing  at  the 
normal  period,  the  anatomical  character  of  the  ovaries  and  the 
sinking  of  the  broad  ligaments  of  the  pelvis,  we  may  relate  the 
following  details  in  cases  presenting  the  common  characteristic 
that  they  fail  to  conceive. 

Quite  exceptionally  we  met   with   cystic   degeneration   of  the 


Nymphomania  173 

ovaries  in  cows  which  were  in  estrum  regularly  every  21  daj's 
and  showed  constant  slight  sinking  of  the  broad  pelvic  ligaments. 
In  one  instance  we  recognized  a  small  cyst  in  the  right  ovarj' 
and  a  large  one  in  the  left,  in  one  case  a  cysto-fibrous  degenera- 
tion of  the  left  ovary,  in  another  animal  etidomeh'itis  catarrhalis 
chronica,  and  in  a  third,  an  endometritis  punilcnta  chronica. 

The  usual  case  of  nymphomania  runs  a  chronic  course  without 
fever  and  shows,  among  its  complex  symptoms,  many  variations. 
Often  one  scarcely  notes  any  disturbance  of  the  general  health  ; 
in  other  cases,  it  is  clearly  linked  with  nervous  symptoms.  The 
pulse  varies  between  60-66  per  minute,  the  respirations  from  12- 
24.  The  state  of  nutrition  varies  widely  according  to  the  age, 
environment,  feeding  of  the  animal,  and  the  duration  of  the 
malady,  While  nymphomaniac  heifers  and  young  cows  w^hich 
are  handled  early  are  generall}^  in  a  good  state  of  nutrition  with 
glossy  coat  and  .soft  skin,  in  aged  breeding  and  milch  cows  the 
condition  is  only  moderate  or  even  bad.  The  live  weight  of  large 
nymphomaniac  Simmenthaler  cows,  according  to  our  records, 
varies  between  400-800  Kg.      (i  Kg.  =  2.2  lbs.  ) 

Among  the  earliest  symptoms  of  nymphomania,  is  the  failure 
of  the  milk  yield  to  increase  during  the  few  days  following  par- 
turition and  the  .so-called  "hidebound"  condition  of  the  ani- 
mal, which  maintains  well  nigh  constant  connection  with  the  for- 
mation of  ovarian  cy.sts  in  conjunction  with  slight  endometritis 
catarrhalis  acuta  and  more  rarely  rests  exclusively  and  wholly 
upon  endometritis  catarrhalis  acuta  and  is  characterized  hy  a  vi- 
cious and  restless  behavior  of  the  cow,  nervous  movements,  with 
glassy  eyes,  the  eyelids  opened  wide,  the  animal  easily  terrified, 
staring,  wild,  vicious  expression  and  dry  hair.  Sooner  or  later 
there  appears,  also,  a  loss  of  appetite  and  condition  and  decreased 
lactation.  The  animal  feeds  more  and  more  erratically,  becomes 
agitated  without  visible  cau.se,  the  agitation  not  unfrequently 
amounting  to  a  veritable  storm,  accompanied  with  pawing,  low- 
ing and  bellowing  (bellowing  disease.) 

Should  the  latter  symptoms  develop  during  the  night,  other 
cattle  in  the  same  stall  are  made  to  suffer  and  even  the  people  of 
the  house  may  be  disturbed.  In  some  cases  the  disea.sed  animal 
may  escape  from  its  fastenings,  and  opportunity  be  given  for  the 
fracture  of  the  external  angle  of  the  ilium,  the  pelvis,  etc.  Hand 
in   hand  with  these  symptoms  goes  sexual  excitement  of  great 


174  Veterhiarv  Obstetrics 

intensity  but  not  identical  with  normal  estrum  ;  sometimes  it 
follows  a  very  slight  estrum,  in  other  cases  it  is  brought  to  light 
only  when  a  cow  standing  beside  the  diseased  one  comes  into 
heat  and  very  often  is  first  observed  when  the  animal  is  out  at 
pasture.  Sexually  excited  cows  seldom  lie  down  and  only  for 
brief  periods.  They  assume  an  aggressive  behavior,  attempt  to 
rub  their  posterior  parts  upon  other  cows  or  objects,  elevate  the 
tail,  urinate  frequently,  less  frequently  exhibit  vaginal  straining 
and  neither  drink  deliberately  nor  even  graze  quietly.  In  the 
pasture  these  animals  graze  badly,  run  about,  annoy  the  herd, 
and  tear  up  the  earth  with  horns  or  hoofs.  If  the  nymphomania 
is  intensely  developed  the  animal  becomes  very  vicious  toward 
surrounding  objects,  especially  strange  persons  or  glistening 
bodies  in  bright  colors  and  falls  upon  them,  as  we  have  repeatedly 
observed,  in  maniacal  fury.  In  some  cases  of  nymphomania,  the 
affected  animals  attempt  to  mount  neighboring  cows,  bulls,  oxen, 
and  even  persons  and  continue  to  ride  the  former  for  a  long  in- 
terval ;  on  the  other  hand,  they  permit  bulls  and  also  other  cows 
to  mount  them  constantly.  [The  viciousness  of  nymphomaniac 
cows  and  their  tendency  to  mount  persons  when  not  on  their 
guard  make  such  animals  a  positive  menace  to  keepers  or  others 
who  come  in  contact  with  them,  as  we  have  had  occasion  to  per- 
sonally observe.  In  one  instance  observed  by  us,  a  previously 
kind  cow  became  dangerously  vicious  toward  women  and  would 
attack  them  furiously  at  every  opportunity.] 

There  occur  nymphomaniac  cows  with  cystic  ovaries,  however, 
which,  on  the  contrary,  resist  all  attempts  of  bulls  or  of  other 
cattle  to  mount  them.  After  a  variable  duration  of  the  malady 
the  affected  cow,  which  has  already  become  markedly  unthrifty, 
shows  an  elevated  croup,  a  forward  sinking  of  the  anus  and  vulva, 
lordosis,  stiffness  of  the  loins,  a.ssociated  with  an  upright  direc- 
tion or  knuckling-over  of  the  hind  fetlock,  "  kuhhessige  "  posi- 
tion and  often  a  slightly  staggering  gait.  That  a  nymphomaniac 
cow  may  suffer  simultaneously  from  other  disea.ses,  such  as  capped 
knee,  pelvic  fractures,  foul  in  the  foot,  etc.,  is  to  be  regarded 
merely  as  a  coincidence  and  that  old,  oft  recurring  cyst  forma- 
tion may  lead  to  an  exaggeration  of  all  the  symptoms  described 
is  readily  understood. 

According  to  the  duration  of  time  between  the  last  parturition 
and  the  advent  of  the  nymphomania,  there  is  a  somewhat  corre- 


Nymphomania  175 

spending  variation  in  the  character  of  the  udder  and  milk.  In 
most  of  the  cases  observed  by  us,  the  udders  were  large  and  finely 
developed  and  3'ielded,  before  the  advent  of  nymphomania,  8-12 
liters  of  milk  per  milking  and  only  in  a  dozen  cows  were  we  able, 
in  the  year  of  1905,  to  recognize  a  small  and  flaccid  udder  and  in 
but  a  single  animal  a  fleshy  udder  and,  in  harmony  therewith,  a 
yield  of  but  2)^  to  6  liters  of  milk  per  milking. 

In  nymphomaniac  cows  which  had  been  in  milk  for  a  long 
period  the  milk  from  one  or  more  of  the  quarters  was,  in  some 
cases,  white  and  without  coagula  but  usually  somewhat  alkaline 
or  bitter.  Occasionally  there  was  a  "  holding  up  of  the  milk  " 
during  one  milking,  a  phenomenon  which  we  attribute  to  vaso- 
motor paralysis  and  debility  of  the  vascular  muscles  of  the  teats. 

Special  Symptoms. 

Among  the  special  apparent  symptoms  of  ovarial  nymphoma- 
nia, sinking  of  the  broad  ligaments  of  the  pelvis  takes  the  first 
place.  Although  not  pathognomonic,  it  is  constant.  This  symp- 
tom may  reveal  itself  in  varying  degree  and  it  isnecessarj'  for  its 
proper  observance  that  the  animal  be  stood  in  a  normal  position 
on  even  ground. 

Concerning  the  relaxation  of  the  great  sciatic  ligaments, 
Goubaux  first  suggested  that  it  was  the  result  of  a  serous  infil- 
tration of  these  structures,  leading  to  their  elongation  and  de- 
creased tension.  In  a  similar  manner  Franck  expres.sed  the 
opinion  that,  in  addition  to  this  cause,  the  gravid  uterus  exerted 
an  influence  by  dragging  the  anus  and  vulva  downward  and  for- 
ward, thus  pulling  the  .sacro-sciatic  ligament  inwards  into  the 
pelvic  cavity.  Berdez  '  was  the  first  to  describe  the  sinking  of  the 
sciatic  ligaments  as  a  purely  mechanical  result  of  a  flexion  of  the 
pelvis  at  the  sacro-iliac  articulation  by  which  the  ligaments  be- 
came relaxed,  permitting  them  to  sink  inwards.  He  constructed 
a  highly  ingenious  model  for  that  purpose,  by  which  he  showed 
how  the  weight  of  the  gravid  uterus  upon  the  abdominal  floor 
served  to  stretch  the  sacro-sciatic  ligaments.  Shortly  prior  to 
birth  the  uterus  contracts,  the  load — fetus,  fetal  membranes  and 
waters — is  lifted  from  the  abdominal  floor  and  is  largely  supported 


1  Berdez,  Schweitz  Archiv.    fiir  Tierheilkunde  u.  Tierzucht,  vol.  4,   1882, 
page  188. 


176  Veterinary  Obstetrics 

b}'  other  agencies,  such  as  the  mesometrium,  vagina,  diaphragm 
of  the  pelvis,  etc.  The  pelvic  ligaments  are  thereby  relaxed  and 
sink  inwards.  This  very  simple  and  plausible  theory  of  Berdez 
is  opposed  by  Zschokke  because,  according  to  his  inv-estigations, 
drawing  in  the  direction  of  the  rectus  abdominis  muscle  does 
not  produce  the  effects  described  nor  can  the  unilateral  sinking 
frequently  observed  in  practice  be  explained  by  that  theory.  What 
effect  the  contraction  of  the  rectus  abdominis  muscle  exerts  is 
not  stated  by  Zschokke. 

Fuhrimann '  was  enabled  for  the  first  time,  in  our  ambulatory 
clinic,  to  recognize  that  sinking  of  the  sciatic  ligaments  occurs 
in  various  diseases  of  the  genital  organs,  as  well  as  of  the  milk 
glands,  and  is  not  at  all  confined  to  di.seases  of  the  ovaries.  He 
was  further  able  to  induce  sinking  of  the  broad  ligaments  of  the 
pelvis  experimentally  by  inserting  kelp  pencils  in  the  cervix  uteri. 
From  these  data  it  follows  that  any  sufficiently  powerful  irrita- 
tion in  any  portion  of  the  genital  tract  is  capable  of  inducing 
sinking  of  the  broad  ligaments  of  the  pelvis.  The  previously 
accepted  theory  of  infiltration  of  the  ligaments  must,  therefore,  be 
abandoned . 

The  measurements  taken  by  Fuhriman  on  the  prepared  pelvis 
have  further  indicated  that  the  stretching  and  relaxation  of  the 
pelvic  ligaments  through  flexion  of  the  ilio-.sacral  articulation 
may  be  induced,  as  claimed  by  Berdez,  and  that  these  movements 
are  greatly  favored  in  the  cow  becau.se  of  the  extraordinary 
mobility  of  the  lumbo-sacral  articulation,  especially  by  the  sink- 
ing of  the  loins.  It  is  recognized  that  a  mild  grade  of  physio- 
logic sinking  of  the  broad  ligaments  of  the  pelvis  occurs  often 
during  normal  estrum,  also  in  a  normal  manner  8  to  15  days 
before  calving  or,  under  .some  conditions,  such  as  high  feeding 
and  having  to  lie  on  sloping  floors,  it  even  occurs  4  to  6  weeks 
ante  partum,  and  normally  di.sappears  inside  of  8  to  12  days  after 
parturition. 

In  cases  where  the  relaxed  condition  of  the  pelvic  ligaments 
persisted  on  one  or  both  sides  throughout  the  entire  duration  of 
pregnancy  and  at  times  even  embraced  several  con.secutive  preg- 


*  Fuhrimann,  Uber  die  Senkung  der  breiten  Beckenbander  beim  Rinde. 
Berner  Inaugural-Dissertation  1906  und  Archiv.  fur  wissent.schaftliche  und 
praktisclie  Tierheilkunde,  Bd.  32,  1906. 


Nyviphomania  177 

nancies,  in  many  instances  to  a  marked  degree,  we  observed  now 
and  then — and  these  cases  afford  striking  evidence — that  sinking 
of  the  hips  and  pregnane}'  are  not  incompatible.  We  also  now 
and  then  see  the  so-called  false  estrum,  especially  during  the 
second  half  of  pregnancy,  probabl}'  as  the  result  of  active  hy- 
peraemia  of  the  genital  canal.  We  have  ob-served  this  false 
estrum  continue  throughout  the  period  of  pregnancy  and,  accord- 
ing to  our  observations,  it  is  very  .similar  to  the  normal  estrum 
of  non-pregnant  cows.  In  one  cow  in  which  there  was  sinking 
of  the  right  broad  pelvic  ligament  throughout  pregnancy  there 
was  a  constant  sexual  excitement,  as  evidenced  by  her  mounting 
other  cows.  We  here  recognized  a  salpingitis  of  the  right 
oviduct,  which  had  not  prevented  conception.  In  another  case,  a 
cow  five  months  pregnant  had  to  be  returned  home  from  the 
mountain  pasture  because  she  constantly  permitted  the  bulls  to 
copulate  with  her. 

We  recognize  the  abnormal  sinking  of  the  broad  ligaments  in 
the  following  diseased  conditions  :  in  92  ^r  of  the  cases  of  ovarial 
cysts  as  well  as  in  advanced  fibrous  degeneration  of  the  ovaries, 
in  hydrops  tubarum  (cystic  distension  of  oviducts)  with  sound 
ovaries,  in  acute  and  chronic  catarrhal  and  purulent  metritis, 
pyometra.  prolapsus  of  the  vaginal  portion  of  the  uterus,  vaginal 
prolapse,  infectious  nodular  metritis  and  vaginitis,  septic  me- 
tritis, tubercular  metritis,  severe  traumatic  vaginitis  and  collitis, 
large  retention  cysts  in  Bartholini's  glands,  .severe  mastitis  40 
hours  after  its  development,  bacterial  pyelo-nephritis,  orchitis 
and,  in  old,  heavy  nonpregnant  cows  and  in  one  breeding  bull 
from  over  fatigue  from  transportation  on  foot. 

We  have  now  and  then  ob-served  a  slight  sinking  of  the  broad 
ligaments  of  the  pelvis  in  cows  which,  in  spite  of  regular  estrum, 
do  not  conceive  and  in  which  the  cervical  canal  remains  open 
as  a  consequence  of  chronic  catarrh.  A  similar  condition  is  also 
seen  in  profuse  milkers  2-3  weeks  after  parturition  due  to  a  gen- 
eral debility  and  atony  of  the  genital  organs  in  connection  with 
insufficient  uterine  involution,  especially  a  slight  catarrhal 
metritis. 

In  reference  to  the  date  of  the  advent  of  the  sinking  of  the 
broad  pelvic  ligaments  in  newly  calved  cows,  a  study  of  those 
cases  in  which  data  upon  this  point  have  been  secured  and 
12 


J 78  l^etefi7ia}y  Obstetrics 

which  inchide  but  a  very  small  percentage  of  the  total  number 
of  cases  of  nymphomania  recorded  by  us,  it  appears  that,  in  12 
cases  out  of  120  observed  during  the  first  six  months  of  1905,  a 
complete  return  to  the  normal  elevation  of  the  hips  or  recovery 
in  tone  of  the  broad  ligaments  did  not  occur  within  the  normal 
period  after  calving  but  that  the  sciatic  ligaments  retained  their 
relaxed  condition  during  the  first  12  days  or  increased  somewhat 
after  3-7  days.  In  100  cases  the  normal  tension  of  the  broad 
ligaments  was  reestablished  within  12  days  after  calving  which, 
however,  after  the  following  periods  of  time,  again  became  re- 
laxed, namely  : 
In 


2 

cases 

inside 

of 

16 

days 

post 

part  urn 

7 

3 

weeks 

" 

4 

4 

" 

" 

6 

5 

" 

" 

5 

6 

" 

5 

7 

" 

14 

2  1 

months    " 

" 

12 

3 

" 

10 

4 

" 

" 

7 

5 

" 

" 

9 

6 

" 

" 

3 

7 

" 

" 

3 

8 

" 

" 

2 

.  9 

" 

" 

4 

10 

" 

5 

12 
14 

15 

" 

" 

According  to  these  exhibits,  the  relaxation  of  the  broad  liga- 
ments of  the  pelvis  occurred  during  the  period  of  most  intense 
lactation,  the  first  4  months  after  calving  furnishing  77  cases,  as 
against  35  cases  at  a  later  date,  or  about  2:1. 

In  regard  to  the  relation  between  the  sinking  of  the  broad  lig- 
aments and  nymphomania,  the  120  cases  cited  above  furnish  the 
following  clinical  data  : 

The  120  cases  of  nymphomania  showed  in  112  cases  a  sinking 
of  the  broad  ligaments,  and  in  8  cases  no  sinking. 

Of  the  112  cases,  the  sinking  of  the  sciatic  ligaments  was  as- 
sociated : 

8  times  with  regularly  recurring  estrum  every  three  months, 
which  was  very  intense  and  was  prolonged  for  3-4  days  ; 


Nymphomania  179 

14  times  with  irregular  estruni  ; 

59  times  with  nymphomania. 

In  31  cases  estrum  failed  to  occur  at  all,  or  occurred  but 
rarely  and  was  very  slight. 

In  13  cases  the  sinking  of  the  ligaments  was  slight. 

In  36  "  "  "  "  "     moderate. 

In  63  "  "  "  "  "     severe. 

The  8  cases  of  nymphomania,  without  sinking  of  the  ligaments, 
occurred  wholly  in  vigorous  cows,  in  high  condition,  partly  in 
animals  yielding  a  heavy  flow  of  milk.  The  group  included  4 
cows  with  bilateral  ovarian  cysts  as  large  as  hazelnuts  ;  one  cow 
which  showed  irregular  estrum  and,  in  addition  to  a  cyst  as  large 
as  hickory  nut  in  the  right  ovary,  exhibited  a  chronic  catarrhal 
metritis;  another  cow  which  had  a  cyst  as  large  as  a  hen's  egg 
and  a  corpus  leutum  in  the  right  ovary  ;  another  showing  in  the 
right  ovary,  a  cyst  of  the  size  of  a  hen's  egg,  in  the  left  a  small 
yellow  body,  and,  in  addition  to  these,  a  slight  catarrhal  endome- 
tritis, and  in  the  last  cow  we  found  in  the  right  ovary  a  cy.st  as 
large  as  a  hickory  nut. 

The  failure  of  the  ligaments  to  sink  when  ovarial  cysts  exist 
depends,  apparently,  on  the  one  hand,  upon  the  slight  individ- 
ual susceptibility,  and  on  the  other,  upon  the  evidently  vigorous 
constitution  of  the  patient. 

As  to  the  relation  of  the  sinking  of  the  sciatic  ligaments  to  the 
presence  of  ovarial  cysts,  our  statistics  revealed  the  following  : 

In  the  112  cases  of  sinking  of  the  broad  ligaments  it  was 
found  that  : 

in  32  cases,  there  was  a  bilateral  sinking  of  the  broad  liga- 
ments accompanied  by  bilateral  ovarian  cysts  ; 

in  24  cases,  the  sinking  was  bilateral  and  the  formation  of  cysts 
unilateral,  in  the  right  ovary  ; 

in  10  cases,  the  sinking  was  bilateral  and  ovarian  cysts  occurred 
only  in  the  left  ovary  ; 

in  4  cases  the  sinking  and  ovarian  cysts  were  alike  found  on 
the  right  side  only  ; 

in  3  cases  the  sinking  and  cysts  were  found  on  the  left  side 
only  ; 

in  I  case  the  sinking  was  bilateral,  the  right  ovary  cystic,  the 
left  had  undergone  fibroid  degeneration  ; 


i8o  Vetcrina)-)'  Obstetrics 

in  2  cases  the  sinking  was  bilateral  and  only  the  left  ovary  had 
undergone  fibrous  degeneration  ; 

in  I  case  the  sinking  was  bilateral,  the  right  ovary  showed 
fibrous  degeneration  and  the  left  was  cystic  ; 

in  I  case  the  sinking  was  bilateral,  while  only  the  right  ovary 
showed  fibrous  degeneration  ; 

in  2  cases  the  sinking  was  bilateral  ;  the  right  ovary  contained 
2  yellow  bodies  and  the  left,  one  cyst  ; 

in  7  cases  the  sinking  was  bilateral  and  both  ovaries  had  un- 
dergone fibrous  degeneration  ; 

in  I  case  the  sinking  was  bilateral  ;  the  right  ovary  appeared 
normal,  and  the  left  contained  a  cyst  as  well  as  2  yellow  bodies  ; 

in  I  case  the  sinking  was  bilateral  ;  the  right  ovary  had  un- 
dergone cystic  and  fibrous,  and  the  left,  fibrous  degeneration  ; 

in  3  cases  the  sinking  and  cystic  degeneration  were  bilateral 
and  accompanied  by  prolapsus  vagina: ; 

in  4  cases  the  sinking  was  bilateral  while  the  cystic  degenera- 
tion, accompanied  by /»r(7/a/!>5«5  z^a^m^,  affected  the  right  ovary 
only  ; 

in  3  cases  the  sinking  was  bilateral,  while  the  cystic  degenera- 
tion, accompanied  by  prolapsus  vagincr,  involved  the  left  ovary 
only  ; 

in  I  case  the  sinking  was  bilateral  and  the  ovaries  normal,  but 
prolapsus  vagime  existed  ; 

in  I  case  there  was  bilateral  sinking ;  the  right  ovary  was 
tuberculous,  the  left  cystic  ; 

in  I  case  the  sinking  was  extreme,  with  bilateral  cystic  de- 
generation, to  which  was  added  fibrous  degeneration  of  the  right 
ovary  ; 

in  I  case  the  sinking  was  severe  and  bilateral  ;  the  right  ovary 
was  cysto-fibrous  degenerated  ;  the  left  only  cystic  ; 

in  I  case  the  sinking  was  severe  and  bilateral  ;  the  left  ovary 
was  cystic  ;  the  right  ovary  contained  a  greatly  hypertrophied 
yellow  body  ; 

in  I  case  the  sinking  was  bilateral  ;  there  was  revealed  a  cyst 
and  a  yellow  body  on  the  right,  and  a  cyst  on  the  left  ; 

in  I  case  the  sinking  was  bilateral  ;  the  right  ovary  contained 
a  cyst,  while  in  the  left  there  was  a  yellow  body  the  size  of  a 
hickory  nut  ; 


Nymphoma  n  ia  1 8 1 

in  I  case  the  sinking  was  bilateral  ;  the  right  ovary  contained 
2  large  cysts,  the  left  was  normal  ; 

in  I  case  the  sinking  was  bilateral  ;  the  right  ovary  contained 
a  cyst  the  size  of  a  hen's  egg,  the  left  was  normal  ; 

in  I  case  the  sinking  was  bilateral  ;  the  right  ovary  normal  ; 
the  left  contained  a  yellow  body  as  large  as  a  man's  thumb  and 
to  this  was  added  the  complication  of  a  chronic  purulent  metritis  ; 

in  I  case  the  sinking  was  bilateral  and  also  there  was 
present  cystic  and  fibrous  degeneration  of  both  ovaries  and 
prolapsus  vagina  ; 

in  I  case  the  sinking  was  bilateral  ;  the  right  ovary,  of  the  size 
of  a  hickory  nut,  was  cystic  and  had  undergone  fibrous  degenera- 
tion ;  the  left  contained  a  hypertrophied  yellow  body  ;  the  os 
uteri  was  open  and  chronic  purulent  endometritis  present  ; 

in  I  case  the  sinking  was  bilateral  ;  the  right  ovary  contained 
a  cyst  the  size  of  a  goose  egg  ;  the  left  was  normal. 

This  tabulated  summary  indicates  that  sinking  of  the  hips 
generally  indicates  some  affection  of  the  sexual  organs,  especially 
of  the  ovaries,  and  that  a  good,  firm  tension  of  the  broad  liga- 
ments of  the  pelvis  constitutes  excellent  evidence  of  sexual  sound- 
ness in  the  cow  because,  between  the  character  of  the  tension  of 
these  sciatic  ligaments  and  the  specific  sexual  organs,  there  exists 
a  relationship  quite  analogous  to  that  in  man  between  the  pos- 
terior portion  of  the  eye  and  cerebral  disease. 

It  further  appears  that  the  relaxation  of  the  sciatic  ligaments 
does  not  always  indicate  bilateral  cystic  degeneration  of  the  ova- 
ries, that  in  individual  cases  it  may  occur  in  the  absence  of  cystic 
degeneration  and  that  the  right  ovary  was  found  cystic  twice  as 
frequently  as  the  left. 

In  general,  we  have  determined  that,  when  the  relaxation  of  the 
sciatic  ligaments  is  unequal,  the  ovary  on  the  side  of  the  greatest 
relaxation  is  the  one  which  has,  most  probably,  undergone  cystic 
degeneration.  On  the  other  hand,  now  and  then,  the  broad 
ligament  is  appreciably  more  relaxed  on  the  .side  of  the  sound 
ovary  than  upon  that  of  the  cystic  gland  and,  in  the  bilateral 
formation  of  the  cysts  in  the  periphery  of  the  glands,  the 
greater  sinking  tends  to  occur  on  that  side  where  the  cyst  or 
cysts  is  the  larger,  firmer  and  older.  Also,  in  unilateral  sink- 
ing of  the  sciatic  ligaments,  cystic  degeneration  may  likewise  be 
unilateral  and  involve  only  that  ovary  on  the  .side  corresponding 


1 82  Veterinary  Obstetrics 

to  the  relaxed  ligament,  and  this  presumption  is  not  changed 
by  the  presence  of  fibrous  degeneration  in  the  other  gland. 
Finally,  in  fibrous  degeneration  of  the  ovaries,  the  sinking 
of  the  hips  is  only  slight  or  moderate,  never  severe. 

In  one  nymphomaniac  cow,  the  right  sciatic  ligament  was 
slightly  sunken  ;  the  left  one,  very  markedly.  The  right  ovary 
showed  a  cyst  the  size  of  a  hen's  egg,  with  slight  increa.se  in  cir- 
cumference of  the  right  uterine  cornu  :  the  left  ovary  was  of  the 
size  of  a  hazel  nut  and  the  left  cornu  the  thickness  of  a  man's 
arm. 

The  question  if,  probably,  the  .size  and  age  of  the  cysts  exert  a 
definite  influence  upon  the  degree  of  the  uni-  or  bilateral  sinking 
of  the  broad  ligaments  must  be  answered  in  the  negative.  Our 
observations  teach  that  small,  and  especially  the  very  small  cysts 
in  heifers,  often  cause  a  very  marked  sinking  of  the  ligaments, 
and  vice  versa  ;  furthermore,  now  and  then,  the  sinking  on  the 
side  corresponding  to  the  smaller  csst  is  materially  greater, 
and  in  cases  of  cysts  varying  greatly  in  size  in  the  two 
ovaries,  the  sinking  in  of  the  hips  may  yet  be  alike  on  both  sides. 

From  the  standpoint  of  age,  it  seems  clear,  from  our  observa- 
tions, that  cows  with  old  and  large  cysts,  becau.se  of  the  chronic 
reflex  irritation  upon  the  sexual  organs,  through  which  the  re- 
laxation of  the  broad  ligaments  is  caused,  generally  show  also  a 
greater  degree  of  sinking  than  those  with  newly  formed  cysts. 

When  the  sinking  of  the  broad  ligaments  does  not  occur  im- 
mediately after  calving,  the  anamnesis  usually  indicates  that  the 
affected  animal  had  already  been  in  estrum  several  times  at  too 
short  intervals  and  too  intense  in  character  or  continued  for  an 
abnormally  long  period,  without  conception  occurring. 

The  degree  of  the  sinking  of  the  hips,  which  is  sometimes  more 
marked  at  the  the  posterior  border,  and  sometimes  upon  the  flat 
surface  of  the  hips,  but  is  usually  equally  evident  in  both  areas, 
is,  as  already  stated,  extremely  variable.  The  .sinking  is 
very  greatly  emphasized  by  a  high  croup,  which  has  no  real 
influence  upon  the  sinking  of  the  ligaments  and  has,  under 
normal  conditions,  merely  the  value  of  a  blemish.  In  exag- 
gerated ca.ses,  the  sunken  broad  ligaments  of  the  pelvis  con- 
stitute an  almost  flat  surface  beneath  the  tail  and,  at  the  sides, 
of  the  root  of  the  tail,  cause  cavities  the  size  of  a  fist. 


Nymphomania  183 

Out  of  the  120  nymphomaniac  cows  of  our  statistics,  47  ex- 
hibited more  or  less  evident  changes  in  the  vulva,  consisting  of 
an  edematous  swelling  of  variable  intensity,  exceptionally  greater 
og  one  side,  and  an  elongation  and  widening  of  the  vulvar  com- 
missure. In  12  cases  there  was  a  slight  active  hyperaemia  evi- 
denced by  a  redness  of  the  labias  of  the  vulva,  referable  to  a 
pressure  upon  the  vasodilators  in  the  ovaries.  In  a  few  cases,  where 
prolapse  of  the  vagina  coexisted,  there  was  an  evident  wrinkling, 
either  chiefly  in  the  superior  half  or  involving  the  entire  circum- 
ference of  the  vulvar  lips,  as  well  as  invagination,  that  is,  an 
entropium  of  the  vulvar  lips. 

It  is  of  symptomatic  significance  that,  in  heifers  suffering  from 
dumb  estrum  (stillochsigkeit ),  the  variable  edematous  swelling 
of  the  vulva,  under  some  conditions,  constitutes  the  only  notable 
external  symptom  which,  omitting  the  abnormal  findings  in  the 
ovaries,  can  not  at  all  be  explained. 

Among  our  120  cases  there  existed  in  42  a  very  variable  vaginal 
discharge.  In  30  ca.ses,  this  was  slight,  vitreous  and  slimy  ;  in  the 
other  12,  on  the  contrary,  muco-purulent  or,  when  it  had  to  do 
with  old  purulent  metritis  or  pyometra,  wholly  purulent. 
In  a  combination  of  nymphomania  with  prolapse  of  the  vagina 
or  of  the  vaginal  portion  of  the  uterus,  there  was  found  a  muco- 
purulent discharge  mixed  with  fecal  particles,  which  were  later 
drawn  into  the  vagina  by  the  spontaneous  reduction  of  the  pro- 
lapse when  the  cow  assumed  the  standing  position. 

If  vaginal  discharge  exists,  the  hairs  of  the  vulvar  tuft  are 
matted  and  the  ventral  surface  of  the  tail,  next  to  the  vulva, 
soiled. 

The  vaginal  mucosa,  in  J5  %  of  the  ca.ses  of  nymphomania,  is 
reddened,  injected  and  swollen,  the  latter  especially  marked 
when  prolapse  of  the  vagina  or  vaginal  portion  of  the  uterus 
coexists.  Very  often  one  finds  the  symptoms  of  chronic  infectious 
nodular  vaginitis  (nodular  or  granular  venereal  diseases  of  the 
cow  ),  such  as  a  yellowish  hue  of  the  vaginal  mucosa  in  those  parts 
no  longer  inflamed,  blanched  vesicles  and  nodules  no  longer  sur- 
rounded by  inflamed  areas,  either  grouped  in  one  part  or  dissem- 
inated over  the  entire  vaginal  mucosa.  More  seldom,  the  mucosa 
is  superficially  eroded  as  a  result  of  therapeutic  efforts. 

A  comparatively  frequent  finding  is  retention  cysts  of  the  glands 
of  Bartholini,  varying  from  the  .size  of  a  hazelnut  to  a  fi.st  and, 


1 84  Veterinary  Obstetrics 

more  seldom,  vaginal  polypi.  There  also  occurs,  quite  exception- 
ally, at  the  line  of  demarcation  between  the  vestibule  and  vagina 
or  in  the  roof  of  the  vagina  about  a  hand's  breadth  posterior  to 
the  mouth  of  the  uterus,  a  thin  walled  fluctuating  retention  cyst 
the  size  of  a  large  fist,  containing  a  grayish  sero-mucous,  odor- 
less fluid.  The  location  and  character  of  these  cysts  may  best  be 
determined  by  simultaneous  examination  per  tectum  et  pervagi- 
num  and  through  causing  the  former  viscus  to  glide  over  the 
tumor. 

To  the  symptomatology  of  nymphomania  al.so  belongs  the  oft 
ob-served  extraordinarily  great  relaxation  and  widening  of  the 
vagina,  which  here  and  there  shows  evident,  horizontally  di- 
rected scars  and  a  very  notably  increased  facility  for  palpating 
this  organ,  now  so  much  more  roomy. 

Ver^'  seldom  one  finds  by  the  os  uteri  externum  an  abcess  as 
large  as  a  hen's  egg  containing  thick,  white  pus  and  now  and 
then  beneath  the  os  nteri  externum  as  many  as  6  polypoid  growths 
varying  in  size  from  a  pea  to  a  pigeon's  egg,  or  one  to  several 
fluctuating,  spherical,  cordiform  retention  cysts  of  Gaertner's 
ducts  as  large  as  a  small  hen's  egg. 

Not  at  all  rarely,  there  is  found  the  vestigial  remnants  of  the 
incompletely  resorbed  median  walls  of  the  Muelleri an  ducts,  which 
we  have  already  described ',  that  is,  there  exists  immediately 
behind  the  vaginal  portion  of  the  uterus,  perpendicular  bands 
1-3  fingers  in  breadth  and  1-3  cm.  thick.  They  are  easily  en- 
gaged by  the  index  finger,  elastic,  nonvascular  and,  in  non-gravid 
animals  wnth  a  thoroughly  mobile  uterus,  are  readily  drawn  far 
back  into  the  vagina.  These  evidently  may  interfere,  under  cer- 
tain conditions,  with  the  ejaculation  of  the  semen  into  the  cervical 
canal. 

Contrary  to  the  views  of  Zschokke,  who  holds  that,  in  nympho- 
mania, the  OS  nteri  is  closed,  we  are  able  to  state  that  the  nym- 
phomania resulting  from  ovarial  cysts  is  intimately  related  to 
the  abnormal  dilation  of  the  mouth  of  the  uterus  and  of  the  cer- 
vical canal  and  that  it  is  only  very  rarely,  and  chiefly  in  cases  of 
small  cysts  occurring  soon  after  calving,  that  nymphomania  ex- 
ists without  dilation  of  the  os  uteri. 

Approximately  two  to  three  times,  annually  we  find  an  accumu- 

'  Schweizer-Archiv.  fur  tierheilkunde,  1S96,  page  252. 


Nymphotnayiia  185 

lation  of  urine  in  the  vagina  [urovagina  {Vagi7ia  2irinalis)\. 
This  malady  attacks  old,  feeble,  nj'niphomaniac  cows  with  large, 
wide  vaginae  and  uni-  or  bilateral  ovarian  cysts.  The  quantity 
of  urine  found  in  the  vagina  varies  between  500  and  750  grammes, 
is  feebly  slimy  and  shows  with  the  Nessler  reagent  within  12 
hours  after  its  removal  a  marked  ammoniacal  reaction,  and  after 
a  few  hours  standing  a  very  marked  ammoniacal  decomposition, 
which  undeniably  points  to  cow  urine  and  excludes  the  sugges- 
tion of  its  being  some  injected  fluid  or  an  excretion  discharged 
from  the  uterus.  The  accumulation  of  urine  in  the  vagina  is 
explained  by  the  low  pressure  of  the  urinary  stream  while  the 
animal  is  standing  and  the  low  lying,  excavated  vaginal  floor 
about  the  urethral  opening. 

The  external  os  in  cases  of  nymphomania  in  cows  which  have 
recently  calved,  also  in  all  prolonged  and  well  developed  cases  of 
nymphomania,  is  constantly  penetrable  for  a  lead  pencil,  little 
finger,  index  finger  or,  in  cows  very  recently  calved,  for  two 
fingers,  and  it  was  only  in  very  recent  cases  of  nymphomania 
and  along  with  the  existence  of  acute  and  severe  chronic  infec- 
tious nodular  vaginitis  (and  especially  when  the  latter  has  been 
handled  with  powerful  irritants)  that  the  os  uteri  was  found 
closed  in  spite  of  the  existence  of  cystic  degeneration  of  the 
ovaries  and  sinking  of  the  broad  pelvic  ligaments.  Frequently 
the  external  os  is  penetrable  for  one  or  two  fingers  while  further 
forward  it  is  much  narrowed  or  entirely  closed. 

Under  normal  conditions,  in  non-pregnant  cows  and  heifers 
which  are  not  in  estrum  or  have  not  been  for  a  few  days,  as  well 
as  in  those  nymphomaniac  cows  in  which  the  internal  os  is 
closed,  there  is  found  on  the  external  os  only  a  very  .small  clot  of 
a  clear,  tough  mucus,  while,  in  all  cases  of  nymphomania  with 
completely  open  os  uteri,  there  is  as  a  rule  a  hypersecretion.    • 

The  exudate  discharged  from  the  cervical  canal  and  ostiuyn  ex- 
termim  and  accumulating  first  in  the  vagina  in  varying  quantity 
consists  usually  of  vitreous,  transparent,  tenacious  mucus  ; 
more  rarely  of  slimy,  whitish,  or  yellowish  white,  thick  or  thin 
liquid  pus,  which,  in  cases  of  prolapse  of  the  vagina  or  mouth 
of  the  uterus,  may  in  addition  be  mixed  with  fecal  particles. 

If  closed,  the  os  uteri  is  small,  not  at  all  or  but  slightly  swollen, 
and  is  often  recognizable  merely  as  a  small  rosette,  which  may  be 
moved  backwards  or  forwards  and  projects  but  little  beyond   the 


1 86  Veterinary  Obstetrics 

.surrounding  tissues,  with  which  it  is  continuous.  In  case  of  an 
open  cervical  canal,  the  lips  of  the  os  uteri  are  enlarged,  smooth, 
velvet-like,  infiltrated.  In  many  instances,  especially  when 
there  exists  ^prolapsus  portionis  vaginalis  uteri  due  to  recurrent 
cystic  disease  of  the  ovaries,  there  are  one  or  two  flaps  which  are 
readily  recognized  in  the  vagina  as  bodies  as  thick  as  the  hand, 
broad  and  long,  tongue-shaped  and  often  infiltrated  with  blood, 
upon  the  surface  of  which  one  may  recognize.  b\'  palpation,  the 
OS  uteri. 

Now  and  then  there  exists,  as  a  result  of  chronic  irritation  in 
connection  with  the  pathologic  dilation  of  the  cervical  canal  and 
the  swelling  of  the  vaginal  portion  of  the  uterus,  in  cows  suffer- 
ing from  cystic  or  fibrous  ovarian  degeneration,  an  enlargement 
and  conspicuous  firmness  of  the  cervix  uteri,  sometimes  slight, 
sometimes  the  thickness  of  the  forearm  or  arm,  and  without  any 
increase  whatever  in  the  size  of  the  cornua. 

Passing  to  the  changes  in  the  uteri  of  nymphomaniac  cows 
and  heifers,  recognizable  by  palpation,  it  is  to  be  pointed  out 
that  the  size  of  the  organ  in  quite  recent  and  not  severe  cases 
must  now  and  then  be  regarded  as  normal.  So,  for  example, 
we  observed  in  one  mild  and  very  recent  case  of  nymphomania 
in  a  cow  which  had  aborted  at  the  end  of  the  fourth  month  of 
pregnancy,  eight  weeks  after  the  abortion,  a  bilateral  sinking  of 
the  broad  pelvic  ligaments,  a  large  ovarian  cyst  in  the  right 
ovary,  normal  volume  of  the  uterus  and  closed  uterine  os. 

However,  in  the  great  majority  of  nymphomaniac  cows,  the 
patients  show  a  very  variable  degree  of  increased  volume  of  the 
uterus,  either  in  toto  or  chiefly  only  in  one  horn.  Often  the  uterine 
body  at  the  point  of  origin  of  the  cornua  is  only  slightly  thick- 
ened, the  size  of  a  child's  arm  ;  in  other  cases,  as  thick  as  a 
man's  arm. 

Simultaneous  with  the  increa.sed  circumference,  there  occurs 
also  a  varying  elongation  of  the  uterus  to  the  extent  of  2  to  3 
times  its  normal  length,  whereby  its  anterior  end  projects  far 
into  the  abdominal  cavity. 

In  asjnunetric  uteri  the  right  horn  is  greater  in  75^  of  ca.ses 
and  only  exceptionally  is  one  horn  found  to  be  normal  while  the 
other  is  importantly  increased  in  circumference  and  length.  The 
consi.stence  of  the  uterus,  which  is  never  abnormally  sensitive, 


Nymphoviania  187 

is  uniform,  soft-elastic,  more  seldom  tense-elastic,  and  then  dur- 
ing the  existence  of  estrum. 

From  the  above  facts  and  the  post  mortem  findings  yet  to  be 
related,  it  is  indicated  that  cystic  and  cysto-fibrous  degeneration 
of  the  ovaries  almost  uniformly  lead  to  a  non- infectious  chronic 
catarrhal  endometritis  and  only  seldom  to  chronic  muco-purulent 
endometritis  or  to  chronic  purulent  endometritis,  which  makes  it 
self  evident  that  an  impregnated  ovum  could  not  become  attached 
to  the  uterine  wall  to  undergo  development  into  a  fetus.  Rela- 
tions analogous  to  those  existing  between  cystic  and  cysto-fibrous 
ovarial  degeneration  and  the  sinking  of  the  sacro-sciatic  liga- 
ments hold  good  also  between  the  former  and  the  enlargement  of 
the  uterus. 

In  bilateral  cystic  degeneration  of  the  ovaries  there  exists  no 
definite  relation  between  the  size  of  the  cysts  and  the  increased 
circumference  of  the  uterus,  which  is  usually  symmetric,  rarely 
asymmetric.  In  cases  of  unilateral  formation  of  cysts  the 
entire  uterus  is  frequently  uniformlj'  larger  and  longer  or,  on 
the  other  hand,  the  enlargement  may  be  confined  to  the  cornu 
leading  to  the  affected  ovary. 

Finally,  it  must  be  conceded  that,  as  a  general  rule,  the  symp- 
toms of  nymphomania  are  referable  to  the  ovaries  them.selves, 
which  are  the  chief  and  almost  exclusive  seat  of  the  anatomo- 
pathologic  changes,  and  that  disea.ses  of  the  uterus  and  vagina, 
without  involving  the  ovaries,  can  only  very  rarely  lead  to  symp- 
toms of  nymphomania.  On  the  other  hand  we  have  observed, 
and  verified  our  diagno.sis  by /^.y/  mortem  examinations,  that  in 
both  uncastrated  and  castrated  cows,  cysts  in  the  broad  liga- 
ments and  in  the  oviducts,  and  hydatids  in  the  oviducts  or  am- 
pullae can  cause  well  marked  nymphomania. 

As  abnormalities  of  the  ovaries  which  we  have  definitely  recog- 
nized and  verified  in  connection  with  nymphomania  in  cows  we 
may  relate  : 

1.  The  formation  of  cysts  or  vesicles  of  the  folhcles — hyper- 
trophy of  the  ovisacs. 

According  to  Zschokke  three  genetic  forms  of  these  may  be 
differentiated  : 

a.  Those  which  spring  from  the  GraaSan  follicles  and  are  to 
be  designated  as  hydrops  folliculorum. 


1 88  I'eten'yiary  Obstetrics 

b.  Those  which  emanate  from  the  Pfliiger  sheaths  or  from 
yellow  bodies. 

c.  Cysts  which  originate  in  hemmorrhages  or  colloid  degenera- 
tion of  cells,  especially  in  malignant  neoplasms. 

Because  subclasses  b  and  c  produce  nymphomania  only  very 
rarely  and  consequently  possess  no  great  clinical  importance, 
the  subject,  as  related  to  these,  will  not  be  pursued  further  here. 
We  will  simply  remark  that  not  every  ovarian  disease  in- 
duces nymphomania  and  that  an  ovary,  under  some  conditions, 
may  possess  a  tumor  as  large  as  the  fist  without  producing 
symptoms  of  nymphomania  ;  indeed  a  cow  may  have  a  badly 
degenerated  ovary,  as  we  found  in  one  particular  case,  and 
nevertheless  show  normal  estrum  and  become  pregnant.  We 
have  also  repeatedly  observed  that,  when  but  one  ovary  has 
undergone  even  severe  cy.stic  degeneration,  estrum  may  be 
normal  and  impregnation  occur. 

Undoubtedly,  the  most  important  and  common  disea.se  of  the 
ovaries  leading  to  nymphomania  is  the  cystic  degeneration,  which 
may  be  confined  to  only  one  or  two  ovisacs  and  then  be  desig- 
nated as  solitary  cyst  formation,  in  contradistinction  to  multiple 
cyst  formation,  in  which  numerous  Graafian  follicles  become  hy- 
pertrophied  in  equal  or  unequal  degrees. 

In  regard  to  the  formation  of  solitary  cysts  and  fibrous  degen- 
eration of  the  ovaries,  we  would  here  make  the  supplementary 
statement,  or  more  properly,  repeat  that  the  right  ovary  is  more 
frequently  found  diseased  than  the  left,  a  fact  which  stands  in 
an  intimate  relation  with  the  greater  functional  activity  of  the 
right  gland  and  the  more  frequent  occurrence,  approximately 
70%,  of  impregnations  in  the  right  horn. 

It  is  also  interesting  to  note  the  fact,  amply  verified  by  us, 
that  large  cysts,  which,  it  is  to  be  assumed,  have  required  a 
longer  period  of  time  for  their  development  than  do  smaller  ones, 
cause  no  visibly  greater  symptoms  of  nymphomania,  but  that  the 
volume  of  the  cyst  stands  in  no  constant  relation  to  the  intensity 
of  the  symptoms. 

The  size  of  the  solitary  cysts  varies  from  that  of  a  hazelnut  to 
a  hen's  egg  or  a  goose  egg  or  even  as  large  as  a  fist.  In  this 
relation,  it  should  be  here  remarked  that,  in  cattle.  Graafian  fol- 
licles measuring  1.5  cm.  and  upwards  in  diameter  are   to  be   re- 


Nymphom,a7iia  189 

garded  as  cysts,  since,  in  these,  according  to  Rubeli,  (vid.  pages 
163  and  164)  no  ova  are  ever  found. 

They  are  located  either  comparatively  peripherally  or  centrally 
and  lead,  in  both  instances,  to  atrophy  of  the  ovarial  paren- 
chyma, which,  under  the  pressure  of  the  cysts,  may  completely 
disappear.  By  rectal  palpation,  the  peripheral,  solitary  cysts, 
which  are  frequently  thin  walled,  may  be  diagnosed  by  the  en- 
largement of  the  ovary,  upon  which  they  appear  as  elastic,  tense, 
smooth,  fluctuating  eminences.  In  thick  walled  peripheral  cysts 
the  gland  feels  more  firm  and  elastic. 

More  difficult  than  the  diagnosis  of  solitary  peripheral  cysts  is 
the  recognition  of  the  solitarj^  central  cysts,  which  are  common 
and  lead  to  every  grade  of  nymphomania.  One  or  two  of  these 
may  be  located  in  the  center  of  the  gland,  never  project  above 
its  surface  and  are  surrounded  by  a  layer  of  ovarian  tissue  as 
much  as  8  mm.  thick.  Here,  the  diagnosis  is  to  be  based  upon 
the  size  of  the  ovary,  the  increased  tension,  the  less  readily  com- 
pressed, elastic  surface  and  the  non-crusha])le  character  of  the 
gland /<fr  rectum  and  especially  per  vaginam. 

It  is  an  interesting  observation  that,  in  a  cysto-fibrous  de- 
generated ovary,  there  is  now  and  then  found  one,  rarelj'  two 
large  solitarj'  cysts,  after  the  crushing  of  which  there  still  re- 
mains an  abnormally  large,  firm,  solid  ovary.  We  have  also 
found  that  after  vigorous  crushing  of  a  cysto-fibrous  degenerated 
ovary  in  exceptional  cases  there  develop,  after  the  lapse  of  a  few 
weeks,  cysts  from  the  size  of  a  hickorynut  to  that  of  a  small 
hen's  egg  and  that,  by  periodic  compression  and  massage,  the  de- 
velopment of  small  central  cysts  may  be  accelerated,  as  a  con- 
sequence of  which  they  may  then  approach  the  periphery. 

Another  finding,  to  which  we  have  already  referred  and  which 
admittedly  occurs  rarely  in  nymphomaniac  cows,  consists  in  the 
formation  of  multiple  cysts  by  which  several  ovisacs  in  various 
parts  of  the  ovary  hypertrophy  and  acquire  the  dimensions  of 
large  peas,  owing  to  which  those  most  peripherally  located  pro- 
ject slightly  beyond  the  surrounding  surface  of  the  ovary.  The 
disseminated  arrangement  of  the  numerous  follicles  of  approxi- 
mately uniform  size,  as  well  as  the  general,  though  not  constant, 
absence  of  corpora  liitea,  indicates  multiple  cyst  formation  and 
that  they  are  not  normal,  ripe  ovisacs. 

2.  A  quite   frequent  cause  of  nymphomania   consists  of  the 


190  Veteri7ia?Y  Obstetrics 

formation  of  multiple  C3'sts,  accompanied  by  connective  tissue 
hypertroph}-  or  scelerosis  of  the  ovaries,  in  which  a  cut  surface 
reveals  several  Graffian  follicles,  very  small,  up  to  as  large  as  a 
pea,  embedded  in  much  firm,  white  connective  tissue.  Such 
ovaries  vary  in  size  from  that  of  a  hickory  nut  to  a  hen's  egg, 
are  firm  and  hard,  can  not  be  crushed,  and,  now  and  again,  there 
are  still  present  yellow  bodies. 

Contrary  to  the  deductions  of  Z.schokke  and  Simon,  we  were 
in  a  position  14  times  during  the  last  year  to  recognize  with  cer- 
tainty the  presence,  sometimes  of  large,  at  others  of  small,  corpora 
lutea  in  cystic  or  cysto-fibrous  degenerated  ovaries,  and,  indeed, 
one,  two,  or  even  three  of  them  in  one  ovary,  (vid.  post  mortem 
findings  in  Nos.  2  and  3.)  On  the  whole,  there  is  no  substantial 
ground  for  the  opinion  that,  in  intermittent  nymphomania  in 
cows,  yellow  bodies  may  not  still  be  formed. 

Definite  sclerosis  of  the  ovaries  {sclerosis  ovarii)  in  which  all 
appearances  of  ovulation  cease,  such  as  normal  Graafian  follicles 
and  ix^sh.  corpora  hitea,  never  determines  nymphomania,  but  leads, 
according  to  our  observations,  when  bilateral,  to  absence  of 
estrum,  though,  when  one  ovary  remains  normal,  the  animal  may 
conceive.  Selerotic  and  cicatricially  contracted  ovaries  are  the 
size  of  a  hazelnut  to  that  of  a  hickory  nut,  smooth,  and  of  a 
uniformly  firm  or  hard,  nodular  consistence. 

3.  Yet  another  disease  of  the  ovaries,  which,  however,  leads  to 
"  Stillochsigkeit  "  or  dumb  estrum  con.sists  of  the  development 
of  ovarial  cysts  containing  yellowish,  sero-fibrinous,  pap-like 
fluid  or  of  blood  cysts.  The  first  mentioned  formation,  which  is 
very  rare,  varies  in  size  from  a  hen's  egg  to  a  fist  and  feels  like  a 
sac  filled  with  quicksilver.  When  these  are  crushed  in  living 
cows  a  granular,  thick,  gravy-like  mass  escapes. 

4.  In  aged,  good  milk  cows  there  occurs  in  rare  instances,  as  a 
cause  of  nymphomania,  ovarial  dropsy  (hydrops  ovarii).  In  this 
disease  the  ovaries  are  soft,  flabby  and  flattened. 

5.  A  very  rare  cause  of  nymphomia  in  cows,  not  to  exceed 
0.5  %  in  our  clinic,  so  far  as  we  could  determine,  is  tubercular 
ovaritis  (oophoritis  tuberculosa).'  These  cases  run  their  course 
with  and  without  symptoms  of  nymphomania  and  sinking  of 
the  sacro-.sciatic  ligaments. 


'  E.  Hess,  Schweizer-Archiv.  fiir  Tierheilkunde,  1891,  page  161. 


Nymphomania  191 

In  one  cow  with  ovarial  tuberculosis,  which  led  to  abortion  in 
the  sixth  month  of  pregnancy,  the  left  ovary  revealed  one  cyst 
the  size  of  a  hazel  nut  and  one  yellow  bod}'.  The  right  ovary 
in  the  living  cow  was  the  size  of  a  child's  head,  uneven,  nodular, 
slightly  mobile  and  adherent  to  the  right  horn  of  the  uterus.  In 
another  case,  each  ovary  was  like  a  large,  hard  bunch  of  grapes, 
covered  over  with  firm  round  nodules  from  the  size  of  a  pea  to 
that  of  a  hazel  nut.  Both  oviducts  were  as  large  as  the  index 
finger,  serpentine,  rigid  and  likewise  invaded  by  hard  nodes 
from  the  size  of  a  pea  to  a  hazel  nut. 

Finally,  as  further  causes  of  nymphomania  there  occur  very 
rarely  :  oophoritis,  abscesses  in  or  near  the  ovaries,  angioma  of 
the  ovary,  hydrosalpinx  or  dropsy  of  the  oviducts,  perimetritic 
abscesses  following  perforation  of  a  uterine  horn,  and  cysts  in  the 
broad  ligaments  of  the  uterus. 

As  a  result  of  retention  of  the  placenta  and  consequent  .septic 
metritis  there  follows  adhesion  of  the  ovaries  and  uterine  horns 
to  the  surrounding  parts,  which  maj'  cause  nymphomania,  and 
the  ovaries  become  .so  hidden  by  the  adhesions  that  they  are 
scarcely,  if  at  all,  recognizable  by  rectal  palpation  and  are  but 
very  slightl}^  mobile.  In  a  great  many  cases,  in  addition  to  these 
changes,  the  ovaries  undergo  cystic  or  cysto- fibrous  degeneration, 
and  attain  the  size  of  a  hickory  nut  or  hen's  egg  ;  at  times, 
although  quite  seldom,  the  septic  metritis,  in  addition  to  the  ad- 
hesions, leads  to  the  formation  of  abscesses  in  the  ligamentous 
apparatus  of  the  ovary  and  in  the  ovary  itself,  which  latter  con- 
dition from  a  therapeutic  standpoint  warns  one  to  be  cautious. 

In  a  3 ^'s -year-old,  valuable  premium  winning  cow,  which  had 
suffered  from  retained  placenta  following  abortion  and  later  from 
purulent  endometritis,  there  developed,  as  a  result  of  rough 
handling  of  the  vagina  by  the  owner,  which  irritated  the  uterus,  an 
extensive  adhesion  of  the  va/vula  vagijialis  and,  within  a  few  days 
thereafter,  there  occurred  an  extensive  accumulation  of  pus  in 
the  vagina  (/j'(7Z'a^/«a)  amounting  to  fully  3  liters.  After  opera- 
tive withdrawal  of  the  very  fetid  pus,  an  examination  of  the 
sexual  organs  revealed  an  open  cervical  canal,  which  permitted 
the  passage  of  the  little  finger.  There  was  also  present  purulent 
metritis  ;  the  right  ovary  was  the  size  of  a  hazelnut  and  in  the 
left  uterine  horn  there  was  a  tumor  (abscess)   as  large  as  one's 


192  Veterinary  Obstetrics 

fist,  round,  smooth  and  fluctuating.     The    cow  showed    normal 
estrum  14  days  after  the  operation. 

6.  vSupplementary  to  the  foregoing,  we  shall  here  submit, 
through  the  courtesy  of  Professor  Dr.  Gillebeau,  the  appended 
postmortem  findings  relative  to  cystic  degeneration  of  the  ovaries: 

1.  A  cow  which  had  been  handled  by  us  for  a  long  time  was  castrated  on 
December  3,  1903.  The  right  ovary  weighed  20  grammes  and  contained  in 
its  center  2  follicles  the  size  of  peas  ;  the  one  had  the  ordinary  contents,  the 
other  was  filled  with  clotted  blood,  evidently  the  result  of  preceding  severe 
crushing.  Otherwise,  the  ovary  was  in  a  state  of  advanced  fibrous  degener- 
ation.    The  walls  surrounding  the  follicles  were  7  mm.  thick. 

The  left  ovary,  weighing  30  gr.,  was  as  large  as  a  hen's  egg,  4  cm.  in 
diameter  and  contained  6  peripheral  Graafian  follicles,  as  much  as  5  mm.  in 
diameter,  and  one  central  Graafian  follicle,  i  cm.  in  diameter,  with  yellow 
walls  and  contents  consisting  of  a  yellowish-red  fluid  serum  and  blood 
clots,  which  was  likewise  referable  to  the  previous  crushing  of  the  organ. 
Otherwise,  this  ovary  also  showed  extensive  fibrous  degeneration. 

Anatomo-pathologic  diagnosis  :  sclerosis  of  the  right  ovary  and  cysto- 
fibrous  degeneration  of  the  left. 

2.  A  6-year-old  cow.  Six  months  previously,  ovarial  cysts  had  been 
crushed  for  the  first  time  ;  later,  they  recurred.  The  patient  suffered  also 
from  vaginal  prolapse.  Slaughtered  on  the  21st  of  December,  1905.  The 
vagina  was  decidedly  wide,  the  mucosa  covered  with  much  tenacious  mucus. 
The  habitually  prolapsed  portion  was  intensely  hyperaemic,  the  lips  of  the 
OS  uteri  swollen,  the  cervical  canal  penetrable  for  one  finger.  Weight  of 
uterus  900  grammes,  as  against  a  normal  weight  of  600  to  700  grammes. 
The  exaggerated  weight  is  referable  to  the  hypermaemia  of  the  cervix. 

Uterine  cavity  normal.  Left  ovary  somewhat  enlarged,  tissue  dense  with 
one  follicle  of  the  size  of  a  pea  and  2  yellow  bodies.  The  right  ovary  con- 
sists of  a  cyst  the  size  of  a  hen's  egg,  with  clear  contents,  a  moderately 
large  yellow  body  and  a  vestige  of  normal  ovarian  parenchyma. 

Diagnosis  :  Chronic  colpitis  and  cystic  degeneration  of  right  ovary. 

3.  A  2>^  year  heifer,  which  had  not  been  pregnant,  was  first  handled  on 
May  8,  1895,  because  of  a  cyst  in  the  left  ovary  of  the  size  of  a  hens  egg. 
On  the  28th  of  the  same  month  there  was  recurrence  of  a  cy>t  in  the  same 
ovary,  and  4  weeks  later  a  recurrence  of  cysts  in  both  glands.  She  was 
slaughtered  August  loth,  1895. 

Anatomo-pathologic  findings  : 

The  dorsal  vaginal  arch  is  dispropojtionately  deep,  so  that  the  <?,? ///^r; 
externum  is  not  directly  toward  the  vulvar  oj>ening  but  downwards  against 
the  vaginal  floor.  Above  the  os  externum  there  lay  a  broad  lip,  which,  in 
the  usual  condition,  scarcely  covered  the  os,  but  when  hyperaemic  certainly 
must  have  covered  it  completely.     Uterus  and  oviducts  were  normal. 

The  right  ovary  weighed  no  grammes.  Its  length  was  3.5  cm.,  breadth 
2.5  cm.  and  thickness  1.5  cm.  At  various  points  on  the  surface  there  ap- 
peared yellow  bodies  3-7  mm.  broad.     Through  the  dense  fibrous  tissue  of 


Nymphoniayiia  193 

the  gland  there  could  be  seen  several  Graafian  follicles.  The  contents  of 
one  cyst  of  the  size  of  a  hickory  nut  were  bloody.  The  left  ovary  weighed 
55  grammes.  Its  length  was  3.3  cm.,  its  width  2.3  cm.  and  thickness  1.3  cm. 
The  periphery  was  smooth.  Upon  section,  this  ovary  was  found  to  have 
undergone  extensive  fibrous  degeneration  and  it  contained  a  few  follicles. 

Pathologico-anatomical  diagnosis :  indurative  cystic  ovaritis  of  right 
ovary,  and  indurative  oophoritis  of  left. 

4.  In  an  aged  nymphomaniac  cow  which  was  slaughtered  on  the  12th  of 
November,  1904,  the  mouth  of  the  uterus  was  penetrable  for  one  finger,  the 
lips  of  the  OS  were  slightly  swollen,  the  uterus  somewhat  enlarged,  the  right 
uterine  horn  was  empty.  To  it  was  suspended  an  abscess  in  the  form  of  a 
pedunculated  tumor.  The  right  oviduct  was  dilated,  its  ovary  the  size  of 
an  apple  and  affected  with  two  cysts  as  large  as  hickory  nuts. 

The  left  uterine  cornu  contained  some  mucus  and  was  adherent  to  the 
anterior  extremity  of  the  bladder.  The  left  oviduct  was  as  thick  as  a  man's 
finger  and  contained  some  pus.  The  left  ovary  was  small  and  contained 
some  pea-sized  follicles. 

Pathologico-anatomical  diagnosis :  encapsulated  abscess  of  right  uterine 
horn,  adhesion  of  left  uterine  horn  to  the  urinary  bladder,  left  pyosalpinx 
and  cystic  degeneration  of  both  ovaries. 

5.  A  three  year  old  cow,  which  had  not  been  pregnant,  had  shown  normal 
estrum  for  3  months  but  had  not  conceived  ;  ovarial  cysts  and  nympho- 
mania then  developed. 

Post  mortem  examination  on  December  13th,  1905  revealed :  the  lips  of 
the  OS  uteri  externum  small,  the  cervical  canal  closed.  In  the  cervical 
canal  there  was  some  viscid  mucus.  Weight  of  uterus  375  grammes. 
Uterine  cornua  very  small.  Uterine  mucosa  pale.  Cotvledonal  nodes 
normal.  Right  ovary,  weighing  6  gr.,  contained  several  small  yellow  bodies 
and  6  pea-sized  follicles.  Left  ovary  weighed  11  grammes  and  was  normal. 
Pathologico-anatomical  diagnosis  :  Multiple  formation  of  cysts. 

6.  A  cow  which  had  been  nymphomaniac  for  ten  months,  with  marked 
sinking  of  the  broad  ligaments  of  the  pelvis,  revealed  the  following  upon 
post  mortem  examination  :  lips  of  os  uteri  somewhat  swollen,  injected 
clear  mucus  in  the  cervical  canal,  in  the  walls  were  very  hard  areas  sug- 
gestive of  cancer.  The  uterus  somewhat  enlarged,  peritoneal  surface 
smooth.  In  the  right  horn  was  an  intensely  pigmented  area,  3x1  cm.  in  ex- 
tent. Right  oviduct  dilated,  its  walls  thin,  its  ampulla  adherent  to  the 
ovary  and  distended  into  a  thin  walled,  pear-shaped  cyst  15x9  cm.  in  size, 
filled  with  a  clear,  serous  fluid.  The  ovar}',  concealed  in  the  adherent 
ampulla,  was  normal  in  size  and  contained  yellow  bodies. 

Left  oviduct  also  dilated.  Fimbriated  end  adherent,  leading  to  the  ex- 
istence of  an  hour-glass-shaped  sac  12  cm.  long  and  9  cm.  broad  at  its 
widest  point.  It  was  thin-walled  and  filled  with  a  clear  yellowish  serosity. 
The  left  ovary  was  normal  in  size,  concealed  in  the  ampulla  and  contained 
one  large  corpus  luteum.  The  arteries  of  the  broad  ligament  were  some- 
what large  and  inflexible. 

13 


194  Veterinary  Obstetrics 

Pathologico-anatoinical  diagnosis  :  bilateral  serous  salpingitis  with  oblit- 
eration of  the  opening  of  the  ampullse  through  adhesion  of  their  margins 
to  the  surface  of  the  ovaries. 

7.  A  yearling  goat  which  had  not  shown  estrum  at  all,  nor  nympho- 
mania, was  slaughtered  on  October  26th,  1905. 

The  post  mortem  examination  revealed  :  uterus  symmetric,  its  body 
3  cm.  and  its  horns  7  cm.  long.  From  the  right  ovary  there  hung  by  a 
pedicle  6  cm.  long  a  spheroidal,  free-swinging  tumor  8  cm.  in  diameter. 
This  2  celled  tumor  contained  a  freely  flowing  yellowish  fluid  with  numer- 
ous fibrin  floccules.  The  left  ovary  was  likewise  enlarged,  3  cm.  broad, 
fluctuating,  three  chambered,  the  cavities  containing  a  clear,  pap-like  fluid. 
Pathologico-anatomical  diagnosis  :  congenital  ovarial  cystic  degeneration. 

8.  A  2  year  old  brood  sow.  apparently  perfectly  sound,  which  had  already 
borne  two  litters  of  pigs,  being  fat,  was  slaughtered  on  May  8,  1906,  and 
revealed  the  following  : 

The  ovaries  were  each  as  large  as  a  fist  and  weighed  together  500  grammes. 
Each  consisted  of  numerous  thin-walled  fluctuating  cj'sts,  varying  in  size 
from  a  nut  to  an  egg,  the  contents  consisting  of  a  transparent  serum.  In 
the  right  ovary  there  was  a  yellow  body  as  large  as  a  pea. 

Pathologico-anatomical  diagnosis  :  cystic  degeneration  of  both  ovaries. 

The  contents  of  solitary  ovarial  cysts  usually  consist  of  a 
watery,  transparent  fluid  having  an  alkaline  reaction  and  con- 
taining albumen;  less  frequently  the  contents  are  yellowish, 
reddish  or  bloody. 

It  has  been  recognized  for  several  decades  that  the  thin  walled 
peripheral  ovarian  cysts  tend  to  recur.  The  recurrence  involves 
largely  for  a  long  duration  of  time  the  same  ovar}- ;  at  other 
times  it  alternates,  first  one,  then  the  other  ;  or  both  may  be- 
come involved  simultaneously  or  in  rapid  succession.  It  is 
worthy  of  note  that,  strictly  speaking,  the  symptoms  of  nympho- 
mania resulting  from  recurrent  ovarian  cysts  are  frequently 
more  marked  and  intense  than  those  accompanying  primary 
cysts.  Exceptionally  in  cows  which  have  developed  "  stillochsig- 
keit,"  or  dumb  estrum,  as  a  result  of  ovarial  cysts,  and  these 
have  been  crushed,  intense  erethetic  nymphomania  may  occur 
8-14  days  later  because  of  the  recurrence  of  the  cysts. 

An  additional,  though  very  rare,  observation  included  three  cows 
which  were  handled  because  of  recurrent  cysts,  after  which  concep- 
tion followed  but,  during  the  entire  span  of  gestation,  sexual  desire 
was  easily  excited  so  that  they  would  neither  graze  quieth-  nor 
could  they  be  turned  out  with  other  cows  to  drink  and,  even  on 
the  day  before  calving,  attempted  to  ride  other  cows.     In  two  of 


Nymphomania  195 

them  (the  third  was  sold) the  ovaries  felt  normal  a  few  days  after 
parturition  and  contained  no  yellow  bodies  ;  four  months  after 
parturition  both  animals  showed  bilateral  cystic  degeneration  of 
the  ovaries  and  again  well  marked  nymphomania. 

The  length  of  interval  between  recurrences  is  very  variable  in 
different  individuals  and  ranges  between  a  minimum  of  3  and  a 
maximum  of  120  days,  between  which  occur  periods  of  8,  12,  14, 
16,  20,  27,  30  and  60  days.  Often  we  find,  in  heifers  and  j-oung 
cows,  at  the  beginning,  long  and  regular  intervals  ;  later  short  and 
irregular,  or  the  reverse.  So,  for  example,  we  observed  the  : 
first  formation  of  cysts  i  ro  daj^s  after  calving,  in  both  ovaries  ; 
second  formation  of  cysts  120  days  after  calving,  in  the  right 

ovary ; 
first  formation  of  cysts  60  days  post  partum,  in  both  ovaries  ; 
second    formation    of    cysts    120   days  post  partum,   in   right 

ovary ;   and 
third  formation  of    cysts    160  days   post   partum,  likewise   in 

right  ovary. 
One  three  year  old  cow  which  had  not  yet  been  pregnant 
showed  cysts  in  the  left  ovary  three  times  in  succession  at 
intervals  of  one  month  each.  Three  months  later,  both  ovaries 
had  undergone  cysto-fibrous  degeneration  and  estrum  now  re- 
curred every  8  days. 

In  another  three  year  old  cow  which  had  not  been  pregnant, 
estrum  recurred  at  first  every  28  days  and  lasted  2  days  ;  later 
the  patient,  suffering  from  recurrent  bilateral  ovarian  cysts,  was 
in  estrum  every  12  days. 

A  2^  year  old  heifer,  which  had  not  been  pregnant,  showed 
at  first  a  small  cyst  in  the  left  ovary,  eight  days  later  a  cyst  as 
large  as  a  hazelnut  in  the  same  gland,  and,  further,  15  days  later, 
a  cyst  in  each  ovary  the  size  of  a  large  hazlenut. 

When  the  period  elapsing  between  the  recurrence  of  cysts  is 
comparatively  long,  there  frequently  occurs  one  or  two  normal 
estrual  periods,  the  cow  appearing  in  all  ways  normal  but  failing 
to  conceive. 

The  frequency  of  recurrence  is  extremely  variable.  In  50  % 
of  the  cases,  after  the  cysts  have  been  crushed,  they  do  not  re- 
cur until  after  the  next  calving.  In  individual  cows,  the  forma- 
tion of  cysts  occurs  almost  immediately  after  each  calving,  and  rel- 
atively such  animals  very  frequently  conceive  after  proper  hand- 


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Nymphomania  197 

ling.  The  recurrence  of  cysts  for  3-6-10-15  times  is  not  rare  ; 
it  then  frequently  leads  to  atrophy  and  a  fibrous  thickening  of 
the  ovary  (vid.  table). 

The  size  of  the  cysts  and  thickness  of  their  walls  stand  in  a 
certain  relation  to  the  intervals  of  recurrence,  in  that  in  shorter 
intervals  the  cysts  are  small  and  thin  walled,  in  longer  intervals 
they  are  usually  larger,  their  walls  thicker  and  their  rupture 
more  difficult. 

The  post  mortem  findings  in  the  case  detailed  in  the  table 
upon  the  opposite  page  were  as  follows  :  In  the  right  ovary 
there  were  recognizable  four  scars  and  a  very  thin-walled 
cyst  the  size  of  a  hen's  egg  which,  in  consequence  of  the  for- 
mation of  partitions,  was  separated  into  three  sections.  Of 
real  ovarian  tissue  only  a  trace  remained.  The  left  ovary,  also 
exhibiting  four  well  defined  scars,  was  the  size  of  a  hickorynut 
and  contained  a  hazelnut  sized  cyst.  The  slightly  enlarged 
uterus  weighed  i  kilogram  and  contained  some  mucus.  It  is  an 
interesting  fact  that  all  the  cysts  could  be  ruptured  per  rectiitn, 
that,  further,  there  was  constantly  a  restoration  of  the  tension 
of  the  broad  ligaments  of  the  pelvis  after  4  days  ;  the  quantity 
of  milk  increased  and  the  prolapse  again  vanished  four  to  ten 
days  after  the  operation. 


B.     ABSENCE  OF  ESTRUM 
Dumb  Estrum.     "  Stillochsigkeit." 

We  have  already  related  that  sinking  of  the  broad  ligaments 
of  the  pelvis,  in  connection  with  cystic  or  cysto-fibrous  degenera- 
tion of  the  ovaries,  is  not  necessarily  associated  with  nympho- 
mania or  abnormal  sexual  excitement  but  that  there  occur  cases  in 
cows  in  which  there  is  an  absence  of,  or  only  a  slight  degree  of, 
sexual  excitement.  In  these  animals,  absence  of  sexual  excite- 
ment does  not  interfere  with  their  feeding  and  they  constantly 
tend  to  become  fat.  Accompanying  this  difficulty,  there  is 
usually  present  the  same  sinking  of  the  hips  as  in  nymphomania. 
The  history  of  the  animal  is  about  as  follows  :  after  calving 
there  is  an  entire  absence  of  estrum  or  the  broad  ligaments  of 
the  pelvis  recover  their  normal  tension  in  spite  of  the  ex- 
istence of  the  light,  clear,  albuminous  discharge  from  the  vagina  ; 
no  estrum  appears.  After  3-5  weeks  post  partum  there  appears, 
and  remains  constant,  a  sinking  of  the  broad  ligaments  of  the 
pelvis  although,  during  4-6  months  after  calving,  the  cow  ex- 
hibits no  signs  of  estrum.  Or,  in  other  cases,  estrum  has  oc- 
curred for  the  last  time  6-8  months  previously,  at  which  date 
the  cow  was  bred  and,  because  of  the  non-recurrence  of  estrum 
and  the  general  behavior  of  the  animal,  it  has  been  supposed 
that,  she  was  pregnant.  This,  in  spite  of  the  absence  of  a 
vaginal  discharge,  was  evidently  an  erroneous  view. 

The  condition  is  generally  due  to  a  cystic  degeneration  of  the 
ovaries,  in  which  the  cyst  wall  is  not  usually  so  tensely  stretched 
as  in  nymphomania  but  is  more  flaccid  ;  atrophy  of  the  ovary  ; 
connective  ti.ssue  degeneration  (cicatricial  degeneration,  ovarial 
sclerosis)  and,  in  a  few  cases,  to  parturient  paresis,  that  is,  as  a 
result  of  the  consequent  changes  taking  place  in  the  ovaries  after 
parturient  paresis.  In  such  cows  we  were  repeatedly  able  to 
recognize,  after  many  weeks,  a  persistent  yellow  body  with  ab- 
sence of  estrum  or  a  cystic,  or  more  especially  a  cysto-fibrous 
degeneration  of  one  or  both  ovaries,  with  sinking  of  the  .sacro- 
.sciatic  ligaments,  the  os  uteri  open  to  a  degree  to  admit  the  passing 
of  a  finger,  and  the  uterus  enlarged  as  a  result  of  mild  chronic 
catarrhal  endometritis.  Seven  times  we  recognized  ovarial  cysts 
198 


Absence  of  Estriim  199 

in  cows  which  had  previously  suffered  from  parturient  paresis 
and  then  showed  dumb  estrum  with  sinking  of  the  broad  pelvic 
ligaments.  In  one  instance  these  phenomena  were  associated 
with  a  persistent  yellow  body  in  the  right  gland.  In  five  of 
these  cases,  in  spite  of  extreme  sinking  of  the  broad  ligaments  of 
the  pelvis  and  marked  bilateral  cystic  disease,  there  was  not  a 
trace  of  estrum  to  be  seen. 

In  one  dumb  estrual  cow,  presumed  to  have  been  6  months 
pregnant  and  showing  extreme  sinking  of  the  broad  ligaments, 
there  was  present  in  the  right  ovary  a  large  cyst  and,  in  addition, 
an  extensive  pyometra  with  purulent  discharge.  In  another 
dumb  estrum  cow,  affected  with  extreme  sinking  of  the  broad 
ligaments,  the  two  ovaries  hung  far  down  in  the  peritoneal  cavity 
and  each  contained  a  large  cyst,  in  addition  to  which  there  was 
a  perivaginal  abscess  present. 

A  fat  young  cow,  a  few  hours  subsequent  to  normal  parturition, 
exhibited  sexual  excitement  and  attempted  to  mount  the  milker. 
The  broad  ligaments  resumed  their  normal  position  very  promptly 
but  sunk  again  to  an  extreme  degree  on  the  sixth  day  and  re- 
mained permanent  thereafter,  while  estrum  failed  entirely  to 
recur.  In  the  right  ovary  there  was  recognized  a  cyst  the  size 
of  one's  fist,  in  the  left  a  cyst  the  size  of  a  large  hazelnut. 

One  observes  now  and  then,  in  fat  cows  or  deep  milkers  which 
are  kept  stabled,  a  marked  sinking  of  the  broad  ligaments  of  the 
pelvis  with  large  cysts  in  the  ovaries  without  any  symptoms  of 
nymphomania.  The  latter  tends  to  appear  first  after  the  animal 
has  run  at  pasture  for  several  weeks.  In  addition  to  the  symp- 
toms of  cystic  degeneration  alread}^  related,  the  following  phe- 
nomena are  of  great  clinical  interest. 

C.   Prolapsus  Vagina. 

There  occurs  with  relative  frequency  in  non-pregnant  cows, 
seldom  in  heifers,  far  more  frequently  in  dumb  estrual  cows,  an 
habitual  prolapse  of  the  vagina.  According  to  our  investiga- 
tions, extending  over  a  number  of  years,  at  least  50  %  of  the 
cases  of  prolapse  of  the  vagina  occur  in  nymphomaniac  animals, 
which  must  generally  be  referred  to  the  persistent  occurrence  of 
small  or  large  ovarian  cysts,  seldom  to  cy.sto-fibrous  degeneration 
of  the  ovaries  or  to  ovarial  cysts  in  combination  with  chronic 
catarrhal  or  purulent  endometritis.     We  have  good   proof  that 


200  Veterinary  Obstetrics 

the  existence  of  the  prolapse  of  the  vagina  in  non-pregnant  cattle 
is  due  to  a  chronic,  permanent  irritation  of  the  genital  organs 
owing  to  the  presence  of  diseased  ovaries,  because,  if  we  can 
bring  about  a  normal  state  of  the  ovaries,  the  sinking  of  the  broad 
ligaments,  the  swelling  of  the  vulva  and  theflaccidity  of  the  vagina 
all  cease  in  from  seven  to  twelve  days,  while  the  milk  flow  in- 
creases. Furthermore,  if  ovariotomy  be  performed  upon  these 
animals,  the  prolapse  of  the  vagina  disappears  in  95  %  of  the 
cases,  thus  demonstrating  the  co-ordination  between  the  cysts 
and  the  vaginal  prolapse. 

We  should  not  underestimate,  as  a  cause  of  continued  or  newly 
occurring  prolap.se  of  the  vaginaduring  the  first  two  to  six  weeks 
afterbirth,  an  acute  or  chronic  catarrhal  or  purulent  endometritis 
due  to  the  relaxed  state  of  the  pelvic  diaphragm. 

As  prodromata  of  vaginal  prolapse  due  to  ovarian  cysts,  there 
is  observed  a  sinking  of  the  sacro-sciatic  ligament  and  a  .swelling 
of  the  lips  of  the  vulva.  As  a  general  rule,  the  prolapse  does  not 
occur  at  the  same  time  as  the  formation  of  the  ovarian  cysts  or 
the  sinking  of  pelvic  ligaments,  but  follows  these  some  days  or 
weeks  later.  It  often  appears  simultaneously  with  a  well  marked 
erethetic  nymphomania.  Now  and  then  the  quantity  of  milk 
sinks  one-half  and  along  with  it  sometimes  occurs  a  "holding 
up"  of  the  milk.  In  rare  cases,  some  time  after  the  appearance 
of  prolapse  of  the  vagina  there  also  appears  a  slight  prolapse  of 
the  rectum.  In  one  such  case  we  identified  on  the  right  side  an 
ovarian  cyst  the  size  of  a  hazelnut  and  in  the  left  ovary  a  greatly 
hypertrophied  corpus  luteum. 

The  prolapse  often  involves  only  the  superior  wall  of  the  vagina. 
The  swollen  lips  of  the  vulva  are  clearly  sunken  forward  and  ap- 
parently small ;  in  many  cases  they  hang  loo.sely;  in  the  superior 
half  of  the  vulva  they  are  folded  and  wrinkled.  The  wrinkles 
extend  regularly  from  above  and  outward,  downward  and  in- 
ward, and  are  almost  wholly  caused  by  the  muscular  contraction 
of  the  walls  of  the  vestibule  of  the  vagina  or  possibly  are  a  result 
of  the  flaccidity  of  the  radiating  muscle  of  the  vulva  and  common 
fibers  of  the  sphincter  ani  extermis  and  constrictor  cunni, 
causing  an  invagination  of  the  lips  of  the  vulva,  that  is,  an 
e?itropium  vulvae  spasticus,  from  which,  in  place  of  the  normal 
mucous  margins  of  the  vulva,  two  haired  cutaneous  surfaces 
come  in  contact.     The  last  related  symptoms  (wrinkling  and  en- 


Absence  of  Est  mm  201 

tropiiim  formation  of  the  vulvar  lips)  are,  from  a  diagnostic, 
pathonogmonic  and  superficially  visible  standpoint,  of  much  im- 
portance. Moreover,  the  vulvar  opening  is  frequenth-  much 
elongated,  the  vestibule  of  the  vagina  markedh'  enlarged  and 
flaccid,  so  that,  in  individual  cows,  air  may  readily  become  aspired 
into  the  enlarged  vaginal  cavity,  which  may  become  greatly 
distended,  so  that,  upon  palpation  per  rectum,  the  vagina  may  be 
found  tensely  inflated  with  air,  in  order  to  evacuate  which  it  is 
necessary  to  apply  pressure  and  backward  massage  to  the  vagina, 
per  rectum/ 

If,  in  addition  to  the  prolapse  of  the  vagina,  there  is  also  en- 
dometritis, the  OS  uteri  is  found  sufficiently  open  to  admit  the 
index  finger  :  out  of  it  flows  a  mucous  or  muco-purulent  exudate 
and  the  uterus  shows  an  increased  size.  In  cows  which  have 
suffered  from  prolapse  of  the  vagina  dependent  upon  ovarial  cysts 
and  have  not  been  treated  for  these,  but  have  had  vulvar  sutures 
applied  to  overcome  the  condition,  there  is  now  and  then  violent 
straining  and  pressing,  on  which  account  practitioners  who  are 
not  experienced  replace  the  vulvar  sutures  by  a  vaginal  bandage 
or  truss  in  order  to  give  the  prolapse  more  room.  It  is  scarcely 
necessary  to  suggest  that,  in  order  to  determine  the  etiology  and 
rational  therapeutics  in  each  case  of  prolapsed  vagina  in  non- 
pregnant cows,  palpation  per  vaginam  and  per  rectum  should  be 
employed  and  that  these  rules  are  constantly  applied  in  this 
clinic. 

D.   Prolapsus  Portionis  Vaginalis  Uteri. '^ 

Quite  analogous,  from  the  standpoint  of  cause  and  curative 
means,  to  the  prolapse  of  the  vagina  is  the  prolapse  of  the 
vaginal  portion  of  the  uterus.  In  very  great  flaccidity  of  the 
genital  organs  this  prolapse  can  be  brought  about  artificially  by 
drawing  backward  upon  the  os  uteri. 

E.  Prognosis. 

Cystic  degeneration  of  the  ovaries  offers  a  favorable  prognosis 
in  general,  since,   in  our  statistics,    certainly   70%    of  nympho- 


['  In  this  relation  it  needs  be  borne  in  mind  that  the  vagina  possesses  the 
power  of  ballooning,  much  as  related  here.] 

-  E,    Hess,    vSchweizer   Archiv   fiir   Tierheilkunde,    1886,  p.  74  :    1890,  p. 
212  and  1896,  p.  228. 


202  Veterinary  Obstetrics 

maniac  cows  have  been  restored  to  fertility  and  again  become 
pregnant.  The  remainder  were  mostly  rendered  at  least 
temporarily  quiet.  The  prognosis  is  the  more  favorable  when 
the  veterinary  handling  is  begun  early  and  the  animal  is  not  fed 
too  intensely. 

The  prognosis  becomes  doubtful  in  fat  heifers  which  have 
never  been  pregnant,  in  old,  deep-milking  cows  with  depressed 
regenerative  powers,  as  well  as  in  cases  of  old  standing  and  those 
in  which  the  cysts  have  recurred  six  or  more  times. 

Estrum  and  pregnancy  do  not  occur  in  cows  whose  ovaries 
have  undergone  .senile  atrophy  or  which  have  suffered  atrophy 
from  the  rupture,  by  compression,  of  ovarian  cysts.  It  should  be 
noted,  however,  that  a  very  small  remnant  of  ovarian  tissue  may 
possess  much  regenerative  power  because  there  may  form  within 
six  days  in  some  ca.ses  either  large  corpora  lutea  or  one  or  two 
cysts,  as  our  collections  very  well  show. 

A  spontaneous  recovery  or  rupture  of  the  cysts  has  been  ob- 
served by  us  in  a  few  cases  of  cows  which  had  calved  normally 
two  to  six  weeks  before.  And  it  is  well  to  observe  in  our  pre.sent 
state  of  knowledge  that  it  was  not  the  use  of  posset  or  sillabub 
that  cau.sed  the  rupture  of  the  very  thin  walled  cyst  any  more 
than  the  extreme  filling  of  the  rumen,  which  pressed  upon  the 
ov^aries  while  the  animal  was  lying  down  on  a  slanting  floor,  or  to 
severe  pressure  of  feces. 

Nymphomaniac  cows  which  are  not  handled  tend  to  become 
emaciated,  wasted  and,  finally,  to  succumb  to  cachexy. 

In  reference  to  the  prognosis  of  prolapsus  vaginae  of  non- 
pregnant cows,  experience  teaches  that,  in  so  far  as  the  causes 
can  be  removed,  and  the  atony  of  the  pelvic  diaphragm  is  not 
extreme,  the  prolapse  disappears  within  twelve  to  twenty  days 
or,  if  the  cysts  recur,  the  prolapse  likewise  returns. 

In  hydro-  and  pyometra,  the  outlook  needs  be  based  upon  the 
duration  of  the  affection,  the  volume  of  the  collection,  and 
chiefly  upon  the  facility  with  which  the  ovaries  may  be  reached 
and  restored  to  their  normal  condition  through  rectal  or  vaginal 
manipulation  ;  if  these  can  be  corrected,  the  results  are  often 
excellent. 


THERAPY 

A.   Medicinal. 

We  cannot  undertake  to  discuss  all  the  remedies  which  have 
been  proposed  by  veterinarians  of  earh'  times  for  the  relief  of 
nymphomania  in  cows,  nor  those  which  have  actually  been  put 
in  use  and  have  from  time  to  time  won  high  repute  in  those 
regions  where  inner  palpation  of  the  genital  organs  of  nympho- 
maniac cows  is  very  rarely  practiced. 

To  these  belong  venesection,  magnesium  sulphate  and  sodium 
sulphate,  in  combination  with  aniaris,  aromatics  and  etherial  oils, 
as  :  Rad.  Gentian,  Herb.  Centmir  nii7ior,  asafetida,  Rad.  Angelic, 
Rhiz.  Calami,  Cantharid.  pjilv.,  Fol.  Mefith.  Piperit.,  Fruct 
Foeniadi,  Fnict  Jmiperi,  Piper  Nig  r.  pulv.,  Rad.  Valerian;  also 
such  depressant  drugs  as  Camphor,  Potassa  Bromid,  etc. 

Slight  sinking  of  the  .sacro-sciatic  ligament  dependent  upon 
atony  of  the  genital  organs  frequently  recovers  promptly  after 
the  use  of  the  following  : — 

B^   Magnesium  Sulphate  300  grams 

P.  Gent.  Rad. 

"  Cinchonae  Cort.  aa  150  grams 

"  Cascarilla        "  100  grams 

Aq.  font.  q.  s.  ut  fiat 
decoct,  ad.  colat.  8000  cc. 

Sig  : — One  pint  internally  2-3  times  daily. 
Sulphate  of  iron,  5-10  grams  dissolved  in  4  liters  of  water  or 
camomile  tea,  is  used  for  the  same  purpose. 

A  yet  greater  reputation  for  influence  upon  the  relaxed  sacro- 
sciatic  ligaments  and  genital  organs  is  accredited  to  resinous  and 
balsamic  substances,  especially  Ol.  Terebinth.  The  latter  may 
be  given  in  doses  of  15-20  cc.  in  3^2  liter  of  milk  three  times 
daily.  Turpentine,  camphor  and  asafetida  has  each  the  disad- 
vantage that,  when  given  for  several  days,  it  imparts  an  unpleas- 
ant flavor  to  the  milk,  and,  although  we  have  prescribed  turpen- 
tine or  myrrh  frequently,  we  have  never  been  able  to  observe 
the  disappearance  of  ovarian  cysts  as  a  result  of  its  use. 

In  earlier  times,    they    bathed    the    loins  and   sunken   sacro- 
sciatic  ligaments  daily  with  cold  water  or  applied   with   massage 
203 


204  Veterinary  Obstetrics 

spiritoiis,  feebly  stimulant  drugs  or  even  volatile  liniments,  ol. 
turpentine,  rape  oil  i  :5,  or  compound  cantharides  ointment.  Fric- 
tions over  the  sunken  pelvic  ligaments  are  merely  of  theoretic 
interest. 

The  value  of  medicinal  handling  is  doubtless  frequently  over- 
estimated ;  nevertheless,  it  constitutes,  in  many  cases,  when 
applied  alone,  a  valuable  method,  which  is  not  to  be  underesti- 
mated, and  in  many  other  cases,  a  highly  important  adjunct  in 
combination  with  operative  handling.  In  those  cows  where 
estrum  appears  shortly  after  parturition  and  the  uterus  has  not 
undergone  normal  involution  and  is  flaccid  and  slight  catarrhal  en- 
dometritis arises  without  being  caused  by  any  recognizable  anato- 
mical changes  in  the  ovaries,  but  resulting  rather  from  a  depres- 
sion of  the  vital  energy,  stimulants  and  tonics  exert  a  very 
beneficial  effect. 

In  catarrhal,  muco-purulent  or  purulent  endometritis,  in  addi- 
tion to  internal  medication,  it  is  advisable  to  douche  out  the 
vagina  daily  with  astringent  and  disinfectant  decoctions  or  solu- 
tions, such  as  sol.  plumbi.  subacet.  15:1000,  alum  ust,  0.5-1%, 
Zinc  Sulph.  o.25-o.5<5^,  Creolino.5-1%,  Ly sol  0.25-1  %,  etc. 

Under  all  conditions,  the  beginning  veterinarian  has  to  behave, 
in  the  handling  of  nymphomaniac  cows,  so  far  as  he  will  not 
seriously  injure  his  repute  or  practice,  with  some  respect  toward 
ancient  customs  and  psychologic  considerations  and,  in  opposition 
to  views  recently  expressed  in  veterinary  periodicals,  endeavor 
to  express  himself  frankly,  tactfully  and  without  reserve  to  the 
owner. 

B.  Operative  Handling  of  Ovarian  Cysts. 

The  operative  therapeutics  of  ovarian  cysts  should  always  be 
preceded  b)'^  a  painstaking  consideration  of  the  anamnesis  and  a 
thorough  examination  of  the  special  reproductive  apparatus,  as 
well  as  the  other  organs  of  the  body.  The  proper  arrange- 
ment of  the  data  derived  from  the  study  of  the  case  absolutely 
demands  the  entrance  of  all  notes  in  a  special  journal. 

The  investigation  and  examination  is  best  conducted,  from  the 
standpoint  of  light  and  cleanliness,  outside  the  stable,  in  which 
case  the  numerous  simple  and  cheap  stocks  very  common  in  this 
region  serve  an  excellent  purpose. 

Should  this  be  wanting,  the  cow  should  be  closely  secured  to  a 


operative  Ha?idlmg  of  Ovariayi  Cysts  205 

ring  in  the  wall  or  to  a  wagon,  by  means  of  a  strong  halter  or 
horn  rope.  The  position  of  the  examiner  should  not  be  too  low, 
and  should  be  clean  and  dry.  Cows  which  are  sensitive  about 
the  handling  of  their  genitals  should  be  secured  so  that  they  can 
not  move  very  freely,  by  forming  a  triangle  by  means  of  a  wall 
with  a  wagon  placed  obliquely  against  it,  the  cow  being  tied  short 
in  the  apex  of  the  triangle  so  that  she  can  neither  move  forwards 
nor  backwards,  while  lateral  movements  are  controlled  b}'  pushing 
the  heavy  wagon  toward  the  wall  and  closing  the  base  of  the 
triangle.  In  very  cold  weather  or  when  flies  or  gadflies  are 
numerous,  the  animal  may  be  secured  and  examined  in  a  horse 
stall.  Prior  to  the  examination,  the  external  genitals,  anus  and 
vagina  should  be  well  cleansed  bj'  means  of  a  clean  handtowel. 

If  the  right  hand  is  to  be  used  b}-  the  examiner,  the  tail  should 
be  turned  to  the  right  and  held  by  an  assistant  standing  on  the 
left  side  of  the  cow,  and  reversely.  The  proper  examination  of 
the  special  genital  organs  requires  a  blouse  to  protect  the  cloth- 
ing and  two,  or  better  three  assistants,  much  patience,  at  all 
times  great  cleanliness,  removal  of  all  finger  rings,  thorough 
oiling  of  the  hand  and  arm,  as  well  as  closely  trimmed  nails. 
The  evacuation  of  the  rectum,  especially  in  winter  and  in  ani- 
mals not  greatly  excited  sexuall5^  is  most  conveniently  brought 
about  by  inserting  the  fingers,  up  to  the  metacarpus,  in  the  anus 
and,  spreading  the  digits  apart,  permitting  air  to  enter  the  rectum, 
upon  which  defecation  usually  occurs  spontaneously  ;  otherwi.se 
the  rectum  needs  be  evacuated  with  the  hand.  A  special  flush- 
ing out  of  the  rectum  with  the  addition  of  anaesthetics  we  deem 
unnecessary. 

In  order  to  avoid  as  far  as  possible  the  troublesome  arching  of 
the  back  and  pres.sing  upon  the  rectum,  which  renders  the  ex- 
amination and  handling  difficult  and,  especially  when  upon  green 
food,  becomes  very  disagreeable,  it  is  recommended  to  gather  the 
skin  in  folds  just  behind  the  withers,  to  pinch  the  skin  of  the 
back  between  the  fingers,  to  press  upon  the  anterior  dorsal  region 
by  means  of  a  round  beam,  and  to  strike  sharph- upon  the  horns 
with  a  small  stick.  [A  wooden  beam  5  to  6   feet  long  placed 

across  the  back  and  borne  down  by  a  man  on  either  side,  is,  in 
our  experience,  the  most  effective  plan  for  preventing  straining.] 

In  locating  the  ovaries  it  is  to  be  first  remembered  that  the 
normally  involuted,  symmetrical,  unimpregnated  uterus,  weigh- 


2o6  Veterinary  Obstetrics 

ing  600  to  700  grams,  may  be  grasped  in  the  open  hand  and  car- 
ried relatively  far  backwards  into  the  pelvic  cavity.  As  a  result 
of  estrum,  the  uterus  is  normally  quite  hyperaemicfor  three  days, 
abnormally  for  four  to  six  days,  so  that  it  is  consequently  larger, 
denser  and  firmer,  which  condition  causes  it  to  be  readily  felt 
just  beneath  the  rectum. 

It  is  to  be  noted  that  the  uterus  frequently  does  not  lie 
exactly  on  the  median  line  but  either  to  the  right  or  left, 
and  indeed  far  more  frequently  to  the  right  side.  The  find- 
ing of  the  ovaries  and  their  identification,  which  for  the  be- 
ginner is  often  very  trying  and  sometimes  accompanied  by 
errors  leading  to  fatal  consequences,  requires  much  training. 
The  latter  increases,  however,  the  self-confidence  in  the  proper 
examination  and  handling  of  the  case  and  renders  inner  palpa- 
tion, in  the  course  of  time,  more  and  more  easy,  until  it  finally  be- 
comes no  longer  disagreeable.  In  case  of  veterinarians  with 
limited  experience,  the  ovary  is  most  safely  discovered  by  first 
grasping  the  uterus  and  thence  palpating  along  the  uterine  cornu 
on  the  concave  side  until  the  apex  is  reached,  from  whence, 
slightly  laterally,  the  ovary  is  loosely  attached  in  the  anterior 
border  of  the  broad  ligament,  where  it  can  be  picked  up.  More 
experienced  practitioners  search  directly  for  the  ovarj-  on  the 
anterior  border  of  the  broad  ligament  and  draw  it  backwards. 
In  cases  of  pregnancy  or  pyometra  the  ovaries  are  carried  far 
forward  and  downward  into  the  abdominal  cavity  and  thus  render 
it  difficult  or  impossible  to  reach  and  detect  them.  They  are  also 
frequently  difficult  to  locate  and  grasp  when  the  animal  strains 
violently  and  the  rectal  walls  are  tensely  stretched  and  also 
where  the  ovary  is  enclosed  within  the  ovarian  sinus,  that  is 
where  we  have  to  do  with  a  so-called  encapsulated  ovary.  In 
such  cases  it  avails  nothing,  even  if  theos  uteri  projects  into  the 
vagina  far  enough  to  be  grasped,  to  draw  upon  the  cervix, 
either  with  the  naked  hand  or  with  it  wrapped  in  a  small  clean 
towel.  In  case  of  slight  filling  of  the  uterus  with  pus  or  other 
liquid,  the  ovary  \y'\n%  beneath  the  uterine  horn  may  be  made 
accessible  by  turning  the  uterus  on  its  long  axis  or  the  hand,  w^ith 
which  the  palpation  is  being  made,  passed  underneath  it,  but  not 
by  elevating  the  abdominal  floor  by  means  of  a  beam. 

The   examination    of    the    ovaries    includes   the  size,    form, 
character  of  the  surface,  consistence  of  the  tissues  and   presence 


Rupturing  of  Cysts  per  Rectum.  207 

or  absence  of  pain  on  manipulation.  Normall}^  ovaries  without 
fresh  corpora  lutea,  according  to  the  age  of  the  animal,  as  already 
related  on  page  168,  are  the  size  of  a  pea,  bean  or  large  hazelnut, 
ovoid  and  of  firm-elastic  consistence.  Large,  ripe  follicles  vary 
in  size  from  a  pea  to  at  most  the  size  of  a  hazelnut  and  are 
recognizable  as  soft,  elastic,  fluctuating  spots,  slightly  elevated 
above  the  surface.  Corpora  lutea,  when  fresh,  vary  in  size  from 
a  hazelnut  to  a  hickorynut,  project  beyond  the  ovarian  surface 
as  slightly  elastic,  wart-like  outgrowths  ;  older  and  partly  re- 
sorbed.  and  persistent  corpora  (corpora  albicantia  and  persisten- 
tia)  are  only  the  size  of  a  pea  to  that  of  a  hazelnut,  protrude 
less,  and  are  of  a  more  firm  and  solid  consistence. 

In  the  handling  of  ovarian  cysts  we  have  for  many  years  re- 
lied upon  the  following  methods  in  this  clinic  : 

1.  The  rupture  of  the  <zysX.s  by  compression  per  rectum. 

2.  The  rupture  of  the  cysts  b}-  compression  per  vaginam. 

3.  The  puncture  of  the  cysts  through  the  vaginal  roof. 

4.  The  injection  of  disinfecting  liquids  into  the  ovaries. 

5.  Unilateral  or  bilateral  castration. 

I.  Rupturing  the  Cysts  per  Rectum. 

By  this  process,  which  was  first  described  by  Zangger,  the 
cystic  degenerated  ovar}'  is  grasped  through  the  rectal  wall,  and 
the  cyst  ruptured,  either  by  compression  with  the  entire  hand  or 
by  grasping  it  between  the  volar  surfaces  of  two  fingers  and  the 
thumb  bent  at  a  right  angle  or  by  pressing  it  between  the  hand 
and  the  ilial  shaft  or  border.  Care  is  to  be  taken  that  the  bowel 
contains  no  feces,  and  it  is  to  be  remembered  that  the  operation 
is  more  difficult  in  freshly  fed  cows  on  account  of  the  more 
abundant  defecation  and,  therefore,  when  practicable,  should 
be  undertaken  during  the  afternoon,  which  has  the  further  ad- 
vantage that,  in  case  of  the  advent  of  fatal  hemorrhage,  the 
emergency  slaughter  need  not  be  undertaken  until  the  following 
morning,  instead  of  during  the  night.  In  a  large  proportion  of 
cases,  moderate  pressure  suffices  to  bring  about  the  rupture  of  the 
cysts,  the  accomplishment  of  which  is  to  be  recognized  by  a 
sudden  collapse  of  the  ovary  in  the  hand. 

In  reference  to  the  possibility  of  rupturing  the  cysts,  those 
which  are  solitary,  thin  walled  and  of  recent  formation  are  uni- 
formly most  certain  and  easiest.     In  our  experience  with  many 


2o8  Veterijiary  Obstetrics 

thousands  of  cases  of  cystic  ovaries,  we  find  the  recent  and 
easily  ruptiirable  ones  chiefly  in  heifers  and  in  cows  which  have 
recently  calved  and  indeed  with  equal  certainty  whether  the 
duration  of  pregnancy  has  been  normal  or  not.  The  same  is  true 
of  nymphomaniac  cows  which  have  only  recently  become  affected, 
and  of  cases  previously  treated,  in  which  the  cysts  have  recently 
recurred. 

By  mere  accident  apparently,  in  certain  herds  in  which  the 
cows  and  heifers  run  at  pasture  the  entire  summer  and  where 
thej^  receive  very  little  artificial  food,  the  cysts  are  generally  thin 
walled  and  easily  ruptured. 

If  the  peripheral  cysts  be  of  long  standing  and  possess  a  thick, 
tough  capsule,  earnest  warning  need  be  given,  before  the  rup- 
ture of  the  cysts  per  rectum  is  undertaken,  against  the  accom- 
panying dangers  of  severe  maiming  or  tearing  of  certain,  or  of 
all  the  tissues  of  the  rectal  walls. 

It  makes  a  bad  showing  if — in  cases  where  the  operation  has 
been  very  difficult,  as  for  example,  where  the  patient  is  very 
resistent,  shows  great  uneasiness  and  strains  violently,  or 
great  sensibility  in  the  ovaries  which  have  already  been  sub- 
jected to  the  crushing  of  cysts  several  times,  or  difficulty  in  locat- 
ing and  grasping  them,  etc., — the  operator  withdraws  from 
the  rectum  a  bloody  hand,  since  these  unfavorable  appearances 
do  not  tend  to  increase  the  esteem  in  which  the  operation  is  held, 
nor  the  standing  of  the  operator. 

In  peripheral  cysts  of  varying  ages,  a  cyst  in  one  ovary  may  be 
easily  crushed  while,  in  the  other  gland,  one  of  equal  size  will 
be  very  difficult  or  impossible  of  rupture.  In  cases  of  two  or 
more  cysts  in  one  ovary,  first  one  cyst  and  then  the  other  is  felt 
to  rupture,  after  which  there  is  recognizable  a  minute  fragment 
of  the  ovary,  which,  however,  amply  suffices  for  inducing  the 
occurrence  of  normal  estrum,  although  the  remnant  consists 
merely  of  an  empty,  collapsed  capsule;  a  small,  empty,  flat  bag. 
If,  in  addition  to  one  or  two  cysts,  a  corpus  luteum  is  found, 
the  latter  usually  becomes  ruptured  or  pressed  out  first  and  then 
the  cysts  often  burst  .spontaneously  ;  however,  it  sometimes 
occurs,  as  shown  by  our  collection,  that  the  cj^sts  rupture  while 
a  small  corpus  luteum  remains  intact  in  the  ovary,  and  for  its 
dislodgement  a  still  greater  pressure  is  necessary. 


Rupturing  Cysts  per    Vaginam  209 

2.  The  Rupture  of  the  Cysts  Per  Vaginam. 

For  a  long  time  we  have,  in  addition  to  the  rupturing  of  ovar- 
ial  cysts  per  rectum,  also  practiced  rupturing  them  per  vaginam, 
an  experience  devoid  of  danger  throughout,  easil}'  accomplished 
and  accompanied  by  excellent  results. 

The  operation  per  vaginam  is  to  be  recommended  in  all  those 
cases  where  ovarial  cysts  cannot  be  easil}'  and  safely  ruptured 
per  rectum.  In  this  regard  it  is  to  be  preferred  in  all  those  cases 
of  peripheral  cysts  with  thick  walls,  such  as  usually  form  in 
dumb  bullers,  "stillochsigkeitt,"  and  also  in  old,  recurrent, 
thick- walled  cysts,  as  well  as  in  multiple  and  central  cysts.  Like- 
wise, it  constitutes  an  excellent  method  for  dislodging  very  firmly 
embedded  hypertrophied  corpora  lutea  which  require  removal. 

The  operation  is  uniformly  possible  in  cows  of  the  spotted  and 
brown  breeds  so  long  as  the  vulva  and  vagina  are  free  from 
strictures  and  also  in  large  two-year-old  heifers  with  sound  vag- 
inae it  succeeds  almost  without  exception  if  certain  precautions 
are  observed.  Palpation  per  vaginam  is  difficult  or  impossible 
in  heifers  with  fresh  vaginitis  follicidaris  infectiosa,  in  heifers 
and  cows  which  have  been  handled  for  this  disease  with  power- 
fully irritant  or  caustic  remedies  ;  also  in  animals  with  strictures 
or  adhesions  of  the  vagina,  to  which  there  is  almost  uniformly  a 
well  marked  tendency  after  vaginal  injections  of  a  2%  pyoktanin 
solution  in  a  vagina  affected  with  infectious  nodular  disease  ;  and 
finally  in  two  or  three-year-old  animals  which  have  aborted  dur- 
ing the  first  half  of  pregnancy  or  have  suffered  from  placental 
retention  and  whose  vaginae  have  been  irritated  and  lacerated  by 
palpations  by  inexperienced  and  incompetent  persons. 

Besides  the  customary  precautions,  palpation  of  the  genital 
organs  demands  a  thorough  oiling  of  the  vulva  and  the  hand. 
The  hand,  usually  the  right,  which  is  naturally  the  stronger,  is 
then  gently  pushed  through  the  vulva  with  a  rotary  motion 
until  it  reaches  the  os  uteri  externum.  After  the  right  hand  has 
been  successfully  introduced,  the  left  can  then  readily  be  in- 
serted without  special  difficulty.  After  completing  the  examina- 
tion of  the  vagina,  the  manual  displacement  of  the  ovary  is  car- 
ried out.  Following  the  grasping  of  the  cyst  per  rectum  it  is 
then  pushed  backwards  with  the  right  hand  and  held  down- 
14 


21  o  Veterinary  Obstetrics 

wards.  First  the  diseased  ovary  is  firmly  grasped  and  drawn  as 
far  backwards  as  possible.  The  left  hand,  carefully  prepared,  is 
then  inserted  with  the  greatest  caution  into  the  vagina  and  the 
ovary,  now  held  in  the  right  hand  per  rectum,  is  grasped  firmly 
with  the  left  through  the  roof  of  the  vagina. 

Should  the  ovary  escape  because  of  sudden  straining,  search 
for  and  grasp  it  again  with  the  right  hand,  per  rectum,  for  which 
purpose  it  is  best  to  partly  withdraw  the  left  until  the  gland  is 
again  located  and  .secured.  By  lifting  and  pushing  the  rectum 
aside,  the  ovary  is  freed  from  the  bowel  and  lies  now  surrounded 
only  by  the  superior  vaginal  wall.  Grasping  the  gland,  either 
between  the  thumb,  index  and  middle  finger,  or  in  the  entire  left 
hand,  it  may  then  be  pressed  and  ruptured  with  all  the  force  at 
command  without  any  important  injury  to  the  vagina.  In  one 
exceptional  instance,  indeed,  in  a  case  of  sclerotic  ovary,  the 
albuginea  was  ruptured,  which  was  followed  by  no  ill  con.se- 
quence.  Should  the  left  hand  for  any  rea.son  whatever  become 
exhausted,  it  should  be  withdrawn  and  the  right  used  in  its 
stead. 

The  bursting  of  thick- walled,  large  cysts  is  recognizable  by 
the  sudden  disappearance  of  resistance  and  is  now  and  then  evi- 
denced by  a  slight  cracking  sound.  It  is  highly  advantageous 
that  the  rectal  straining  generally  exerts  no,  or  in  other  ca.ses, 
only  very  slight  influence  upon  the  fixation  of  the  ovary  per 
vaginam,  as  a  consequence  of  which  the  final  compression  is 
very  much  easier  and  more  possible  than  by  fixation  of  the  ovary 
through  the  rectum.  The  thinner  and  more  flaccid  the  superior 
vaginal  wall  and  the  farther  the  ovary  can  be  drawn  backwards, 
the  easier  the  operation,  and  vice  vensa 

We  have  attempted  to  rupture  central  cysts  through  the  supe- 
rior vaginal  walls  by  a  .specially  constructed  instrument  similar 
to  the  lithotrite  of  Weiss,  but  without  result,  as  it  was  impos.sible 
to  .secure  the  affected  ovary  through  the  superior  vaginal  wall 
even  though  ample  and  flaccid. 

In  cows  with  large,  wide,  relaxed  vaginae  we  have  also  at- 
tempted to  secure  the  ovary  through  the  superior  vaginal  wall  by 
means  of  an  ecraseur  chain  and  then  to  rupture  or  puncture  the 
cysts,  but  we  have  found  it  a  very  exhau.sting  ta.sk,  which  rarely 
succeeds,  and  our  experience  has  not  warranted  recommending  it. 

In  cystic  degeneration  with  adhesions  of  the  ovaries  to  neigh- 


Punctjiri7ig  Cysts  through  the    Vagiyial   Wall  211 

boring  parts  so  that  they  cannot  be  pushed  backwards  per  rectum, 
as  well  as  in  cases  of  abscess  of  the  ovary,  it  is  good  policy  to 
abandon  manual  handling  and,  instead,  to  castrate  the  animal  hy 
intra-abdominal  ligation.  And,  finally,  in  cases  of  encapsulated 
ovaries  which  cannot  be  detached  and  which  resist  attempts  to 
rupture  them  in  their  sinuses,  there  only  remains  castration  with 
ligation  of  the  ligamentary  apparatus. 

3.  The  Puncture  of  the  Cysts  Through  the 
Superior  Vaginal  Wall. 

This  operation  is  indicated  in  cases  of  very  thick-walled  pe- 
ripheral or  central  cysts  which  cannot  be  ruptured  per  vaginam. 

It  may  be  carried  out  with  a  very  small  concealed  bistoury  or 
with  equal  facility  by  means  of  the  5.5  cm.  long  intestinal  trocar 
without  canula  such  as  we  have  used  for  some  years  and  is  made 
by  Hauptner  in  Berlin.  The  strictest  possible  antisepsis  of  the 
external  genitals,  of  the  hand  introduced  into  the  vagina  and 
disinfection  of  the  instruments,  is  essential.  The  operation  is 
simple  and  is  not  followed  by  important  sequelae.  The  affected 
ovary  is  grasped  and  fixed  with  the  right  hand  per  rectum  while 
the  instrument,  carried  into  the  vagina  with  the  left,  is  pas.sed 
through  the  superior  vaginal  wall  into  the  cysts. 

The  puncture  of  the  cyst  causes  a  disappearance  of  resistance 
and  by  light  pressure  complete  evacuation  is  readily  induced. 
The  ovary  then  consists  essentially  of  an  empty  capsule.  If  the 
first  effort  is  unsuccessful,  draw  the  trocar  back  into  the  vagina 
somewhat  and  insert  it  at  a  different  point  in  the  ovary. 

In  this  operation,  owing  to  the  fact  that  the  ovary  is  fixed 
by  the  hand  in  the  rectum,  it  occasionalh'  happens  that  the 
intestinal  wall  is  wounded,  but  this  is  of  no  consequence  since 
the  muscles,  being  both  circular  and  longitudinal,  promptl}' 
close  the  small  wound  and  prevent  any  escape  of  contents.  This 
occurrence  may  be  avoided  in  old  cows  with  roomy  vaginge  \>y 
grasping  the  ovary  through  the  vaginal  walls  with  the  left  hand 
and  holding  it  far  backwards,  and  then  passing  the  right  hand, 
armed  with  the  instrument,  alongside  the  left  and  making  the 
puncture  with  entire  safety. 

When  the  ovary  can  be  drawn  far  backwards  we  have  been 
enabled  to  make    the    puncture  with   the    intestinal    trocar    by 


212  Veterinary  Obstetrics 

merely  inserting  the  fingers  of  the  right  hand  into  the  vestibule 
of  the  vagina. 

4.  Injection  of  DisinfectanTvS  into  thk  Ovaries. 

Quite  analogous  to  emptying  the  ovarian  cysts  by  puncture  is 
the  injection  of  them  with  disinfecting  "and  dispersing  agents. 
This  was  first  recommended  by  Bertschy  (Schweitzer-Archiv. 
1906,  p.  155)  in  cases  of  cystic  ovaries,  especially  those  under- 
going fibro-cystic  degeneration  or  containing  central  cysts.  We 
use  for  this  purpose  a  Dieulofoy  syringe  fitted  with  a  special 
rubber  tube  from  the  syringe  to  the  canula,  through  which  we 
inject  a  1:10  Tr.  Iodine  solution. 

The  practical  results  of  puncture  of  cystic  degenerated  ovaries, 
as  well  as  the  intra-ovarian  injections,  according  to  our  statistics, 
are  evident  only  in  rare  cases,  a  fact  which  supports  our  teach- 
ing throughout  that,  when  cy.stic  ovaries  cannot  be  restored  to 
their  normal  condition  and  function  by  rupturing  the  cysts  by 
compression,  either  through  the  rectum  or  vagina,  the  last  and 
only  rational  resort  is  the  uni-  or  bilateral  castration  of  the 
animal. 

When  the  cysts  are  succe.ssfully  evacuated  early,  there  is  re- 
covery from  the  nymphomania  in  from  two  to  eight  days.  First 
the  sexual  excitement  abates  ;  the  animal  becomes  more  quiet  in 
from  12  to  24  hours,  more  docile  and  can  again  be  turned  with 
the  other  cows  to  water  or  pasture.  The  sunken  sacro-sciatic  lig- 
aments become  normal,  the  vulva  smaller  and  firmer,  the  vulvar 
opening  and  vagina  narrower  and  the  vaginal  entropium  ceases. 
Becau.se  of  the  contraction  of  the  uterus  and  closure  of  the  cervical 
canal,  the  slimy  mucous  discharge  cea.ses.  The  heretofore  wild 
expression  of  the  eyes  becomes  again  normal  and  docile,  and  in 
a  short  time  there  is  distinct  improvement  in  the  body  nutrition, 
be.sides  a  qualitative  and  quantitative  improvement  in  the  milk 
secretion,  changes  which  clearly  increa.se  the  worth  of  the  patient. 
Within  about  twenty  days  after  the  operation  another  notable 
result  appeans — the  disappearance  of  the  prolapsus  vagincc,  ox  pro- 
lapsus portionis  vagiiialis  uteri.  It  is  to  be  observed  in  reference 
to  the  latter  that  the  recovery  occurs  without  vulvar  sutures  and 
without  the  notable  vulvar  cicitrization,  which  decreases  the  value 
of  the  animal.  Only  in  old  cases  with  debility  are  vulvar  sutures 
demanded.     F'urthermore,  in  about  three  weeks  the  normal  estrum 


Sequelce  of  Crushing  the  Ovaries.  213 

appears,  when  it  is  advisable  to  allow  the  animal  to  be  bred.  The 
custom,  in  some  regions,  of  causing  the  cow  to  be  served  immedi- 
ately after  the  operation  is  not  favorable  to  conception  according 
to  our  observation  and  raises  the  question  whether  this  premature 
copulation  and  excitation  of  the  genital  system  does  not  really 
do  harm  and  tend  to  cause  the  recurrence  of  the  cystic  degener- 
ation. Especiallj'  in  well  nourished  heifers  and  in  deep  milking 
adult  cows,  ovarian  cj-sts  sometimes  recur  again  and  again  so 
that  they  may  be  ruptured  three  to  fifteen  times,  which  puts  a 
heavy  tax  on  the  time  and  energy  of  the  veterinarian. 

It  is  interesting  to  note  that  exceptionally  in  ca.ses  of  dumb 
estrum,  after  the  cysts  have  been  ruptured,  normal  estrum  fol- 
lows or  erethetic  nymphomania  with  a  recurrence  of  the  cj-sts. 
Further,  in  rare  cases,  thick  walled  cysts,  present  at  a  first  exam- 
ination and  impossible  of  rupture,  are  readily  ruptured  under  mod- 
erate pressure  two  or  three  weeks  later. 

We  have  also  noted  rarely  that  fibrous  degenerated  ovaries, 
after  vigorous  vaginal  pressure  and  massage,  sometimes  develop, 
in  the  course  of  fourteen  days,  cysts  as  large  as  small  hen's  eggs. 

In  general  the  rupture  of  ovarial  cj'sts,  when  carefully  under- 
taken, is  easy  of  accomplishment  and  without  danger,  and  onh' 
requires  after  attention  in  the  exceptional  cases  alread}'  men- 
tioned. Serious  or  fatal  sequelae  have  not  followed  the  rupture 
of  ovarian  cysts  or  the  dislodgement  of  persistent  or  hypertro- 
phied  corpora  lutea  in  this  ambulator}-  clinic  in  spite  of  the  many 
thousands  of  cases  operated  upon,  but  we  have  had  the  fortune 
to  observe  such  accidents  elsewhere. 

Among  the  sequelae  we  may  mention  : 

A.  Great  Hyperesthesia  of  the  Rectum  and 
Genital  Organs. 

Now  and  then  one  meets  with  a  cow  which  has  been  rudely  pal- 
pated per  rectum  several  times  by  an  inexperienced  person  ;  or 
affected  with  a  chronic  intestinal  catarrh  or  intestinal  tubercu- 
losis ;  adhesions  of  the  uterine  cornua  and  ovaries  to  the  sur- 
rounding organs  ;  abscesses  in  the  ovarian  ligament  ;  or,  from 
handling  for  granular  venereal  disease,  has  become  uncommonly 
sensitive  and  strains  violently,  accompanied  by  the  inspiration  of 
air  into  the  rectum.  The  straining  may  be  somewhat  controlled 
by  pinching  or  nipping   the  dorsal  spine   for  30  to  60  minutes, 


214  Veterina)-y  Obstetrics 

while  the  inspiration  of  air  into  the  rectum  ma\'  be  obviated  b}' 
pressure  on  the  anus  or,  still  better,  by  covering  the  anal  opening 
with  a  folded  hand-towel. 

Heifers  and  cows  which  have  been  previously  handled  for  in- 
fectious granular  venereal  disease,  with  irritant  remedies,  or  are 
still  suffering  from  the  malady,  are  frequently  so  irritable  and 
afraid  of  the  handling  of  the  vulva  or  vagina  that  they  are  very 
resistent  and  require  very  careful  and  close  securing  and,  even  in 
the  stocks,  may  either  lower  the  hind  quarters,  rear,  or  throw 
themselves  down  and  thus  render  the  examination  very  difficult. 
As  a  general  rule  the  hyperesthesia  of  the  rectum  and  vagina 
disappears  spontaneously  after  eight  to  ten  weeks. 

B.  Kinking  of  the  Lumbo-Sacrai.  Symphysis. 

By  this  term  we  understand  a  sudden  and  rapidly  alternating 
elevation  and  depression  of  the  lumbo-sacral  articulation,  with  a 
cracking  sound.  It  occurs  in  young,  timid  animals  and  now  and 
then  also  in  animals  suffering  from  a  serous  infiltration  of  the 
superior  vaginal  wall.  As  soon  as,  or  just  after,  the  hand  is 
passed  into  the  rectum  or  vagina  there  occurs  a  sudden  elevation 
and  depression  of  the  symphysis,  which  painfully  injures  the 
operator's  arm  and  causes  him  to  let  go  the  ovary,  which  has 
already  been  grasped.  This  very  annoying  symptom  usually 
ceases  spontaneously  in  a  few  minutes  but  disappears  more 
promptly  by  tapping  the  horns,  pressing  upon  the  back  and 
leaving  the  arm  wholly  passive  in  the  rectum. 

C.    Serous  Infiltration  of  the  Superior  Wall 
OF  THE  Vaccina. 

This  condition  is  rarely  seen  except  as  the  consequence  of  re- 
peated rude  palpation  of  the  vagina  or  as  a  result  of  the  injec- 
tion of  irritant  remedies,  especially  in  the  treatment  of  granular 
venereal  disease.  As  a  result  the  vagina  becomes  as  much  as  5 
cm.  thick  with  extensive  serous  infiltration,  is  sensitive,  and  the 
folds  are  obliterated  so  that  grasping  of  the  ovary  through  the 
vaginal  wall  is  exceedingly  difficult,  if  not  impossible. 

By  suspending  the  vaginal  palpation,  recovery  occurs  sponta- 
neously in  4-6  weeks. 

D.  The  Detachment  of  the  Ovary. 
In  the  operation  of  securing  the  ovary  per  rectum  preparatory 


Sequela:  of  Crushing  the  Ovaries.  215 

to  rupturing  C3'Sts  or  detaching  persistent  hypertrophied  corpora 
lutea,  it  has  happened  to  us  in  four  cases  in  high  bred,  excitable 
heifers  and  j-oung  cows  (never  in  adults),  owing  to  sudden 
straining  or  the  sudden  dropping  of  the  lumbo-sacral  articulation, 
that  the  grasped  ovary,  attached  to  the  fine,  tense  ligament,  is 
unexpectedly  torn  away  from  its  attachments  and  remains  in  the 
hand,  to  later  fall  into  the  abdominal  cavity.  The  same  misfor- 
tune can  occur  by  drawing  the  ovary  too  far  backward  when 
grasped /^T  rectum  or  vagi^iavi.  In  all  such  cases,  the  ligament- 
ous apparatus  should  be  immediately  and  carefully  examined  in 
order  that  hemorrhage,  if  present,  may  be  controlled  by  compres- 
sion. In  two  of  these  cases  we  clearly  felt  per  rectum  the  pulsa- 
ting, bleeding  ovarian  artery,  which  we  compressed,  as  well  as 
possible,  for  twenty  minutes.  Of  the  four  cases,  one  failed  to 
again  show  estrum,  but  the  other  three  all  conceived. 

It  is  well  to  bear  in  mind  that,  after  the  total  ablation  of  an 
ovar5%  as  also  after  the  pressing  out  of  large,  fresh  corpora  lutea 
and  vigorous  after-compression  of  the  ovary,  the  animal  now  and 
then  shows,  for  30-60  minutes,  sligiit  colic  symptoms  (castration 
colic),  such  as  uneasiness,  suspension  of  feeding,  elevation  of  the 
tail  without  tympany,  which  symptoms  .spontaneously  di.sappear 
in  a  short  time. 

F.  Laceration  of  the  Rectum. 

This  accident  occurs  mostly  in  delicately  built  heifers  with  a 
narrow  rectum,  or  in  good  milch  cows  in  which  the  rectum  pos- 
sesses very  slight  resistant  power  and,  even  by  very  slight  pres- 
sure, is  lacerated.  These  rather  frequent  lacerations,  due  con- 
stantly to  improper  palpation,  may  involve  only  the  mucosa  or 
include  the  mu.scular,  and  even  the  serous  coats. 

While  .scratches  and  lacerations  in  the  mucosa  of  the  pelvic 
portion  of  the  rectum  from  too  long  finger  nails  is  as  a  rule 
inconsequential,  extensive  lacerations  of  the  mucosa  and  muscu- 
laris  lead  readily  to  rectal  strictures  and  to  adhesions  of  the  rectum 
to  the  surrounding  parts.  Small  penetrant  wounds  in  the  pelvic 
rectum,  which  quickly  close,  lead  to  exten.sive  suppuration  or 
septic  phlegmon  in  the  peri-rectal  or  peri-vaginal  connective 
tissue  and  thereby  cause  compression  of  the  rectum  with  long 
continued  straining  and  pressure  upon  the  feces,  marked  narrow- 
ing of  the  rectum  and  vagina,  adhesions  of  the  rectum  to  its  sur- 


2i6  l^eterinaty  Obstetrics 

roundings,  slight  pyaemic  fever,  emaciation,  lumbar  weakness 
and  septicaemia.  Now  and  then  the  abscesses  break  into  the 
vagina,  following  which  complete  recovery  may  occur.  Severe 
penetrant  wounds  of  the  rectum  lead  to  fatal  hemorrhage  or 
septic  peritonitis. 

G.  Fatal  Hrmorrhagk  From  the  Ov^arian  Artery. 

{Hemorrhagia  artcrice  ovaricce.) 

The  most  to  be  dreaded  and  certainly  also  more  common  sequel 
of  ovarian  operations  than  generally  believed,  is  the  slow  bleed- 
ing to  death  from  the  ovarian  arteries.  Because  of  the  non- 
vascularity  of  the  capsule  in  peripheral  ovarian  cysts,  hemorrhage 
does  not  occur  from  them,  but  serious  or  fatal  hemorrhage  is  at 
times  observed  after  the  dislodgement  of  corpora  lutea  by  com- 
pression, after  severe  crushing  and  laceration  of  the  ovaries,  and 
is  possible  also  after  the  inadvertent  tearing  away  of  the  ovary 
from  its  attachments.  In  ovaries  affected  with  angioma  and 
blood  cysts,  fatal  hemorrhage  may  readily  be  caused. 

In  the  last  case,  which  is  very  rare,  the  ovary  feels  soft,  elastic, 
flabby,  spheroidal,  varies  in  size  from  that  of  a  man's  fist  to  a 
child's  head  and,  in  case  of  an  angiom,  possesses  a  spherical  or 
slightly  nodular  character.  Upon  pressure,  the  angiom  dimin- 
ishes in  size  but  when  the  compression  is  removed  the  refilling  of 
blood  .soon  restores  it  to  its  former  dimensions.  We  have  twice 
had  the  opportunity  of  observing  cows  in  which  ovarian  angioma 
had  been  lacerated  through  improper  handling,  followed  by  severe, 
though  not  fatal,  intra-abdominal  hemorrhage. 

The  symptoms  which  serve  to  indicate  ovarian  hemorrhage 
and  which  appear  a  few  hours  after  the  operation  are  as  follows  : 
decreased  or  wholly  su.spended  appetite,  fullness  in  the  upper 
flank,  weariness,  weakness,  quickening  of  the  respiration,  violent 
heart  beat,  feeble  pulse,  muscular  tremblings,  cold  horns,  ears 
and  feet,  anaemia  of  the  visible  mucosa  and  the  skin  of  the  udder. 
Death  usually  follows  15-36  hours  after  operation. 

A.side  from  these  fatal  hemorrhages,  others  of  a  less  serious 
character  occur  and  become  spontaneou.sly  stopped.  The  condi- 
tion may  cau.se  a  more  or  less  complete  lo.ss  of  appetite  and  rumin- 
nation  for  one  or  two  meals  and  a  varying  degree  of  fullness  in 
the  upper  flank  region.     After  24-96  hours  the  animals  recover 


Seqiielce  of  Cncshing  the  Ovaries. 


217 


their  normal  health.  Evidenth',  fatal  hemorrhage  may  also  ac- 
company more  or  less  extensive  lacerations  of  the  rectum. 

In  one  cow  we  ruptured  by  compression  on  two  occasions, 
April  and  August,  1906,  what  we  believed  to  be  thick- walled  ab- 
scesses the  size  of  a  hen's  egg  in  the  right  ovar}-,  which  was  fol- 
lowed in  each  case  24  hours  after  operation  by  symptoms  of  se- 
vere peritonitis,  which  persisted  for  14  days,  so  that  our  view 
was  supported  that  in  this  case  we  were  not  dealing  with  a  cyst, 
but  with  an  ovarian  abscess. 

With  a  view  to  prophylaxis  of  fatal  hemorrhage,  we  believe  the 
chief  danger  lies  in  too  hasty,  too  careless  operations,  and  in 
a  too  loose  generalization  of  cases.  If,  therefore,  each  case  is 
judiciously  considered  separately,  as  is  undeniably  demanded, 
there  is  no  fear  of  after-hemorrhage.  The  careful,  experienced 
practitioner  will  find  cases  of  diseased  ovaries  which  it  is  injudi- 
cious to  handle. 

From  a  prophylactic  standpoint,  it  is  desirable,  in  all  those  cases 
where  it  is  not  perfectly  certain  that  it  is  a  cyst  which  is  being 
ruptured,  that  digital  compression  should  be  applied  to  the  ovary 
for  10  to  20  minutes  after  the  operation,  or,  this  being  impractic- 
able, the  compression  may  be  applied  per  rectum  or  per  vaginam 
to  the  ovarian  artery,  which  lies  just  beyond  the  apex  of  the 
uterine  cornua.  While  the  after-compression  carried  out  per 
rectum  has  the  disadvantage  of  being  rendered  difficult  by  the 
straining,  and  is  more  certain,  reliable  and  easier  per  vaginam, 
either  is  efficient  and  trustworth}-.  In  addition,  the  owner  or 
milker  should  keep  the  patient  under  obser\'ation,  whether  day 
or  night,  for  some  fifteen  hours  after  operation. 


5.  CASTRATION 

This  final  therapeutic  agency,  the  last  resort,  the  indications 
for  which  have  become  constantly  more  precise  during  recent 
years,  and  the  worth  of  which  in  certain  cases  is  unquestioned, 
is  also  to  be  considered  here. 

The  reasons  for  castration,  as  revealed  by  our  numerous  obser- 
vations, are  as  follows  : — 

a.  Recurrent  peripheral  cyst-formation  in  one  or  both  ovaries, 
accompanied  by  nymphomania,  when,  in  spite  of  frequently  re- 
peated rupturing  of  the  C5'sts,  a  restoration  to  the  normal  condi- 
tion cannot  be  effected.  The.se  conditions  apply  especially  to 
aged  cows  yielding  more  than  three  liters  of  milk  per  milking,  in 
which,  in  spite  of  repeated  rupturing  of  cysts,  a  slight  sexual  ir- 
ritation, such  as  a  slight  falling  in  of  the  broad  ligaments  of 
the  pelvis  and  swollen  vulva,  persist.  On  the  other  hand,  we 
have  not  castrated  any  young  breeding  cows  for  years,  becau.se 
of  peripheral  C3^sts,  until  after  we  had  ruptured  the  cysts  6-8 
times  in  an  attempt  to  bring  about  recovery,  and  in  several  cases 
it  was  not  until  after  the  cysts  had  been  ruptured  8-12  times  that 
normal  estrum  and  pregnancy  resulted. 

b.  Central  or  multiple  cysts  which  cannot  be  broken  by  com- 
pression nor  evacuated  by  puncture. 

c.  Finally,  ovarian  edema  and  ovarian  abscesses. 
The  operation  is  contraindicated  : 

a.  In  dumb  estrum,  loss  of  estrum  due  to  atrophy  and  sclero- 
sis of  the  ovary  ; 

b.  In  ovarial  tuberculosis  ; 

c.  In  cancer  of  the  ovary  ; 

d.  In  nymphomania  dependent  upon  di.sease  of  the  oviducts, 
the  ovarian  ligaments,  the  uterus  or  the  vagina,  such  as  .serous 
salpingitis,  cystic  formation  in  the  ligamentous  apparatus  of  the 
ovary,  tuberculosis  and  cancer  of  the  uterus  and  vaginal  polypus. 

e.  In  tuberculous,  poor,  cachectic  animals. 

/.   In  cows  with  too  narrow  vaginae  due  to  vaginal  stricture.* 

[*The  author  apparently  has  in  mind  only  the  vaj^nal  ovariotomy   which 
the  pathologic  condition  prevents,  but  which  could  not  influence  the  flank 
operation.] 
218 


Castration 


219 


From  the  foregoing  it  will  be  seen  that  the  indications  for 
castration  have  been  reduced  to  a  more  limited  compass  than 
during  earlier  years,  and  there  can  be  scant  objection  thereto 
because  of  the  present  enormously  high  price  of  breeding  cattle, 
so  that  it  becomes  one  of  the  greatest  duties  of  the  practicing 
veterinarian  to  resort  to  every  possible  means  to  preserve  to  the 
utmost  the  breeding  power  of  well  bred  and  valuable  animals. 

We  hold  therefore  that  the  wholesale  castration  of  nympho- 
maniac cows  without  first  resorting  to  earnest  attempts  at  curing, 
the  malady,  robs  them  of  their  parturient  function  in  a  manner 
contrary  to  the  interests  of  science,  veterinary  practice  and  stock- 
breeding. 

According  to  veterinary  authors  cows  may  be  castrated  by  : 

^7.   The  flank  incision  ; 

b.  The  vaginal  incision  ; 

c.  Ligation  of  the  ovary  through  the  inferior  rectal  wall  (Ex- 
perience of  Trachsler-Berdes,  Koch's  Encyclopaedia  der  gesamm- 
tenThierheilkunde  und  Tierzucht). 

For  a  number  of  years  we  have  endeavored  to  perfect  the 
method  of  castrating  cows.  We  have  made  the  following  in- 
vestigations upon  cows  designed  for  slaughter  : 

a.  Ca.stration  by  tearing  the  ovaries  from  their  attachments. 
In  heifers  with  thin,  weak  ligaments  the  detachment  of  the 
ovaries  per  rectum  or  vaginam  is  comparatively  easily  and 
quickly  effected,  while  in  old  animals  with  strong  broad  liga- 
ments the  operation  becomes  impossible  even  per  vaginam. 
The  character  of  the  lesion  after  division  by  tearing  the  ovary 
away  in  young  animals  is  analogous  to  that  induced  by  the 
ecraseur,  while,  in  old  cows,  the  ligamentous  apparatus  of  the 
ovary  tears  very  irregularly  and  .sometimes  involves  the  uterine 
cornua. 

The  danger  from  fatal  hemorrhage  may  be  excluded  b}'  after 
compression,  the  artery  being  compres.sed  between  the  thumb 
and  fingers  for  a  few  minutes,  but  in  one  case  we  observed  in 
the  abdomen,  one  hour  after  castration,  about  one  liter  of  blood. 
We  have  further  found  that  the  power  of  ovarial  regeneration 
in  the  heifer  is  astonishing  and  that  if  a  fragment  of  ovarian 
tissue  as  large  as  a  pea  or  even  a  pinhead  is  left  on  the  ligament 
it  may  rapidly  develop  and  within  9-10  days  contain  one  or  two 
large   corpora    lutea   or   a    cyst.      [Upon   the  western  plains  of 


220  I'^eterinary  Obstetrics 

America  where  remov^al  of  the  ovaries  by  hnear  tension  or  tear- 
ing away  is  practiced  in  the  spaying  of  heifers  for  fattening, 
estrum  and  nymphomania  are  reported  common,  surely  as  a 
result   of  leaving  behind    some  vestiges  of  ovarian  tissues.] 

b.  Castration  by  torsion  of  the  ovary  from  the  rectum  or 
vagina.  While,  in  the  cadaver,  the  detachment  of  the  ovary  by 
torsion  requires  6-10  complete  revolutions,  we  failed  in  every 
case  to  bring  about  its  removal  by  this  means  in  the  living 
animal  because  of  the  firmness  of  its  attachment  to  the  broad 
ligament  and  the  smoothness  of  the  ovary,  which  caused  it  to 
inevitably  slip  away. 

c.  Equally  impracticable  to  the  two  preceding  methods  have 
proven  our  attempts  to  ligate  the  ovary  through  the  superior 
vaginal  wall,  including  the  latter  with  strong  silk  or  elastic  liga- 
ture, which  was  attempted  by  us  in  old  cows  with  wide,  flaccid 
vaginae.  Apparently  our  failure  was  due  to  the  violent  strain- 
ing following  the  operation. 

d.  On  the  other  hand,  the  method  of  castration  which  we  have 
regularly  applied  in  our  work  and  which  has  yielded  excellent 
results  is  based  upon  the  modern  surgical  principle  that  only  the 
disea.sed  part  is  to  be  removed,  so  that  for  some  years  we  have 
practiced  unilateral  castration  by  vagiyial  incision. 

This  operation  is  indicated  in  valuable  pedigreed  animals  with 
only  one  ovary  involved  in  cystic  degeneration,  of  a  character 
which  can  not  be  removed  by  manipulation  and  which  is  causing 
nymphomania  or  sterility.  Its  success  depends  upon  the  sound- 
ness of  the  remaining  ovary,  which  can  be  readily  verified  by 
direct  palpation  through  the  vaginal  opening  during  the  opera- 
tion. The  practical  results  of  this  operation,  showing  its  great 
economic  value,  we  are  able  to  show  from  our  experience  that,  if 
the  remaining  ovary  is  wholly  normal,  estrum  ensues  in  three 
weeks  after  castration  and  that,  after  another  three  weeks,  the  ani- 
mal can  be  successfully  .served  and  impregnated.  On  the  other  hand 
we  freely  confess  that  the  one  sided  castration,  by  increasing  the 
nutritive  supply  to  the  remaining  sound  ovary,  may  lead  to  its 
cystic  degeneration,  and  that  experimentally  we  may  cause  the 
development  of  cysts  by  unilateral  castration.  If  the  remaining 
ovary  is  only  slightly  enlarged,  the  increased  nutritive  supply  to 
it  resulting  from  the  removal  of  the  diseased  organ  causes  the 
regular  occurrence  of  peripheral  cysts  in   from   2-4   weeks  after 


Castration  221 

the  operation.  The  repeated  rupture  of  these  by  compression 
is  indicated,  but  the  constant  tendency  is  toward  an  eventual 
sclerosis  of  the  organ.  More  seldom  the  operation  is  followed  at 
first  by  an  exaggerated  estrum  with  a  large  corpus  luteumand, 
after  its  dislodgement  by  compression,  solitary  or  multiple 
peripheral  cysts  appear  and  the  ovary  becomes  sclerotic.  Should 
the  changes  in  the  ovary  seem  incurable  and  be  accompanied 
by  nymphomania,  the  castration  needs  be  completed. 

In  a  very  valuable  Simmerthal  cow  which  had  been  under 
treatment  for  nymphomania  for  nine  months,  we  found  the  left 
ovary  the  size  of  a  hen's  egg  and  affected  with  multiple  cy.sts. 
The  right  ovary  was  divided  into  two  spherical  parts,  which  were 
separated  about  4  cm.  from  each  other  and  possessed  a  dumb-bell 
form  in  miniature.  In  this  patient  the  left  ovary  was  completely 
removed  with  an  emasculator  and,  from  the  right  organ,  only  one 
of  the  two  spherical  masses  was  removed  with  the  chain  ecraseur. 
Examination  of  this  mass  showed  it  to  be  a  large,  round,  firm  cor- 
pus luteum  permeated  by  connective  tissue.  Ten  days  later  the  cow 
showed  nymphomania,  from  a  cyst  formed  in  the  right  ovary, 
and  eight  weeks  later  it  became  necessarj-  to  completely  remove 
the  remainder  of  the  right  ovary  because  of  extensive  cystic 
disease  after  the  cysts  had  been  ruptured  eight  times  in  vain. 

e.  The  results  of  complete  castration  are  similar  in  man}'  respects 
to  the  successful  handling  by  rupture  of  the  cysts.  The  animals 
become  quiet,  sexual  excitement  disappears  completely  and  the  sa- 
cro-sciatic  ligaments  resume  their  normal  position.  As  a  result  of 
the  decrea.sed  vascularity,  the  uterus,  vagina  and  vulva  become 
distinctly  smaller,  prolapsus  vagince  or  prolapsus  uteri  portio  vagi7i- 
a//5  disappears  and  nutrition  is  increased,  that  is,  the  animal  is  more 
readily  fatted  and,  while  the  animal  yielded  but  about  three  liters 
of  milk  per  milking  before  castration,  by  inhibiting  the  sexual 
functions  and  reflexes,  the  milk  is  material!}'  increased  in  quan- 
tity and  the  ' '  holding  up  ' '  of  the  milk  is  stopped.  The  influence 
of  castration  upon  the  course  of  tuberculosis — whether  it  amelio- 
rates the  disease  and  tends  to  cure  it  or  not  and  what  general 
influence  it  exerts  upon  soundness  and  vigor,  as  indicated  by 
cardiac  and  muscular  power — it  would  be  interesting  to  determine 
by  further  experiment. 


The  sequelae  of  castration  as  observed   by  us  in  the  course  of 


222  Veterinary  Obstetrics 

years  are  b^-  no  means  of  so  harmless  a  nature  as  many  would 
have  us  believe  and  there  is  good  room  for  differences  of  opinion 
as  to  its  value  in  many  cases.  Among  these  unfavorable  results 
are  to  be  counted  severe  or  fatal  hemorrhage,  in  connection  with 
which  it  might  be  urged  that,  in  the  castration  of  cows,  the  most 
rigid  antiseptic  precautions  should  be  observed  and  that  the  pre- 
vention of  even  the  slightest  hemorrhage  from  the  ovarial  arteries 
is  of  very  great  importance  in  relation  to  infection,  because  any 
hemorrhage,  with  the  resultant  formation  of  hematoma  or  blood 
coagula,  tends  to  favor  the  development  of  severe  complications, 
the  blood  clots  serving  as  a  culture  medium  for  bacterial  growth. 

Hemorrhage  from  the  ovarian  artery  also  tends  to  induce 
ichorous-purulent  and  sero-fibrous  peritonitis,  indigestion  and 
gastric  catarrh,  accompanied  often  by  a  permanent  reduction 
of  the  milk  secretion  ;  also  serious  phlegmon  in  the  periproctal 
-vaginal  and  -vesicular  connective  tissue,  complicated  by  difficult 
urination  ;  abscessation  in  the  stump  of  the  ovarian  ligament,  with 
or  without  rupture  into  the  rectum  ;  pelvic  abscess,  with  rupture 
into  the  vagina  or  later  into  the  peritoneal  cavity  ;  encapsulated 
intra-peritoneal  abscesses,  leading  to  great  emaciation  ;  cysts 
as  large  as  the  fist  forming  in  an  ovarian  ligament,  leading  to 
emaciation  ;  as  well  as  incomplete  removal  of  the  ovary,  leading 
to  the  recurrence  of  cysts  and  nymphomania. 

Young  and  old  castrated  cows  in  a  moderate  or  good  state  of 
nutrition,  according  to  our  observations,  fatten  well ;  but  when 
slaughtered  the  flesh  is  yellowish,  spongy,  coarse-grained  and 
not  to  be  called  prime  in  quality,  for  which  cause  in  this  region 
old,  fat  castrated  cows  are  not  sought  after  as  first-class  butchers' 
stock.  It  is,  however,  to  be  remarked,  as  we  have  frequently 
observed,  that  thin,  castrated  cows  are  largely  sold  fraudulently 
as  dry,  farrow  animals. 

II.    COLLKCTIONS   OF    PuS    IN   THE    UTERUS. 

Pyometra.    Hydromctra. 

By  pyometra  or  hydrometra  we  understand  the  collection  of  a 
varying  amount  of  pus  or  muco-purulent,  (pyometra)  or  sero- 
niucoid  fluid  (hydrometra)  in  the  uterus.  This  is  comparatively 
common  in  the  cow,  more  rare  in  the  goat,  and  is  accompanied 
or  succeeded  by  various  diseases  of  the  genital  organs      It   oc- 


Pyotnetra.  223 

curs  chiefly  in  4-8  year-old  cows,  mostly  in  breeding  and  good 
milking  cows,  seldom  in  farrow  animals.  It  is  largely  caused 
by  abortion,  premature  birth,  retained  placenta,  catarrhal  or 
purulent  endo-metritis,  maceration  of  the  fetus  and,  according  to 
our  observations,  very  often  by  the  infectious  granular  venereal 
disease. 

Although  the  symptoms  vary  somewhat  they  show  a  notable 
constancy. 

First  of  all,  contrary  to  our  literature  on  the  subject,  our 
numerous  clinical  records  teach  that  cows  with  abnormal  col- 
lections in  the  uterus  do  not  longer  come  in  estrum,  which  con- 
dition, in  cases  where  the  pyometra  had  been  preceded  by  estrum 
and  coition,  very  oftefi  leads  to  the  false  assumptioji  of  pregnancy. 
Furthermore,  the  condition  of  the  broad  ligaments  of  the  pelvis, 
the  size  of  the  vulva,  the  extent  of  the  vulvar  and  vaginal  canal, 
are  ordinarily  normal  or  but  slightly  altered,  and  only  very  sel- 
dom is  there  a  marked  .sinking  of  the  sacro-sciatic  ligaments. 
Vaginal  discharge  is  frequently  absent  in  spite  of  the  fact  that  the 
uterus  is  greatly  distended  and  the  cervix  uteri  is  open  sufficiently 
to  permit  the  passage  of  a  pencil,  the  little,  or  even  the  index, 
finger.  Now  and  then  there  is  seen  in  the  stall,  especially  in 
the  morning,  a  mucous,  muco-purulent  or  flocculent  purulent 
vaginal  discharge  behind  the  recumbent  animal.  This  may  be 
temporary  or  constant  and  variable  in  amount.  It  is  also  ob- 
served that  the  opening  of  the  uterine  cervix  sufficiently  for  the 
passage  of  a  pencil  or  of  the  little  finger,  and  especially  the 
vaginal  discharge,  tends  to  recur  about  every  three  weeks  and 
persist  for  2-3  days,  or  after  about  the  same  interval  of  time  that 
estrum  should  normally  recur  and  enduring  for  about  the  length 
of  time  that  estrum  should  continue.  In  connection  with 
the  open  cervical  canal,  the  cervix  and  uterus  are  slightly  en- 
larged or  increased  to  the  dimensions  of  a  man's  arm.  The  en- 
larged, painless  uterus,  which  is  not  to  be  confused  with  preg- 
nancy, is  either  symmetric  or  now  and  then  asymmetric,  the  one 
horn,  most  generally  the  right,  being  somewhat  more  distended. 

The  size  of  the  diseased  horns  varies  between  three  and  six 
inches  in  diameter  and  naturally  their  length  and  thickness  vary 
greatly.  If  each  horn  does  not  contain  to  exceed  a  few  liters  of 
contents  the  point  of  bifurcation  of  the  horns  is  very  evident  as 
is  also   the   arching   and    curvature  ;  one    may    also    grasp    the 


224  Veierviary  Obstetrics 

curvature  of  the  uterus  per  rectum  and  draw  the  former  back- 
wards and,  what  is  of  still  greater  practical  value,  may  rotate 
the  uterus  90°  or  %  revolution  on  its  long  axis,  by  which  means 
the  ovaries  may  be  grasped  and  examined.  Every  collection 
in  the  uterus  causes  a  displacement  in  the  ovaries,  they  being 
drawn  downward,  forward  and  toward  the  median  line,  beneath 
the  distended  uterine  cornu,  so  that  finding  and  recognizing  them, 
especially  in  cows  which  strain  hard,  is  rendered  very  difficult, 
and  in  the  presence  of  great  filling  of  both  horns  becomes  wholly 
impossible. 

The  uterine  horns  are  smooth  and  of  varying  degrees  of  dis- 
tension, at  one  time  being  relaxed  and  flat,  at  others  more 
tense,  rounded  and  sugillating.  The  contents  consist  of  a 
thin  or  thick  liquid,  which  is  white,  wdiitish-gray  or  grayish- 
yellow;  either  sero-mucous  (myxometra),  or,  more  often,  purulent 
or  muco-purulent,  odorless  or  fetid  (pyometra).  According  to 
its  etiology,  one  may  find  fragments  of  fetal  envelops,  a  macerated 
fetus  or  individual  bones,  which  latter  one  may  distinguish  by 
careful  palpation. 

The  ovaries  are  usually  normal  and  there  is  found,  what  should 
not  be  underrated  from  a  therapeutic  standpoint,  in  one  of  them, 
one,  two  or  three  various  sized  persistent  corpora  lutea  firmly 
imbedded  in  the  organ,  their  presence  depending  upon  the  failure 
of  their  physiologic  atrophy  to  take  place.  The  other  ovary  has 
undergone  fibrous  or  cystic  degeneration  and  is  from  the  size  of  a 
hickory  nut  to  that  of  a  hen's  egg. 

Therapeutics  of  Pyometra. 

At  variance  with  the  general  practice  and  the  teachings  of  ob- 
stetric authors  concerning  the  handling  of  pathologic  collections 
in  the  distended  uterus,  we  have  for  years  followed  a  course  of 
treatment  wdiich  has  yielded  good  results  in  50  %  of  all  our  cases 
and  has  been  accepted  by  many  of  our  colleagues  as  a  reliable 
method. 

Each  practitioner  well  knows  that  the  therapy  proposed  in  our 
literature  for  this  di.sease,  the  prognosis  of  which  is  often  unfa- 
vorable, consisting  of  the  injection  of  astringent  and  anti.septic 
agents  into  the  diseased  uterus,  has  a  higher  theoretic  than  prac- 
tical value  because,  with  the  closed  or  but  .slightly  opened  os 
uteri,  the  sufficient  dilation  of  the  cervical   canal  and  the  sub.se- 


Pyometra  225 

quent  introduction  through  it  into  the  uterus  of  the  douching 
tube,  is  accompanied  by  enormous  difficulty  and  great  loss  of 
time. 

The  therapeutics  of  the  malady  is  not  faciliated,  either,  by  the 
fact  that,  after  the  completion  of  the  first  dilation,  there  follows 
several  hours  of  severe  straining  and  pressing,  with  loss  of  appe- 
tite, which  leads  the  owner  to  become  dissatisfied  and  desist  from 
further  treatment. 

With  a  view  to  facilitating  the  dilation  of  the  cervical  canal 
and  rendering  it  easy,  as  well  as  avoiding  the  afterstraining,  irri- 
gation of  the  vagina  with  water  warmed  to  39  °  C.  is  recom- 
mended before  and  during  the  mechanical  operation.  The  evac- 
uation of  the  pus  is  brought  about  by  depressing  the  funnel 
attached  to  the  end  of  the  rubber  tubing,  which  acts  as  a  siphon. 
Now  and  then,  though  very  rarely,  one  evacuation  followed 
by  flushing  with  lukewarm  water  suffices  to  bring  about  recovery 
and  cause  the  recurrence  of  estrum. 

The  treatment  employed  by  us  consists  of  the  pressing  out  of 
the  corpora  lutea  and  the  per  rectum  stroking  or  massage  of  the 
uterus  from  before  to  behind.  As  already  related,  the  elimina- 
tion of  the  yellow  body  is  only  practicable  when  the  uterus  con- 
tains only  a  few  liters  of  pus,  that  is,  so  long  as  the  ovaries  can 
be  grasped  and  fixed  per  rectum.  The  detachment  of  the  yellow 
bodies  is  brought  about  by  compression  through  the  rectum  or 
vagina.  The  ovary  is  grasped  between  the  volar  surfaces  of  the 
thumb  and  two  fingers  or  between  the  thumb,  index  and  middle 
fingers  and  thus  compressed.  In  old  standing  cases  of  pyometra — 
when  the  animal  is  irritable  and  strains  violently,  the  rectum  is 
very  tense,  and  the  corpora  lutea  are  not  very  large  or  prominent 
and  are  solidly  bound  by  connective  tissue,  that  is,  almost  com- 
pletely encapsulated — the  operation  becomes  very  difficult,  in 
which  case  it  is  our  practice  to  not  press  out  the  yellow  bodies, 
but  to  vigorously  massage  and  rub  the  ovary  between  the  fingers. 
If  a  voluminous  collection  exists  in  the  uterus  and,  in  spite  of 
drawing  it  backwards,  the  ovaries  cannot  be  brought  in  reach, 
the  cow  should  be  at  once  fed  for  early  slaughter. 

After  dislodgement  of  the  corpus  luteum,  contraction  of  the 
uterus  follows,  the  os  uteri  opens  from  before  backward  and  the 
uterine  contents  are  evacuated  ;  in  approximately  18-72  hours 
15 


226  ]^eteri}iarr  Obstetrics 

after  the  operation  there  is  observed,  especially  when  the  animal 
is  recumbent,  an  astonishingly  abundant,  purulent  vaginal  dis- 
charge. It  should  be  seen  that  this  drains  away  promptly  and  that 
the  floor,  where  the  cow  lies,  and  the  gutter  are  well  disinfected. 
As  soon  as  the  discharge  ceases,  which  is  usually  after  a  very 
brief  time,  the  uterus  is  small  and  empty  and  estrum  often  appears 
as  early  as  the  4th  day,  still  more  commonly  between  the  4th  and 
loth  days,  after  the  dislodgement  of  the  yellow  bodies,  and 
tends  afterwards  to  recur  regularly.  Upon  the  second  return  of 
estrum  it  is  advisable  to  permit  her  to  be  served  and  conception 
usually  follows. 

Exceptions  to  the  type  of  cases  described  are  seen  in  those  cases 
in  which,  after  the  di.slodgement  of  the  corpora  lutea,  the  patient 
shows  pain,  evidently  the  result  of  uterine  contractions,  and,  for 
the  first  six  hours  after  the  operation,  shows  loss  of  appetite  and 
slight  tympauy.  With  the  advent  of  the  vaginal  discharge, 
these  symptoms  promptly  disappear.  In  more  tardy  contraction 
of  the  uterus  the  profuse  vaginal  discharge  extends  beyond  a 
week  and,  in  the  place  of  the  dislodged  yellow  body,  a  second 
fresh  one  as  large  as  a  hickorynut  develops  which,  in  the  interest 
of  the  evacuation  of  the  uterus,  is  again  to  be  eliminated  and 
indeed  this  operation  should  be  repeated  as  long  as  is  needful  and 
until  the  volume  of  the  uterus  returns  to,  and  remains,  normal. 

In  other  cases,  as  a  consequence  of  the  prolonged  treatment 
with  repeated  massage  of  the  ovaries  and  uterus,  pain  and 
chronic  purulent  endometritis  (whites)  are  shown  by  the  patient, 
accompanied  by  slight  emaciation.  Nevertheless  normal  estrum 
eventually  appears  and  conception  takes  place. 

In  one  cow  with  recurrent  pyometra  and  dense  ovaries  with- 
out 3'ellow  bodies,  we  crushed  the  right  ovary  per  vaginam,  upon 
which,  after  18  hours,  a  complete  evacuation  of  the  uterus  oc- 
curred and,  after  8  days,  normal  estrum  followed. 

Besides  the  dislodgement  of  corpora  lutea,  the  kneading  and 
massage  of  the  ovaries  and  the  gentle  pressure  and  stroking  of 
the  uterus,  I  have,  upon  the  advice  of  my  colleague,  Anderegg, 
in  Meringen,  administered  internally  for  pyometra,  bicarbonate 
of  soda  in  do.ses  of  150-200  grammes  a  day  as  an  emmenagogue. 
The  results  from  this  plan  w^ere  indeed  superior  to  the  irriga- 
tions but  not  so  prompt  as  by  operative  interference.  After  a 
few  days  our  cows  showed  a  profuse  vaginal  di.scharge  and  evi- 


Dislodgment  of  the  Corpus  Luteiim  227 

dent  decrease  in  the  size  of  the  uterus.  Recpver}-  or  the  recur- 
rence of  estrum  occurred  in  one  cow  4  weeks  after  the  com- 
mencement of  the  treatment. 

When  symptoms  of  soda  poisoning  appears  such  as  weakness 
and  diarrhose,  the  administration  of  the  sodium  bicarbonate  must 
be  suspended  for  a  few  days. 

III.  The  Dislodgment  of  the  Corpus  Luteum. 

According  to  our  observations,  extending  over  many  years  and 
including  a  large  number  of  cases,  we  have  reached  the  conclu- 
sion that  this  operation  has  not  yet  received  the  deserved  atten- 
tion. When  carefully  carried  out  it  is  not  dangerous,  causes 
little  pain  and  the  succeeding  straining  rapidly  disappears. 
Aside  from  the  fact  that  the  elimination  of  the  yellow  bodies  by 
inducing  an  active  hyperaemia  of  the  uterus,  which  awakens  its 
contraction  and  increases  the  auto-antiseptic  power  of  the  geni- 
tal canal  when  affected  with  pyometra  and  thus  serves  a  funda- 
mentall}'  useful  purpose  in  this  direction,  we  have  also  been  led 
to  apply  this  new  therapeutic  measure  to  other  cases  with  now 
and  then  good  results. 

It  has  proven  useful  in  chronic  purulent  and  catarrhal  en- 
dometritis when  combined  with  massage  of  the  uterus,  provided 
that  the  condition  was  not  dependent  partly  upon  tuberculosis 
or  malignant  neoplasms. 

It  has  also  proven  valuable  in  the  induction  of  artificial  abor- 
tion in  young  heifers  which  have  been  impregnated  too  early,  and 
in  cows  with  large  callus  formation  in  the  pelvis  which  would 
prevent  parturition  at  full  term.  The  expulsion  of  the  fetus 
accompanied  by  the  membranes  follows  in  from  24-72  hours 
after  the  operation. 

This  plan  of  handling,  at  least  so  long  as  the  ovary  can  be 
reached  and  grasped,  is  far  preferable  to  the  use  of  drugs  de- 
scribed in  our  literature  as  competent  to  induce  labor  pains. 
The  elimination  of  corpora  lutea,  in  combination  with  gentle 
massage,  is  ineffectual  in  cows  in  which  a  munmiif.ed  fetus  is 
lodged  in  the  uterus,  a  fact  which  must  be  attributed  to  the  con- 
dition of  the  uterine  walls  themselves. 

The  fact  that  estrum  does  not  appear  while  the  yellow  body 
persists  is  of  great  scientific  and  practical  interest.  The  condi- 
tion that,  so  long  as  a  corpus  luteum  persists,  estrum  does  not 


228  ]''eteri7iary  Obstetrics 

recur  and  that,  if  it  is  removed,  the  estriim  promptly  reappears, 
has  long  been  known.  Upon  this  point  our  statistics  teach  some 
important  lessons.  In  addition  to  the  persistent  absence  of  the 
symptoms  of  estrum,  such  animals  show  the  normal  tension  of  the 
sacro-sciatic  ligaments  as  well  as  a  normal  uterus  and  vagina. 

There  is  regularly  found,  in  those  cases  which  have  not  yet 
been  handled,  in  one  ovary  a  yellow  body  varying  in  size  from  a 
pea  to  a  hazelnut  or  small  hickorynut,  sometimes  inconspicuous, 
sometimes  prominent  and  firm,  often  easily  detached  and  many 
times  removable  only  with  difficulty  or  even  not  at  all,  especially 
when  completely  encapsulated  in  connective  tissue.  In  rare 
cases,  in  addition  to  the  foregoing,  there  may  exist  in  the  same 
gland  a  cyst  the  size  of  a  hazelnut  to  a  hickorynut  ;  conse- 
quently the  ovary  is  enlarged,  smooth  and  fluctuating  on  one 
end,  while  at  the  other  it  appears  lumpy. 

It  is  to  be  observed  in  the  dislodgement  of  the  persistent 
yellow  bodies  per  rectum  or  per  vaginam  that,  when  these  co- 
exist in  both  ovaries,  the  elimination  of  the  larger  corpora  lutea 
as  a  rule  suffices,  and,  when  both  a  corpus  luteum  and  a  cyst  exist 
in  one  and  the  same  ovary,  the  cyst  should  first  be  ruptured  if 
possible  and  then  the  yellow  body  pressed  out.  In  this  con- 
nection, we  have  noted  at  times  that,  after  rupturing  the  cyst, 
the  yellow  body,  which  could  be  clearly  recognized  but  could 
not  be  dislodged,  soon  became  absorbed  and,  after  a  time,  estrum 
spontaneously  recurred  ;  on  the  other  hand  we  have  also  seen 
under  like  conditions,  after  an  operative  elimination  of  the  cyst 
and  with  the  presence  in  the  same  ovary  of  a  persistent  yellow  body 
which  failed  to  be  absorbed,  that  the  cyst  only  very  rarely  re- 
turned. If  the  yellow  body  is  small  and  not  detachable,  there  is 
yet  hope  for  bringing  about  estrum  through  invigorating  the  ova- 
rian circulation  and  causing  the  resorbtion  of  the  corpus  luteum 
by  the  application  of  vigorous  massage  to  the  affected  gland. 
After  squeezing  out  the  corpus  luteum,  it  should  never  be  neg- 
lected to  apply  after-compression  to  the  ovary  for  10-20  minutes. 
If  possible,  the  tip  of  a  finger,  either />^r  rectum  or  per  vaginam, 
should  be  pressed  into  the  cavity  from  which  the  corpus  luteum 
has  been  removed.  In  the  walls  of  either  the  rectum  or  vagina 
the  pulsation  of  an  artery  is  occasionally  to  be  felt,  which  is 
not  to  be  confounded  with  the  ovarian  artery. 


Hypertrophy  of  the  Corpus  Lideufn  229 

The  artificially  aroused  estrura  is  identical  with  that  occurring 
normally  and  the  percentage  of  impregnations  is  as  high  as  in 
spontaneous  heat.  The  artificially  aroused  estrum  appears  in 
50  %  of  the  cases  on  the  evening  of  the  third  day  or  on  the  morn- 
ing of  the  fourth,  in  20  %  from  4-10  days,  and  in  10  %  from 
10-28  days  after  the  operation.  In  20  %  of  the  operated  animals, 
estrum  failed  to  appear.  At  the  point  from  which  the  persistent 
yellow  body  was  dislodged  there  often  develop,  but  not  always, 
one  or  several  new  corpora  in  the  course  of  a  few  days,  which,  in 
case  estrum  fails  to  appear,  should  again  be  pressed  out. 

IV.  Hypertrophy  of  the  Corpus  Luteum. 

In  this  region  there  is  observed  not  rarely  a  condition  which, 
up  to  the  present,  has  not  been  considered  in  veterinar\^  litera- 
ture as  a  cause  of  sterility  in  cows,  the  same  consisting  of  a 
hypertrophy  of  the  corpus  luteum. 

The  animals  which  have  been  affected  with  this  lesion  have 
been  young  cows  and  heifers,  which  have  in  all  cases  suffered,  a 
few  weeks  to  2  to  4  months  previously,  from  infectious  granular 
vaginitis  and,  after  recovery,  in  spite  of  estrum  having  recurred 
regularly  and  normally  every  three  weeks  or  in  rare  cases  every 
19-20  days  and  having  been  regularly  bred  to  healthy  bulls,  first 
to  one  and  then  another,  yet  fail  to  conceive.  All  animals 
affected  with  hypertrophy  of  the  yellow  bodies  show  as  a  rule  a 
shortened  estrual  period  of  12-15  hours  duration.  Rarely,  it  is 
normal  or  persists  for  48  hours  and  is  too  severe,  and  as  a  rule 
these  animals  show  for  2-4  days  after  estrum  a  voluminous  dis- 
charge of  .sanious  mucus,  which  is  always  prognostically  bad  for 
conception.  Examination  reveals  normal  tone  and  tension  of 
the  sacro-.sciatic  ligaments,  constant  traces  of  infectious  granular 
vaginitis,  con.stricted  vulva,  normal  os  uteri  and  uterus. 

One  of  the  ovaries,  and  indeed  almost  always  the  left,  appears 
normal  ;  the  other,  even  when  examined  only  a  few  da3's  prior 
to  the  appearance  of  estrum,  is  found  affected  with  one  to  three 
greatly  hypertrophied  corpora  lutea,  and  presents  prominent, 
deeply  fissured,  clearly  defined  outgrowths,  as  thick  as  one's 
thumb  and  as  much  as  4  cm.  long,  spherical,  papilliform  or  wart- 
like, at  times  soft,  in  other  cases  firm,  elastic  in  consistence. 

Our  method  of  handling  consists  either  of  administering  daily 
for   6-10  days   before    breeding,    25-40   grammes  of   powdered 


230  Veterinary  Obstetrics 

myrrh  in  a  liter  of  water,  or,  what  is  more  rational,  the  complete 
elimination  of  the  yellow  bodies,  followed  by  compression  when 
possible  of  the  remnant  of  the  ovary  with  three  fingers  or  the 
entire  hand,  through  the  vaginal  wall. 

In  pressing  out  hypertrophied  yellow  bodies,  it  occurs  excep- 
tionalh'  that  the  ovarj^  or  enlarged  yellow  body  splits  into  two 
portions,  which  remain  loosely  attached  to  each  other.  In  such 
cases  each  portion,  which  is  soft  and  elastic  and  consequently 
consists  only  of  tissues  characteristic  of  the  yellow  body,  is  to  be 
removed.  After  the  operation  the  animal  shows  for  from  20 
minutes  to  three  hours  a  slight  arching  of  the  back  and  elevation 
of  the  tail,  at  first  slight  straining  and  very  rarely  a  dimini.shed 
appetite  at  the  next  feeding  time. 

At  the  point  where  the  corpus  luteum  has  been  pressed  out,  one 
to  several  fresh  corpora,  less  developed,  generally  form  within 
3-12  days  and  indeed  we  have  observed  two  new  corpora  in  the 
left  ovary  nine  days  after  operating  and  three  in  the  right  organ 
after  twelve  days. 

The  normal  duration  of  estrum  is  not  affected  b}'  this  operation 
but  in  those  cases  where  it  was  previously  abnormally  short  it 
tends  to  become  normal  and  our  clinical  records  indicate  clearly 
that  95  %  of  animals  so  handled  conceive  at  the  first  service. 
The  hypertrophy  of  the  corpora  lutea,  like  so  many  other  phe- 
nomena in  the  sexual  life  of  cows,  is  referable  to  the  irritation  to 
the  sexual  apparatus  due  to  the  prior  attack  of  infectious  granu- 
lar venereal  disease. 


Finally,  not  only  with  reference  to  the  indications  for  castra- 
tion but  also  from  the  view  point  of  butter  and  cheese  production, 
we  should  consider  the  influence  of  nymphomania  and  castration 
upon  the  quality  of  the  milk. 

Prof.  Dr.  SchaflFer,  Canton  Chemist  in  Berne,  has  favored  us 
with  the  following  milk  analyses  and  explanatory  text  with  ref- 
erence to  the  influence  of  nymphomania  and  castration  upon  the 
character  of  the  milk  : 

Our  literature  is  contradictory  to  a  marked  degree  regarding 
the  influence  of  sexual  excitement  of  milking  animals  upon  the 
quality  of  the  milk.  While  Fleischmann  (Landw.,  Jahrbuch  20, 
Erganzungsband  U.S.  192)  found  a  marked  diminution  of  butter 


« 
Influence  ot  Castration    Upon  Milk  231 

fat,  Wryssmann  and  Peter  (Schweiz.  Milchztg.  1902,  No.  30) 
found  the  milk  of  cows  in  estrum,  in  general,  somewhat  richer  in 
cream.  They  showed  especially  in  several  cases  that  the  per  cent 
of  fat  was  decidedly  higher  for  one  or  two  days  before  estrum  than 
during  it.  Also  G.  vSchroeder  (Milchztg.  1874,  No.  104)  and 
F.  Schaffer  (  Mitteil.  d.  Naturf.  Ges.  in  Berne  1884  u.  Milchztg. 
1885,  S.  151)  found  that  the  milk  of  cows  in  estrum  showed  a 
high  percent  of  fat.  In  the  same  publication  the  latter  mentions 
a  case  of  continued  nymphomania,  in  which  the  per  cent,  of  albu- 
minoids and  solids  was  very  high,  and  the  rising  quality  of  the 
cream  markedly  weak,  for  w^hich  two  reasons  were  suggested. 
on  the  one  hand  the  increased  density,  on  the  other,  the  want  of 
large  fat  globules. 

The  influence  of  castration  upon  the  milk,  and  especiallv  in 
cases  of  nymphomania,  is,  according  to  all  the  above  investigators, 
favorable.  Still  our  literature  contains  but  few  contributions  upon 
the  matter.  Dieulafait  (Journ.  d'Agric.  Pract.  1864  I.,  P.  519, 
ff. ),  as  well  also  as  L.  B.  Arnold  (Milchztg.  1873,  S.  337)  has  ob- 
served, by  castration  experiments,  that  the  solid  contents  of  milk 
increased  and  the  flavor  improved,  but  the  quantity  decreased. 
The  analy.ses  made  by  these  investigators  vary  in  their  contents 
within  the  boundaries  of  normal  milk.  Since  castration,  espec- 
ially in  nymphomaniac  cows,  is  very  common  in  Switzerland,  the 
analysis  of  the  milk  from  these  appealed  strongly  to  us. 

For  the  investigations,  milk  was  taken  from  nymphomaniac 
and  castrated  cows.  On  the  whole,  the  experiment  animals 
under  our  control  were  constantly  in  good  general  health,  the 
udders  completely  sound   and   the  milk  macroscopically  normal. 

As  experiment  animals  there  were  used  the  cows.  Stor,  Reh 
and  Graf  ;  Stor  and  Reh  during  n3-mphomania,  and  Stor  and 
Graf  after  their  castration. 

Cow  No.  I,  Stor,  Simmerthal  breed,  about  10  years  old,  in 
medium  condition.  The  cow  calved  the  last  time  on  June  24, 
1903,  and  -Still  yielded  in  January,  1904,  three  liters  of  milk  per 
milking,  and  weighed  620  Kg.  Since  early  in  December,  1903, 
she  had  shown  well-marked  nymphomania,  but  on  account  of 
the  experiment  was  not  handled.  Castration  occurred  on  Feb- 
ruary 18,  1904,  and  the  results  were  favorable.  The  first  milk 
taken  for  chemical  analysis,  after  castration,  was  on  May  3,  1904. 


232 


Veterinary  Obstetrics 


Cow  No.  II,  Reh,  Simmerthal  breed,  was  about  12  years  old 
and  weighed  610  Kg.     The  cow  calved  the  last  time  on  May  25, 

1903,  and  -Still  gave  3.5  liters  of  milk   per  milking,  in  January, 

1904.  The  first  signs  of  nymphomania  occurred  late  in  October, 
1903,  and  the  neglected  disease  became  very  .severe  in  January, 
1904. 

Cow  No.  Ill,  Graf.  vSimmerthal  type,  7  years  old,  in  good  gen- 
eral condition.  vShe  calved  last  on  the  23rd  of  February,  1903, 
became  highly  nymphomaniac  during  the  summer  of  1903,  and 
was  castrated  on  the  3rd  of  the  following  December.  Early  in 
January,  1904,  she  weighed  800  Kg.  and  on  January  13,  yielded 
5.5  liters  of  milk  per  milking. 

The  analysis  gave  the  following  results  : 


A.     MILK  OF  NYMPHOMANIAC  COWS. 


Milk  of  Cow,  No.  I.    i 

;  Milk  of  Cow,  No.  11. 

Jan.  13 

'04 

Jan.  26 
•04 

1.0346 
13.83 
3-98 
4.03 

12^08 

29.18 

7.1° 

Feb.  15 
'04 

1.0347 
13.88 

4.05 

4.03 

0.78 
11.48     j 

29.21 

6.9° 

Jan.   13  Jan.  26 
'04          '04 

1.0340    1.0358 
13.56       14.43 
3.88        4.3 
3.86        4.12 
0.76        0.80 
1459 

26.25      25.32 

6.3°        8.4° 

Feb.  15 
'04 

vSpecific  Gravity  at  15°  C.  , 

1.0342 
13.18 

0.75 
7.0° 

1.0342 
'3-75 

Fat    '/( 

3.95 

Albuminoids,    %   

Salts    'v 

4.07 
0.79 

Chlorine,  ''>  of  the  ash 

Phosphoric  acid    '/,    of  the 
ash 

Acidity  of  the  milk  (after 
Soxhlet,  in  ioocm')__ 

■5-09 
26.18 
7.0° 

The  reaction  to  rennet  was  not  remarkable  in  any  test  made. 
The  milk  coagulated  under  the  casein  test  in  9)^  to  13  minutes. 
The  coagulation  was  in  no  test  abnormal.  Tests  of  the  behavior 
of  the  milk  in  the  incubator  likewise  showed  normal  characters. 

On  the  other  hand,  the  tests  showed,  on  the  whole,  a  defective 
rising  of  cream  in  that,  at  a  temperature  of  10  to  12°  C,  no  evi- 
dent line  of  demarcation  between  cream  and  milk  appeared.  Meas- 
ured by  the  micrometer,  the  fat  globules,  in  the  milk  of  cow  1, 
showed  a  diameter  of  0.0022  to  0.0104,  and  in  cow  II,  of  0.0017 
to  0.0104  mm. 


Influence  of  Castration    Upon  Milk 


233 


B.     MILK  OF  CASTRATED  COWS. 


Milk  of  Cow  III. 

(Castrated  on  Dec  3,  1903.) 


Milk  of  Cow  I. 
(Castrated  ou  Feb.  18, 


Specific  Gravity  at  15  C._ 

Solids,  '/f 

Fat,   ^/, 

Albuminoids,  '/o 

Salts,    '/, 

Chlorine,  '/,  of  theash... 

Phosphoric  acid,  'A  of  the 

ash 

Acidity  of  the  milk  t  after 
Soxhlet,  in    100  cm') - 


Jan.  13     Jan.  26 
'04  '04 


1-0325 
13.08 

3-95 

3.88 

0.70 
12.76 


Feb.  15      May  3    ^ 
'04  '04       \ 

.0329        1.0329        1.0320 


12.98 
3-8o 
3-43 
0.68 

12.64 


13. 1 1 
3-88 
3-45 
0.70 

13-17 


13.02 

3-75 
3-53 
0.70 
13-47 


May  3 
'04 


2937        29.97  28.80  27.74 

7.0°  6.7°     ;       6.8°  7.0° 


1-0337 
13.28 
3-40 
4.01 
0.77 


29-31 
8.0° 


The  behavior  toward  rennet  was  not  abnormal  in  any  ca.se.  In 
the  casein  test  coagulation  occurred  in  11-13^  minutes.  The 
behavior  in  the  incubator  was  also  parallel  to  that  observed  in 
any  good,  fresh  milk.  The  rising  of  cream  showed  nothing  ex- 
traordinary in  the  milk  from  either  cow.  The  measurement  of 
the  fat  globules  in  the  milk  of  cow  No.  Ill,  showed  a  diameter 
of  0.00135  to  0.0193  mm.,  while  that  of  Cow  No.  I,  gave  a  meas- 
urement of  0.00  [  19  to  0.0149  mm. 

If  we  now  compare  the  data  under  tables  A  and  B  with  each 
other  we  first  observe  a  higher  specific  gravity  in  table  A  and  a 
larger  amount  of  .solids  than  in  table  B.  It  is  thereby  indicated 
that  the  milk  of  nymphomaniac  cows  is  not  only  somewhat  richer 
in  its  contents  than  that  of  normal,  but  also  of  castrated  milk 
animals.  In  castrated  cows,  it  approaches  more  nearly  the  char- 
acter of  normal  milk. 

In  conclusion,  it  should  not  be  forgotten  that  a  thorough  clin- 
ical examination  and  a  rational  handling  of  diseases  of  the  genital 
apparatus  of  cows,  in  spite  of  the  many  di.sagreeable  features  con- 
nected therewith,  belong  nevertheless  among  the  most  important, 
prominent  and  appreciable  duties  of  veterinary  practice,  and  not 
alone  contribute  to  the  increase  of  the  national  resources  and 
dissipate  errors  and  discontent  in  agricultural  industries,  but 
also  add  to  our  knowledge  of  the  cause  of  sterility,  and,  not  the 
least,  add  to  the  well  deserved  standing  of  veterinary  science. 
In  reply  to  the  question  as  to  how  we  might  increase  veterinary 
authority  and  efficiency  in  this  regard,  we  would  unqualifiedly 
answer  that,  in  order  to  reach  this  plane    with  security,  a  great 


234  Veierhiary  Obstetrifs 

advance  can  be  made  in  the  teaching  of  veterinary  students  by 
the  institution  of  a  new  and  absolutely  indispensable  course,  for 
inexperienced  veterinarians,  to  be  known  as  "  Palpation  Course 
of  the  Genital  Organs  of  Cows  "  and  earnestly  endeavor  to  give 
them  an  extensive  practical  discipline  along  this  line.  Many  a 
momentary  deep  regret  and  complaint  would  be  spared  to  our 
younger,  enthusiastic  veterinarians  in  agricultural  practice,  and 
they  would  be  led  to  say  :   "  Labor  omnia  vincit  improbus.'^  ' 

Cystic  or  CVvSTo-Fibrous  Degeneration  of  the  Ovaries, 
WITH  Nymphomania,  in  other  Animals 

THAN    THE    CoW. 

On  page  194  we  have  recorded  the  occurrence  of  cystic  de- 
generation in  the  ovaries  of  a  goat  and  of  a  sow. 

While  nymphomania  is  not  extremely  rare  in  all  domestic  ani- 
mals, it  is  preeminently  common  in  the  cow,  not  so  much  in  a 
specific  sen.se  but  rather  in  the  closely  housed  and  high  bred,  fed 
and  milked  dairy  cow. 

In  economic  importance,  nymphomania  in  the  mare  assumes 
the  place  next  to  that  of  the  alTection  in  the  da'ry  cow  while, 
in  other  animals,  it  is  not  of  great  economic  importance. 

Nymphomania  in  the  Mare. 

Nymphomania  in  the  mare  is  rare  in  some  sections  of  the 
country,  while  in  others  it  is  quite  common  and  possesses  much 
economic  importance,  not  so  much  because  of  the  failure  of  the 
affected  animal  to  breed,  but  because  of  its  decreased  value  for 
work  purposes,  owing  to  the  unusual  development  of  disagree- 
able or  dangerous  vices. 

The  symptoms  of  nymphomania  in  the  mare  are,  in  many  re- 
spects, analogous  to  tho.se  ob.served  in  the  cow.  There  is  a  fund- 
amental difference,  however.  The  mania  in  the  cow  presents  an 
obvious  relationship  to  sexual  excitement  and  is  expressed  chiefly 
by  sexual  signs,  however  erratic,  but,  in  the  mare,  the  .sexual 
signs  tend  to  a.ssume  secondary  importance,  while  the  primary 
place  is  occupied  by  maniacal  symptoms  not  .so  readily  connected 
with  .sexual  excitement. 

Nymphomania  in  the  mare  is  most  commonly  met  with  in  tho.se 


See  foot  note  on  page  161. 


Nymphoviania  in  the  Mare.  235 

animals  which  are  kept  closely  confined  and  are  not  bred.  It  is 
more  rarely  observed  in  mares  regularly  worked  and  is  well  nigh 
unknown  in  those  which  are  free,  and  is  most  commonly  seen  in 
3^oung  or  middle-aged  mares,  rarely  in  aged.  It  is  quite  uncom- 
mon in  mules,  though  in  one  instance,  we  observed  the  disease 
in  so  marked  a  degree  as  to  render  the  otherwise  valuable  ani- 
mal worthless. 

The  symptoms  of  nymphomania  in  the  mare  usually  appear 
just  prior  to  estrum  or  during  that  period.  As  in  the  cow,  so  in 
the  mare,  estrum  may  occur  with  comparative  regularity-,  about 
every  four  weeks  but,  in  some  cases,  is  apparently  more  frequent, 
while  the  duration  of  the  period  may  be  so  prolonged  that  the 
intervals  of  calm  between  the  periods  of  sexual  mania  may  be- 
come very  brief. 

In  general,  the  first  symptom  of  nymphomania,  usually  ap- 
pearing a  few  days  prior  to  estrum,  consists  of  excitability  and 
irritability  of  temper,  though  in  some  cases  this  is  absent. 

The  patient  is  usually  more  or  less  vicious  toward  other  horses 
and  toward  men.  She  will  bite  and  kick  at  her  mate  or  other 
horses  when  approached.  If  working  with  a  mate  she  may  con- 
stantly attempt  to  bite  or  kick  it.  Very  frequently  the  patient 
will  crowd  against  the  pole  of  the  wagon  or  other  vehicle  and 
perhaps  lie  down  upon  it  in  an  effort  to  reach  her  mate  and  in- 
flict injury.  Sh&  manifests  her  viciousness  by  laying  back  her 
ears  and  .switching  her  tail,  while  her  eyes  and  physiognom}-  in 
general  betoken  evil  disposition.  The  mere  meeting  of  a  strange 
animal  of  either  sex  upon  the  highway  frequently  arouses  a 
maniacal  .storm  ;  the  mare  balks,  lies  down  upon  the  pole  or 
thills,  urinates  and  switches  her  tail ;  the  vulva  is  rapidly  opened 
and  closed  ;  the  clitoris  is  erected  ;  and  the  affected  animal  may 
attempt  to  grip  the  reins  with  the  tail,  may  kick,  rear  or  run 
awa}-. 

Toward  persons  her  disposition  is  equally  disagreeable  and, 
indeed,  often  decidedly  dangerous.  Upon  entering  the  stall  to 
groom,  harness,  unharness  or  otherwise  handle  the  animal,  she 
is  liable  to  kick,  bite  or  trample  upon  the  attendant  without 
warning.  In  hitching  or  unhitching  the  animal,  especially  when 
working  about  her  posterior  parts,  she  is  very  liable  to  kick. 

In  the  stable,  even  when  no  other  animal  is  near,  the  patient 
may  show  her  vice  by  kicking   the  sides  of  her  stall,  striking 


236  Veteri?iarY  Obstetrics 

and  stamping  with  the  feet.  In  one  instance  in  our  clinic,  the 
mania  was  almost  exclusively  exhibited  when  the  mare  was 
alone  in  the  stall.  Watched  from  a  distance,  she  would  stamp 
her  feet  and  kick  the  sides  of  the  box  stall  in  which  she  was 
confined.  In  her  maniacal  kicking  she  was  utterly  indiflferent 
of  the  consequences  to  herself  and  would  frequently  and  repeat- 
edly kick  one  leg  viciously  with  the  other.  Her  eyes  were  wild 
and  staring  and  her  whole  appearance  and  behavior  one  of 
violent  insanity.  If  her  owner  or  other  person  entered  the  stall 
she  became  calm,  began  eating  or  fondled  the  person  with  her 
nose  and  appeared  in  every  way  rational  and  docile.  Turned  in 
a  paddock,  she  behaved  normally.  Hitched  in  the  usual  manner 
to  a  single  wagon,  she  behaved  perfectly.  The  duration  of  the 
mania  and  its  intensity  had  increased  for  some  months  until  the 
degree  we  have  described  had  been  reached  and  the  attacks  con- 
tinued during  7-10  days.  Ovariotomy  was  followed  by  complete 
and  permanent  disappearance  of  the  mania. 

The  distinctively  sexual  symptoms  noted  consist  chiefly  of 
tumefaction  of  the  vulva,  injection  of  the  vulvar  mucosa,  and 
increased  secretion  of  mucus,  with  some  mucous  discharge  from 
the  vulva. 

Urination  is  frequent,  while  the  clitoris  is  erected  and  frequently 
protruded  between  the  vulvar  lips.  The  irritability  of  the  vulva 
and  vulvo-anal  region  is  markedly  increased  ancl  the  animal  fre- 
quently violently  resents  the  handling  of  the.se  parts.  This  is 
especially  true,  in  many  cases,  of  the  tail,  the  animal  resenting 
the  raising  of  it  in  order  to  apply  the  crupper  or  remove  it. 
While  driving,  should  the  patient  either  accidentally  or  inten- 
tionally get  her  tail  over  the  reins,  she  grips  them  violently, 
kicks  viciously,  may  turn  abruptly  and  upset  or  break  the  vehicle, 
or  run  away. 

In  some  cases  the  patient  is  perfectly  docile  and  the  only  signs 
of  disease  consist  of  abnormally  frequent  urination  with  repeated 
opening  and  closing  of  the  vulva  and  the  projection  of  the 
clitoris,  making  her  unfit  for  driving  purposes  simply  from 
repulsiveness. 

In  most  cases,  however,  the  patient  is  unreliable  or  dangerous 
and  cannot  be  depended  upon  in  moments  of  emergency.  During 
the  periods  of  nymphomania  she  is  very  liable  to  be  unsteady  in 


Ny7nphoma7iia  in  the  Mare 


237 


draft  work  and  may  at  any  moment  balk  and  tax  the  patience  of 
the  driver  very  greatly. 

Periodical  at  first,  nymphomania  or  the  vices  such  as  kicking, 
balking  and  gripping  of  the  reins  by  the  tail,  tend  to  become 
constant  and  permanent  and  the  animal  degenerates  into  an  in- 
curable rogue,  falls  into  the  possession  of  low  dealers  and  finally 
finds  her  way  into  some  inhuman  hands,  where  she  succumbs  to 
brutal  work. 


Fig.  17.     CvsTo- FIBROUS  Degeneration  of   Ovaries. 
From  insane  mare. 
C,  C,  C,   Cysts.  C,  L,  Corpus  luteum.        One-half  size. 


Fig.  i<S.     Cystic  Degeneration  of  Ovaries. 

From  Nymphomaniac  Mare. 
A,   Sclerotic  Ovary.  B.   Cystic  Ovary. 

Examined  macro.scopically,  the  ovaries  are  usually  large  and 
contain  one  to  several  cysts,  varying  in  size  from  yo-2  in.  or 
more  in  diameter  and  containing  a  clear,  faintly  yellowish 
lymph.  The  cyst  walls  are  thick  and  very  firm  and  the  density 
of  the  albuginea  preserves  to  a  large  extent  the  even  contour  of 
the  ovarial  surface,  so  that  it  is  only  in  case  of  quite  large  cysts 
that  they  project  conspictiously  beyond  the  general  surface  of 
the  gland.      In  some  cases,  the   ovarian   tissue   proper  vanishes 


238  Veferinarv  Obstetrics 

almost  completely  under  the  pressure  of  large  cysts,  so  firmly 
compressed  within  the  enveloping  tunica  albuginea  (see  Figs.  17 
and  18).  In  rare  instances  the  cysts  become  enormous,  reaching 
4-8  inches  and  even  more  in  diameter. 

In  other  instances  of  nymphomania  we  have  found,  in  ex- 
tremely bad  ca.ses,  small,  atrophied,  fibrous  ovaries,  very  hard 
and  dense,  like  fibro-cartilage. 

The  examination  of  the  ovaries  of  the  mare  is  to  be  made 
upon  essentially  the  .same  basis  as  that  already  described  for  the 
cow.  The  examination  is  to  be  made  upon  the  standing  animal, 
due  precautions  being  taken,  according  to  circuni.stances,  to 
avoid  injuries  to  the  veterinarian  from  kicks  and  to  overcome 
any  probable  annoyance  from  movements  of  the  animal.  Usually 
a  single  stall,  with  the  animal  tied  short  in  it,  will  suffice,  but 
vicious  animals  should  be  .secured  in  stocks,  the  twich  applied 
and  a  forefoot  held  up  or  one  hind  foot  rai.sed  by  means  of  a 
sideline. 

The  hand  and  arm  of  the  operator  should  be  well  cleansed  and  .soft- 
ened by  warm  w^ater,  and  disinfected,  and  the  rectum  of  the  ani- 
mal should  be  emptied  of  feces,  usually  by  introducing  a  warm  .soda 
bicarbonate  .solution  ^ into  the  rectum.  The  finger  nails  of  the 
operator  should  be  trmimed  close  and  the  hand  and  arm  thoroughly 
lubricated  with  warm  oil,  lard  or  liquid  paraffin,  and  then  gently 
introduced  into  the  rectum.  Usually  little  progress,  if  any,  can 
be  made  while  the  hand  is  in  the  posterior  or  pelvic  rectum,  but 
it  becomes  necessary  to  push  the  hand  gently  forwards  into 
the  free  portion  of  the  rectum,  which  can  then  be  carried  to  the 
right  or  left,  up  or  down,  and  forwards  or  backwards.  The 
mare  often  strains  somewhat,  which  should  always  be  accepted 
as  a  signal  to  the  operator  to  cease  his  palpation  until  the  expul- 
sive effort  cea.ses,  but  without  withdrawing  his  hand.  Care  upon 
this  point  decreases  the  straining  and  does  much  to  avoid  lacera- 
ation  of  the  rectal  mucosa,  associated  with  hemorrhage. 

With  the  palm  of  the  hand  directed  downwards,  the  cervix 
uteri  and  uterine  body,  about  the  .size  of  a  man's  wrist,  may  be 
traced  forward  to  the  point  of  bifurcation,  where  the  cornua,  al- 
most as  large  as  the  body,  are  given  off  at  approximately  right 
angles.  Tracing  these  to  the  right  or  left,  the  operator  can 
recognize  the  ovaries  at  or  near  the  anterior  margin  of  the  broad 
ligament,  an  inch  or  two  beyond  the  obtuse  end  of    the    cornua. 


Nymphoviania  in  the  Mare  239 

The  normal  gland  in  the  young  or  adult  mare  is  elastic,  smooth, 
firm,  oblong  and  about  2^4 — 3)^  inches  in  its  greatest  diameter, 
by  i>^ — 2  inches  in  its  lesser  diameter.  The  diagnosis  of  cystic 
or  fibrous  degeneration  of  the  ovaries  of  the  mare  and  the  rela- 
tionship between  these  diseases  and  sterility  is  not  always  clear. 
Nymphomania  in  the  mare,  is,  unlike  in  the  cow,  most  frequently 
observed  in  those  animals  not  used  for  breeding  purposes  at  all, 
rarely  in  those  used  in  constant  daily  work,  and  chiefly  in  those 
more  or  less  contantly  stabled,  irregularly  worked  and  not  at  all 
bred . 

How  manj-  of  them  would  conceive  if  bred,  we  do  not  know, 
but  we  dp  know  that  many  nymphomaniac  mares  breed  and  that 
the  nymphomania  usually  disappears  during  the  span  of  preg- 
nancy, to  recur  with  some  degree  of  regularity  after  foaling. 
The  condition  of  the  ovaries  in  such  cases  is  unknown. 

It  is  highly  essential  therefore  that,  in  examining  a  mare  for 
sterility,  a  diagnosis  should  be  made  only  after  the  most  careful 
examination,  not  only  of  the  ovaries  but  of  all  other  generative 
organs  as  well.  At  the  same  time,  we  must  have  due  regard  for 
the  clinical  history  of  the  case  and  the  general  condition  and 
handling  of  the  patient. 

Treatment. 

Since  the  ovisacs  in  the  ovary  of  the  mare  normally  rupture 
only  in  the  hilus  of  the  organ  and  the  tunica  albuginea  is  ex- 
ceedingly thick  and  tough,  as  compared  with  that  of  the  cow 
and  other  domestic  animals,  the  rupture  of  cysts  by  rectal 
compression  is  practically  excluded  in  all  cases.  The  ovarj'  is 
attached  so  far  forwards  that  it  cannot  be  drawn  back  and  com- 
pressed per  vaginam,  as  in  the  cow. 

It  is  possible  to  puncture  the  cystic  gland  by  means  of  a  long 
trocar,  while  the  ovary  is  grasped  per  rectum  ;  or  a  vaginal  in- 
cision for  ovariotomy  may  be  made,  one  hand  introduced  into  the 
the  peritoneal  cavity  and  the  organ  directly  grasped  while,  with 
the  other  hand,  a  long  trocar  is  carefully  inserted,  and  the  cyst 
punctured. 

When  but  one  ovary  is  affected,  unilateral  ovariotomy  may  of 
course  restore  the  breeding  powers  and,  in  properh-  selected 
cases,  becomes  desirable. 


240  Veterinary  Obstetrics 

The  question  of  overcoming  sterility  due  to  cysts  or  other 
ovarian  disease,  with  a  view  to  the  restoration  of  the  breeding 
powers  in  valuable  brood  mares,  has  been  quite  neglected  and 
attention  turned  chiefly  toward  the  amelioration  or  cure  of  the 
vice  attending  the  malady,  as  symptoms,  and  thus  restoring  the 
work  value  of  the  animal.  Since  nymphomania  in  the  mare  is 
largely  observed  only  in  those  not  used  or  desired  for  breeding, 
this  tendency  in  handling  is  natural  and  quite  sufficient  in  this 
class  of  cases.  It  is  only  when  involving  animals  desired  for 
breeding  purposes  that  we  are  specially  concerned  from  an 
obstetric  point  of  view.  When  our  aim  to  restore  fertility  is 
frustrated  by  insurmountable  obstacles,  the  duty  of  the  veteri- 
narian yet  remains  to  preserve  to  the  owner,  as  far  as  possible, 
any  work  value  which  the  animal  may  possess  when  relieved 
of  the  nymphomania. 

Three  plans  for  the  surgical  relief  or  amelioration  of  nympho- 
mania in  the  mare  have  been  more  or  less  advocated  : 

I.   Clitoridectomy. 

Because  some  regard  the  clitoris  as  the  chief  seat  of  irritation, 
from  which  the  nymphomaniac  symptoms  are  reflected,  the  re- 
moval of  this  organ  has  from  time  to  time  found  advocates.  In 
our  experience  it  has  not  proven  its  efficiency,  though  we  must 
confess  that,  owing  to  our  skepticism  of  its  value,  we  have  not 
tested  the  operation  sufficiently  to  warrant  our  condemning  it. 

We  can  not,  however,  admit  that  the  clitoris  is  of  sufficient 
importance  as  a  center  of  sexual  reflexes,  to  warrant  the  belief 
that  its  surgical  removal  will  generally  suffice  to  eliminate  sexual 
mania  unless  first  it  be  shown  that  it  is  in  some  way  organically 
or  functionally  diseased.  We  freely  admit  however  that  clitori- 
dectomy may,  and  does  at  times,  overcome  vice  akin  to  nympho- 
mania in  some  respects,  but,  in  part,  this  may  be  attributable  to 
the  physical  punishment  of  the  animal  under  confinement. 
Nymphomania  being  a  reflex  nervous  disorder,  physical  punish- 
ment may  at  times  possibly  exert  a  curative  influence.  Holling- 
worth '  records  a  case  in  the  mare  where  he  obtained  relief  from 
nymphomania  by  clitoridectomy,  the  operation  being  performed 
under  complete  chloroform  anaesthesia,  in  which  case  the  cure 

'  Veterinary  Magazine,  Volume  I. 


Nymphoviania  in  the  Mare  241 

could  not  be  attributed  to  physical  punishment  so  far  as  the 
operation  proper  was  concerned  and  it  seems  questionable  if  it 
could  be  properly  referred  to.  the  casting  and  confinement  prior 
to  the  anaesthesia. 

The  relationship  between  the  clitoris  and  sexual  desire  is  by 
no  means  clear.  While  disease,  functional  disorder  or  irritation 
may  arouse  sexual  desire,  it  is  equally  true  that  the  excision  of 
the  organ  does  not  abolish  it  nor  interfere  in  the  least  with 
breeding,  as  we  once  witnessd,  where  some  hundreds  of  sow 
pigs,  from  which  this  organ  was  removed  by  a  travelling  im- 
postor who  asserted  that  it  destroyed  sexual  desire  and  fulfilled 
all  requirements  of  castration,  proceeded  to  copulate  as  usual  and 
bred  as  freeh'  as  though  they  had  not  been  operated  upon. 

As  above  stated,  the  nymphomania  of  the  mare  most  fre- 
quently has  its  basis  in  cystic  or  cysto-fibrous  degeneration  of 
the  ovaries,  so  far  as  we  have  been  able  to  determine  in  this 
clinic,  where  we  have  performed  ovariotomy  in  more  than  fifty 
nymphomaniac  patients.  In  such  cases,  excision  of  the  clitoris 
could  apparently  overcome  the  nymphomania  only  by  curing  the 
ovarial  degeneration  and  it  would  be  difficult  to  understand  how 
such  result  could  be  expected. 

We  consequently  believe  that  the  alleviation  of  nymphomania 
by  clitoridectomy  occurs  chiefly  in  those  cases  in  which  ovarial 
origin  may  be  doubted  and  in  which  the  disciplining  of  the 
patient  through  casting  and  securing  and,  if  anaesthesia  is  not 
induced,  the  pain  caused  by  the  operation  effect  the  alleged  cure. 

The  operation  is  simple  and  free  from  any  notable  danger. 
The  animal  may  be  cast  or  secured  on  the  operating  table  or  in 
the  stocks  and  the  operation  maj-  be  performed  under  general  or 
local  anesthesia  or  without  either.  The  vulvar  lips  may  be  held 
apart  with  tenacula  or  retractors  and  the  clitoris  seized  hy  means 
of  a  tenaculum  or  tenaculum  forceps  and,  being  well  drawn  out, 
excised  with  a  scalpel  at  the  point  of  attachment  of  its  crura  to 
the  ischiatic  arch.  Quite  as  conveniently,  a  longitudinal  incis- 
ion may  be  made  from  below  upwards  through  the  floor  of  the 
vulva  and  the  organ  then  excised,  after  proper  dissection  from 
surrounding  tissues. 

The  hemorrhage  is  unimportant  and  may  be  controlled  by 
16 


242  Veteriyiary  Obstetrics 

compression  for  a  few  minutes  by  means  of  forceps.  The  incision 
through  the  floor  of  the  vulva  may  be  sutured  except  a  small 
area  for  drainage. 

2.  Ca-udai,  Myectomy. 

In  dealing  with  the  symptoms  of  nymphomania  in  the  mare, 
we  related  the  very  common  and  vicious  habit  of  gripping  the 
reins  with  the  tail.  Following  the  seizure  of  the  reins,  the 
nymphomaniac  mare  may  lean  heavily  against  the  pole,  kick 
viciously  or,  turning  abruptly,  break  or  upset  the  vehicle  and 
run  away.  This  vicous  habit  con.stitutes  one  of  the  most  danger- 
ous features  of  nymphomania  in  the  mare,  endangering  alike 
property  and  the  life  of  the  driver  or  other  persons  and  of  the 
patient  herself.  Its  amelioration  or  eradication,  consequentl}', 
becomes  important.  The  power  of  the  animal  to  grip  the  reins 
may  be  overcome  by  myectomy,  but  this  involves  ordinarily  no 
other  effect  upon  the  nymphomania. 

As  practiced  in  this  clinic,  the  animal  is  confined  in  the  stocks 
or  upon  the  operating  table  and  the  tail  secured,  firmly  stretched 
dorsalwards.  Under  proper  antiseptic  precautions  and  after  the 
application  of  an  elastic  ligature  at  the  base  of  the  tail,  two  par- 
allel incisions  are  made  directly  over  the  center  of  the  two  de- 
pressor coccygeus  longus  muscles,  commencing  close  again.st  the 
ligature  and  continuing  for  a  distance  of  6-8  inches,  through  the 
skin  and  caudal  aponeurosis,  laying  the  muscles  bare.  The 
muscles  are  dissected  away  from  the  surrounding  parts  and  the 
entire  exposed  portion  is  excised,  after  which  tampons  of  anti- 
septic cotton,  approximately  the  size  of  the  excised  muscles,  are 
laid  in  the  cavities  and,  over  these,  an  antiseptic  bandage  applied 
with  sufficient  firmness  to  control  hemorrhage,  after  which  the 
elastic  ligature  is  removed. 

Properly  carried  out,  the  operation  leaves  the  patient  with  an 
efficient  tail  in  all  respects  except  the  power  to  forcibly  grip  the 
reins.  This  power  being  inhibited,  the  reins  may  be  easily  freed 
by  the  driver.  The  vice  is  thus,  in  many  cases,  greatly  amelio- 
rated or  wholly  relieved,  but  the  ovarian  irritation  presumably 
remains  the  same,  and  only  the  one  important  symptom,  and 
those  as.sociated  with  it,  is  affected. 

Amputation  of  the  tail,  with  or  without  knicking,  brings  about 
the  same  result,  with  the  disadvantage,  or  otherwise,  of  the  loss 


Nymphomania  in  the  Mare.  *  243 

of  the  tail.     Neither  clitoridectomy,  caudal  myectomy  nor  ampu- 
tation affects  in  any  way  the  possibility  of  breeding. 

3.  Ovariotomy.     Oophorectomy. 

When  nymphomania  referable  to  ovarian  disease  is  present  and 
can  not  otherwise  be  effectively  overcome,  castration  is  indicated. 

In  mares  not  desired  for  breeding  purposes,  the  cure  of  ovarial 
nymphomania  otherwise  than  by  castration  is  all  too  liable  to 
prove  ephemeral  and  unreliable,  so  that  castration  in  these  cases 
at  once  presents  itself  as  the  most  reliable  and  enduring  remedy. 
The  operation  is  comparatively 'simple  and  not  highly'  dangerous. 

It  may  be  performed  either  in  the  standing  or  the  recumbent 
position  and  with  or  without  anaesthesia.  In  case  of  a  valuable 
pedigreed  mare  desired  for  breeding  purposes,  with  but  one  ovary 
diseased,  the  operation  is  to  be  limited  to  the  affected  gland. 

In  the  standing  position,  without  anaesthesia,  the  patient  is 
secured  in  stocks,  or  otherwise,  in  a  manner  to  prevent  lying 
down,  kicking  or  any  extensive  movements. 

The  vulva  and  vagina,  as  well  as  contiguous  parts,  are  well 
washed  and  disinfected,  avoiding  always  the  introduction  into 
the  vagina  of  irritant  antiseptics. 

After  the  proper  antiseptic  precautions  have  been  taken,  the 
vagina  should  be  partly  filled  with  a  sterilized,  warm  i  '■'/(;  soda 
bicarbonate  solution,  which  will  cause  the  vagina  to  dilate  or 
balloon.  This  condition  having  been  brought  about,  the  vaginal 
walls  are  tense  and  firm  and  the  operative  area  is  above  the 
OS  uteri  externum  and  standing  perpendicular  to  the  long  axis  of 
the  vagina.  Through  this  a  stab  wound  is  to  be  made,  directly 
forward,  large  enough  to  admit  one  or  more  fingers  into  the 
peritoneal  cavity  and  the  opening  thus  made  forcibly  dilated  by 
the  fingers  until  the  entire  hand  is  passed  through  and  the 
ovaries  reached.  The  ecraseur  is  then  carried  in,  the  ovary 
caught  in  the  loop  of  the  chain  and  the  gland  promptly  detached 
by  ecrasement.  This  usually  takes  place,  .so  far  as  we  have  been 
able  to  determine,  without  important  hemorrhage.  However,  in 
one  case,  when  the  instrument  was  too  sharp,  fatal  hemorrhage 
followed.  Possibly  there  is  usually  a  greater  amount  of  hemor- 
rhage than  we  ordinarily  suspect,  and  it  is  well  to  take  care  that 
the  instrument  is  sufficiently  blunt,  as  indicated  by  the  force  re- 


244  Veterinary  Obstetrics 

quired  to  crush  off  the  gland,  lest  serious  or  fatal  hemorrhage 
occur. 

Uuder  anaesthesia  the  animal  is  confined  in  lateral  recumbency, 
preferably  upon  the  operating  table,  the  hinder  parts  being  ele- 
vated, to  cause  the  abdominal  viscera  to  drop  forward  out  of  the 
way.  Under  anaesthesia  the  vagina  does  not  balloon.  The  in- 
cision is  made  at  the  same  point  and  in  essentially  the  same 
manner.  The  recognition  of  the  ovaries  and  their  removal  is  the 
same  as  in  the  standing  operation. 

The  patient  is  to  be  kept  quiet  for  6-8  days  on  a  light,  laxa- 
tive diet.  If  the  viciousness  continues,  the  animal  should  be 
turned  out  and  left  without  annoyance  for  several  weeks  ;  if 
docile,  she  may  be  put  to  work. 

In  some  cases  the  viciousness  may  continue  without  visible 
abatement  for  a  while  and  later  wholly  disappear.  Too  much 
should  not,  however,  be  expected  from  spaying.  If  a  mare  is 
fundamentally  vicious,  little  good  is  to  be  anticipated  from  the 
operation,  nor  is  a  cure  to  be  confidently  expected  if  the  opera- 
tion has  been  delayed  till  the  vice  has  become  habitual  instead 
of  periodic. 

Much  depends  too  upon  the  driver  and  his  method  of  handling 
the  patient  ;  gentleness,  firmness  and  a  display  of  good  judge- 
ment are  demanded.  The  work  should  be  regular  and  moderate, 
the  animal  well  fed  and  her  general  health  well  guarded. 

Nymphomania  and  cysts  in  the  ovaries  of  the  smaller  animals 
are  not  common.  In  the  foregoing  pages,  Hess  records  instances 
in  the  sow  and  goat.  We  have  observed  nymphomania  in  a  sow 
without  determining  the  cause.  We  have  also  seen  a  nympho- 
maniac bitch,  which  was  castrated  in  our  clinic  and  in  which 
both  ovaries  were  the  seat  of  enormous  cysts,  as  shown  in  Fig.  19. 

The  diagnosis  of  cystic  ovarian  degeneration  in  the  smaller 
animals  can  only  be  made  by  the  subjective  symptoms  of  nym- 
phomania, to  be  verified  by  laparatomy  and  direct  examination 
of  the  ovaries.  The  best  treatment  is  castration,  though,  in  the 
bitch  and  sow,  it  is  indeed  quite  possible,  in  cases  where  the 
pedigree  renders  the  patient  highly  valuable  for  breeding  pur- 
poses, to  crush  or  puncture  the  cysts  and  return  the  ovaries  into 
the  abdomen  or,  if  only  one  gland  is  involved,  it  may  be  removed 
and  the  sound  one  retained,  in  order  that  the  animal  may  breed. 


Setiile  Atrophy  of  the  Ovaries. 


245 


Fig.  19.     Normal  and  Cystic  Ovaries  of  Bitch. 

A,  Cystic  ovary. 

B,  Normal  ovary  with  the  pavilion  of  the  oviduct  turned  back  to  ex- 
pose the  ovary,  o. 

C,  Normal  ovary  covered  by  the  pavilion  of  the  tube,  showing 
the  meatus,  M,  of  the  ovarian  sac,  by  which  it  communicates 
with  the  peritoneal  cavity. 

One-half  size. 

7.  Senile  Atrophy  of  the  Ovaries. 

In  aged  females,  senile  ovarian  atrophy  occurs  to  mark  the 
cessation  of  the  power  of  breeding  and  the  advent  of  the  brief  old 
age  of  our  domestic  animals.  The  advent  of  this  period  varies 
greatly  with  species  and  individuals.  Fertility  usually  persists 
longest  in  animals  regularlj^  bred  and  w^ell  kept,  while  senile 
ovarian  atrophy  tends  to  occur  earliest  in  those  animals  which 
are  not  bred  and  are  badly  kept  or  overworked. 

The  disease  is  not  to  be  distinguished,  by  palpation  or  macro- 
scopic appearances  of  the  ovaries,  from  fibrous  degeneration  in 
adult  animals,  as  already  described,  except  bj'  their  very  small 
size.  It  does  not  induce  nymphomania,  is  not  subject  to  remedy 
and  definitely  marks  the  end  of  the  breeding  powers  of  the 
animal. 


246  Veterinary   Obstetrics 

8.  Systemic  and  Painfi'i,  Diseases. 

Sev^ere  systemic  afifections  and  painful  diseases,  which  depress 
the  general  vitality  of  the  patient,  tend  constantly  to  prohibit 
ovulation  and  fertility.  It  is  very  rare  that  the  evidences  of 
ovulation  and  estrum  occur  during  the  existence  of  febrile  dis- 
orders of  any  character.  Chronic  disea.ses — especially  those  of  a 
systemic  character,  like  rachitis,  osteoporosis,  and  such  severe 
bone  diseases  as  are  frequent  in  horses  in  many  regions,  and  are 
expressed  largely  by  the  appearance  of  multiple  .spavins,  ring- 
bones, navicular  disease,  lumbar  anchylosis,  spontaneous  frac- 
tures, etc. — tend  constantly  to  induce  sterility,  due  apparently  to 
non-ovulation  during  the  active  course  of  the  disea.se,  which  may 
continue  for  2-3  years  or  more. 

The  remedy  in  these  cases  evidently  lies  in  the  direction  of 
overcoming  the  constitutional  malady  itself,  which  is  usually 
followed  by  a  restoration  of  the  normal  reproductive  powers. 


II.   DEFECTS     AND     DISEASES     OF     THE    OVIDUCTS, 
UTERUS,  VAGINA  AND  VULVA. 

I.  Arrests  in  Development  of  the  Oviducts, 
AND  Uterus. 

When  dealing  with  arrests  in  the  development  of  the  ovaries, 
on  page  155,  we  necessarily  alluded  to  the  concurrent  arrests  in 
the  development  of  the  genital  tube.  While  arrests  in  the  for- 
mation of  the  genital  glands  and  of  the  oviducts,  uterus  and 
vagina  are  not  necessarily  parallel,  they  are  quite  frequently 
closely  associated  in  the  same  individual.  In  Fig.  51  is  shown 
the  genitalia  of  a  cow,  in  which  the  uterine  body  and  the  vagina 
are  wanting  and  are  replaced  by  two  adherent,  parallel  cords 
representing  the  Miillerian  ducts.  In  freemartins  and  herma- 
phrodites, arrests  in  development  of  the  uterus  and  oviducts  are 
common.  In  one  instance  occurring  in  our  clinic,  a  filly  was 
presented,  with  the  history  that  she  had  an  annoying  mucous 
discharge  from  the  vulva.  Palpation  revealed  that  that  portion 
of  the  ducts  of  Miiller  which  should  have  formed  the  uterus 
had  instead  developed  the  characters  of  a  vagina.  A  slight  con- 
striction denoted  the  location  of  the  cervical  canal  but,  beyond 
this,  the  tube  had  all  the  characters  of  the  vagina  itself  ;  its 
mucosa  was  identical  with  that  of  the  vagina  so  far  as  the  sense 
of  touch  revealed  and  the  function  of  the  tube  was  also  vaginal 
in  character,  ballooning  promptly  upon  palpation,  wholly  unlike 
the  uterus. 

While  aberrations  in  the  development  of  the  oviducts  and 
uterus  are  somewhat  rare,  the  possible  variations  in  such  aberra- 
tion are  extreme  and  their  character  must  be  determined  by 
palpation,  either  through  the  rectum  or  the  vagina. 

Such  aberrations  in  development  are  rarely,  if  ever,  subject  to 
remedy,  and  their  diagnosis  and  the  determination  of  the  character 
of  the  sterility,  whether  it  be  permanent  or  removable,  is  the 
chief  question  to  be  decided  by  the  veterinarian. 

2.  Salpingitis  and  Occlusion  of  the  Oviducts. 

Inflammation  of  the  oviducts,  accompanied  by  suppuration,  ab- 
sces.sation  and  occlusion,  is  somewhat  rarely  recognized  in  veter- 
247 


248  Veterhiary  Obstetrics 

inary  practice,  partly,  perhaps,  because  it  is  quite  rare,  probably 
largely  owing  to  the  fact  that  its  occurrence  usually  passes  un- 
recognized. The  oviducts,  when  felt  per  rectum  in  the  cow, 
are  somewhat  difficult  to  distinguish,  as  very  small,  dense,  tor- 
tuous cords,  extending  from  the  apex  of  the  uterine  cornua, 
toward  the  ovary,  in  the  anterior  portion  of  the  broad  ligament. 
They  are  about  yV  of  an  inch  ih  diameter. 

In  dealing  with  di.seases  of  the  ovaries  on  pages  177  and  193, 
reference  has  been  made  to  recognized  pyosalpinx,  or  abscess  of 
the  oviducts.  Abscess  of  the  ovaries,  which  we  have  mentioned 
on  page  217,  is  presumably  due  to  the  pa.ssage  of  pyogenic  bac- 
teria from  the  uterine  cornua,  through  the  oviducts,  to  the 
ovaries,  there  to  find  lodgement  and  multiply.  In  thus  travers- 
ing the  ducts,  a  more  or  less  pronounced  salpingitis  would  tend 
to  occur  and  this  is  verified  by  sufficient  clinical  and  post  mortem 
observations. 

The  causes  of  salpingitis,  so  far  as  determined,  are  largely, 
infectious  granular  vaginitis  in  the  cow,  and  retained  placenta, 
especially  following  contagious  abortion  in  the  cow,  and  other 
animals.  In  tuberculosis  and  some  other  affections,  the  ovi- 
ducts may  rarely  become  inflamed  and  enlarged  .so  that,  accord- 
ing to  Zschokke,  they  sometimes  attain  the  size  of  a  lead  pencil. 

The  symptoms  have  usually  passed  unobserved,  except  as  re- 
lated to  sterility,  the  disease  leading  rarely  to  nymphomania. 
Its  diagnosis  can  rest  only  upon  palpation  per  rectum  or  va- 
ginani,  by  which  the  ducts  may  be  found  enlarged,  and  their 
consistence  altered.  They  may  be  either  soft  or  hard,  and  may 
contain  abscesses  or  contents  of  variable  character. 

The  prognosis  of  salpingitis  and  pyosalpinx  is  always  grave. 
The  disease  may  abate  and  the  organ  recover,  but  the  po.ssibility 
is  a  remote  one,  since  any  extensive  inflammation  is  likely  to 
lead  to  adhesions  and  occlusion  which  determine  permanent  ster- 
ility. If  but  one  tube  is  involved,  it  may  be  surgically  removed 
and  the  patient  rendered  capable  of  breeding. 

3.  Metritis. 

Metritis  tends  in  all  cases  to  induce  sterility  in  all  animals, 
sometimes  temporary,  frequently  permanent.  The  malady  occurs 
under  a  variety  of  forms,  due  to  a  multitude  of  causes  and  having 


Metritis  249 

a  var^-ing  significance  for  the  fertility  of  the  animal.     The  chief 
varities  to  be  considered  are  : 

a.  Acute  metritis  occurring  in  all  species  of  animals,  follow- 
ing closely  upon  parturition  or  abortion  and  resulting  from  infec- 
tion entering  the  uterus  as  a  result  of  manipulations  during 
parturition,  or  from  retained,  decomposing  afterbirth  or  related 
causes.  The  malady  is  necessarily  considered  later  among  the 
"  Puerperal  Infections  ",  to  which  the  reader  is  referred. 

b.  Chronic  metritis,  pyometra  or  myxometra. — Chronic 
purulent  metritis  (pyometra)  and  muco-purulent  metritis  (myx- 
ometra), as  related  to  ovarian  disease,  have  already  received  con- 
sideration on  page  222.  and  need  not  be  repeated  here. 

These  affections  occasionally  follow  parturition,  especially 
when  accompanied  bj-  dystocia,  or  when  parturition  is  succeeded 
by  retention  of  the  fetal  membranes.  This  type,  like  acute' 
metritis,  is  necessarily  considered  among  "  Puerperal  Infections  " 
and,  accordingly,  need  not  be  repeated  here. 

c.  Chronic  metritis,  or  pyometra,  also  occurs  in  non-breeding 
females,  so  far  as  we  know,  wholly  independent  of  ovarian  disease 
and  non-puerperal  in  character,  as  it  maj-  appear  in  an  animal 
which  has  never  bred  or  in  one  which  has  not  recentlj- bred. 
This  type  of  ca.ses  is  so  like  those  in  the  preceding  class  in 
symptoms,  progno.sis  and  handling  that  they  may  be  most  profit- 
ably and  concisely  dealt  with  in  the  same  chapter. 

Closely  allied  to  chronic  metritis,  also,  is  "  Uterine  Ab- 
scess," which,  following  usually  some  puerperal  infection,  is 
naturally  dealt  with  in  that  group. 

All  these  forms  of  disease  inevitabl}^  cause,  during  their  course, 
sterility,  which  may  be  rendered  permanent  by  the  changes  re- 
sulting in  the  organs  involved.  Salpingitis,  pyosalpinx  and 
occlusion  of  the  oviducts  are  constantly  threatened  in  the  course 
of  these  maladies,  while  ulcerations  and  erosions  of  the  uterine 
mucosa  may  lead  to  adhesions  between  the  uterine  walls  and  ob- 
literation of  the  cavity  of  the  cornua,  uterine  body  or  cervix. 
But  such  is  not  always  true.  The  author  recalls  delivering  a 
cow  after  ten  days  of  dystocia,  with  a  badly  decomposed  fetus, 
intense  metritis  and  enormously  thickened  uterine  walls.  A  few 
months  later  she  conceived. 

Since  all  these  forms  of  disease  have  been,  or  will  be,  con- 
sidered in  other  chapters,  it  suffices  to  mention   them   here  as 


250  Veten'tiary  Obstetrics 

important  maladies  in  reference  to  sterility.  The  prognosis  in 
these  cases  depends  upon  the  promptness  and  efficiency  of  the 
handling,  questions  which  are  fully  discussed  in  the  chapters 
already  mentioned. 

4.    KniCMA    OF    THE    UTERINE    WaLLS. 

In  very  rare  instances,  edema  of  the  uterine  walls  has  been 
recorded,  the  edematous  enlargement  being  so  great  as  to  simu- 
late pregnancy.  Necessarily,  it  induces  sterility  and,  so  far  as 
known,  the  condition  is  incurable. 

5.  Tumors  of   the   Uterus,  Vulva,  Vagina   and   of   the 
Broad  Ligaments. 

Tumors  involving  the  uterus  of  the  domestic  animals  are  not 
.at  all  common  and  play  no  very  important  role  in  the  question 
of  sterility.  Zschokke  claims  that  the  most  common  tumors  af- 
fecting the  uterus  of  the  cow  are  fibroma  and  lipoma. 

Tumors  of  the  vagina  and  vulva  are  more  common  than  those 
of  the  uterus.  Perhaps  the  most  common  place  for  the  occur- 
rence of  benign  tumors  is  on  the  line  of  demarcation  between 
the  vulva  and  vagina,  that  is,  at  the  site  of  the  hymen.  They 
usually  originate  from  the  mucous  membrane  and,  when  located 
in  the  vagina  and  vulva,  tend  to  assume  the  polypoid  form  and 
may  vary  in  color  according  to  their  vascularity.  The  fatty 
tumors  arise  in  the  pelvic  connective  tissues  and  press  upon  the 
vagina  in  a  manner  to  more  or  less  narrow  it. 

Occasionally  we  meet;  with  enlargements  along  the  floor  and 
sides  of  the  vagina,  due  to  a  collection  of  secretions  in  Gartner's 
canals.  These  present  themselves  as  elongated,  fluctuating 
tumors,  which  begin  near  the  meatus  urinarius  and  extend,  in  a 
divergent  manner,  obliquely  forward  and  upward  along  the  sides 
of  the  vagina.  These  retention  cysts  are  easily  diagnosed. 
When  very  large,  they  cau.se  some  narrowing  of  the  vagina  and 
may  interfere  with  coition  or  parturition. 

Tumors  of  the  vulva  and  vagina  which  have  pedicles  are  easily 
and  quickly  removed  with  the  ecraseur.  When  the  tumors  are 
sessile,  it  is  neces.sary  to  use  the  scalpel  or  scissors  for  their  re- 
moval. These  operations  should  be  carried  out  under  strict  an- 
tiseptic precautions  and,  so  far  as  po.ssible,  perforation  of  the 
peritoneal  cavity  should  be  avoided.      If  proper   aseptic  care  has 


Tumors  of  the  Utertis,    Vtdva,  etc.  251 

been  taken,  perforation  is  important  onh'  because  of  possible 
prolapse  of  the  intestines  or  other  viscera.  The  prolapse  may 
be  prevented  by  appropriate  sutures.  Where  the  possibility  is 
foreseen,  the  tumor,  with  a  section  of  the  vaginal  wall,  may  be 
removed  by  ligature. 

Retention  cysts  of  the  genital  passage  may  be  laid  open  freely 
with  the  scalpel,  under  strict  asepsis. 

Diseases  of  the  broad  ligaments  are  rare.  Yet,  they  occur 
with  sufficient  frequency  to  merit  attention.  So  far  as  w^e  are 
aware,  they  occur  chiefly  in  the  cow. 

Various  writers  refer  to  tubercular  deposits  in  the  broad  liga- 
ment, which  cause  them  to  become  thickened  and,  upon  palpa- 
tion, to  give  the  ordinary  characteristics  of  tubercular  invasion. 
In  addition,  there  are  also  symptoms  of  the  disease  in  other  parts 
of  the  body. 

In  one  very  interesting  case  of  sterility,  in  a  highly  valuable 
pedigreed  Holstein  cow  which  we  attended,  it  was  found  that 
the  broad  ligaments  were  the  seat  of  eight  or  ten  large  abscesses 
with  very  dense  capsules.  The  uterus  and  broad  ligaments  were 
adherent,  over  a  large  part  of  their  surface,  to  the  rectum  and 
surrounding  organs,  and  the  ligament  was  invaded  by  multiple 
abscesses  containing  from  two  to  five  or  six  ounces  of  pus  each. 
The  contents  of  the  abscesses  were  of  a  yellowish,  granular 
character,  which  seemed  .strongly  suggestive  of  actinomycosis. 
This  impre.ssion  was  fully  verified  by  microscopic  examination. 
Although  a  careful  search  was  made,  no  signs  of  actinomycosis 
were  found  elsewhere  within  the  body.  The  case  suggests  that 
the  infection  probably  occurred  through  the  medium  of  copula- 
tion. 

Tuberculosis  of  the  uterus  has  been  alleged  to  be  a  frequent 
cause  of  sterility,  but  we  have  few  data  in  support  of  the  pre- 
sumption. Angst'  records  that,  out  of  34  sterile  cows,  31  were 
affected  with  uterine  tuberculosis  ! 

Actinomycosis  and  tuberculosis  of  the  uterine  ligaments  or 
walls,  are  usually  not  subject  to  remedy.  Ivimited  actinomy- 
cosis might  possibly  be  relieved  by  the  internal  administration  of 
potassium  iodide. 


Deutsche  Tierartzlichen  Wochenschrift.iSgS. 


252  Veteriyiary  Obstetrics 

6.  Occlusion  of  thk  Os  Uteri. 

Except  during  the  time  of  estrum  or  at  the  period  of  birth,  the 
OS  uteri  externum  is  normallj-  closed  in  all  animals  to  such  an 
extent  that  the  folds  of  the  mucous  membrane  of  the  cervix  are 
firmly  pressed  together,  so  that  some  degree  of  force  is  required 
to  pass  any  object  of  size  through  it.  The  degree  of  closure 
varies  greatly  in  the  different  domestic  animals,  being  most 
marked  in  the  cow  and  the  least  so  in  the  mare.  In  the  cow,  the 
cervical  canal  is  long  and  tortuous  and  the  cervix  itself  is  thick 
and  firm,  apparently  almost  tendinous.  The  circular  muscle 
fibres  of  the  cervix  of  the  cow  and  other  ruminants  are  very 
numerous  and  powerful  and  maintain  the  closure  of  the  canal  in 
a  very  effective  manner.  In  the  cow,  the  mucous  membrane  is 
thrown  into  the  numerous  longitudinal  folds  common  to  the  uteri 
of  all  animals,  and,  in  addition,  there  are  two  or  three  transverse 
ridges  of  mucous  membrane  surrounding  the  canal  in  such  a 
manner  that  it  becomes  exceedingly  difficult  to  pass  a  sound 
through  it,  from  the  vagina,  into  the  uterine  cavity. 

The  physiologic  dilation  of  the  cervix  during  both  estrum  and 
parturition  is  not  well  understood,  but  seems  to  be  due  to  a 
nervous  reflex.  We  have  already  related,  on  page  32,  that  the 
vagina  has  an  inherent  power  of  dilating  under  sexual  excite- 
ment. This  is  seen  most  marked  in  the  mare  and  less  so  in  the 
cow.  Zschokke  attributes  this  spontaneous  dilation  of  the  vagina 
of  the  cow  to  the  contraction  of  the  longitudinal  muscle  fibers, 
and  to  the  action  of  the  ischio- vaginal  muscles  upon  tho.se  fasciae 
which  extend  deeply  into  the  vagina.  He  suggests  that  it  is 
possible  that  this  dilation  of  the  vagina  acts  upon  the  mouth  of 
the  uterus  and  tends  to  widen  it.  As  already  stated,  we  con- 
sider that  the  rea.sons  advanced  by  Zschokke  are  open  to  question, 
since  the  contraction  of  the  longitudinal  muscle  fibers  should 
tend  rather  to  bring  the  walls  together  than  to  separate  them. 
The  explanation  for  the  ballooning  of  the  vagina  requires  further 
study,  but  we  agree  with  Zschokke  that  it  probably  has  an  influ- 
ence upon  the  dilation  of  the  os  uteri. 

The  closure  of  the  cervical  canal  must  be  referred  to  the  firm 
contraction  of  the  circular  muscles  of  the  part.  In  the  cow,  the 
density  of  the.se  muscles  is  so  great,  and  their  contraction  so 
firm,  that,  except  during  the  periods  of  estrum  and  parturition,  it 


Occlusion  of  the  Os   Uteri  253 

is  exceedingly  difficult  to  insert  even  the  little  finger  through  the 
canal  into  the  uterus.  In  a  perfectly  normal  uterus  of  the  cow, 
it  usually  requires  half  an  hour  to  one  hour  of  hard  work  to  dilate 
the  part  sufficiently  to  insert  an  index  finger.  The  cervix  of  the 
cow  is  so  hard  that  it  frequently  leads  the  inexperienced  veter- 
inarian to  diagnose  sclerosis  when  it  is  perfectly  normal  and  thus 
lead  to  an  error  in  reference  to  the  cause  of  sterility  and  an  equal 
mistake  in  applying  remedies  for  the  sterility.  Zschokke  has 
searched  in  vain  for  cartilaginous  tissue  in  the  cervixes  of  cows, 
but  has  occasionally  met  with  an  excess  of  connective  tissue 
which  has  led,  in  his  judgment,  to  some  sclerosis.  Even  this, 
he  admits,  is  very  seldom.  Zschokke,  in  his  extensive  experience, 
has  never  met  with  a  ca.se  of  atresia  of  the  os  except  as  a  con- 
genital affection,  and  even  then  or^ly  very  rarely. 

It  is  very  evident  that,  if  the  mouth  of  the  uterus  is  completely 
closed,  neither  the  penis  nor  the  semen  can  enter,  because  of  the 
anatomical  relations,  which  have  been  already  discussed.  It  is, 
accordingly,  an  old  custom  in  all  countries  to  examine  the  cervix 
uteri  in  cases  of  sterility  to  determine  if  it  is  open  or  not. 

The  frequency  of  occlusion  of  the  os  uteri  is  a  question  which 
admits  of  much  discu.ssion  and  which  is  differently  answered  by 
different  practitioners.  In  the  judgement  of  some  veterinarians, 
it  constitutes  the  chief  cause  of  .sterility,  while  by  others  it  is  re- 
garded as  a  very  rare  and  more  or  less  mythical  condition.  Hess 
passes  over  the  question  of  occlusion  of  the  os  very  lightly,  while 
Zschokke  considers  it  of  much  importance  and  of  comparatively 
frequent  occurrence.  Bass  deems  it  one  of  the  great  causes  of 
sterility  in  the  cow. 

It  is  difficult  to  harmonize  these  conflicting  views.  It  is  con- 
stantly to  be  remembered  that  an  os  uteri  is  not  closed,  so  far  as 
conception  is  concerned,  .so  long  as  the  canal  will  admit  of  the 
pa.ssage  of  a  small  probe.  There  is  no  essential  reason  why  the 
OS  uteri  externum  should  be  any  wider  than  the  canal  of  the 
oviducts,  which  barely  admit  the  passage  of  a  large  horse  hair. 
The  anatomical  character  of  the  cervix  of  the  cow  renders  it  ex- 
ceedingly difficult  to  determine  if  such  a  passage  exists  or  not, 
until  the  os  has  been  sufficiently  dilated  to  permit  the  passage  of 
a  finger  into  the  uterine  cavity.  According  to  Zschokke  and 
others,  the  occlusion  of  the  os,  or  a  harmful  .stricture,  has  been 
met  with  in  animals  which  have  recently  given   birth   to  young 


254  Veterinary  Obstetrics 

and  has  been  followed  by  a  vaginal  discharge,  presumably  due  to 
endometritis.  In  other  cases,  it  occurs  without  any  preceding 
disease. 

We  have  indeed  very  little  in  our  veterinary  literature  to 
thoroughly  demonstrate  the  closure  of  the  os  uteri,  as  verified 
by  post  mortem  examination,  and  the  diagnosis  has  usually 
been  based  upon  the  difficulty  of  introducing  a  finger  through 
the  cervix  into  the  uterine  cavity.  This,  as  we  have  already 
stated,  is  well-nigh  impossible,  at  most  times,  in  the  normal 
uterus  of  the  cow. 

In  the  mare,  closure  of  the  os  uteri  is  stated  to  occur,  and 
doubtless  does,  but  in  our  experience  we  have  never  seen  such  a 
case  except  in  some  disease  of  the  uterine  cavity  itself,  such  as 
pyometra  or  uterine  abscess,  in  which  the  cervix  becomes  sclero- 
tic and  in  which,  sometimes,  as  observed  by  us  clinically,  a  com- 
plete closure  of  the  canal  results. 

The  diagnosis  of  closure  of  the  os  uteri  is  very  difficult  in  the 
cow,  still  more  so  in  the  small  domestic  animals,  but  there  is  no 
difficulty  ordinarily  in  the  mare.  If  the  uterus  of  the  mare  is 
normal,  the  index  finger  can  readily  be  pa.ssed  through  it,  even 
when  she  is  not  in  estrum.  During  estrum,  it  is  not  at  all  rare 
to  find  the  os  of  the  mare  so  open  and  flaccid  that  the  entire 
hand  may  readily  be  introduced  through  it. 

In  the  cow,  we  should  preferably  examine  the  animal  for  sus- 
pected closure  of  the  os  uteri  during  the  period  of  estrum,  be- 
cause the  canal  is  naturally  more  dilated  and  dilatable  at  that 
time.  The  best  method  for  examining  the  cervix  is  to  grasp  it 
per  rectum  with  one  hand,  so  as  to  fix  and  hold  the  cervix  in  a 
direct  line,  and  then  test  the  patency  of  the  cervical  canal  with 
the  index  finger  of  the  other  hand  or  with  a  sound.  One  of  the 
great  difficulties  in  passing  either  the  finger  or  the  .sound  is  the 
aforementioned  tran.sver.se  folds  of  mucous  membrane,  which 
tend  to  obstruct  the  passage  and  may  lead  to  the  conclusion  that 
the  canal  is  closed  when,  in  fact,  the  sound  or  finger  has  simply 
been  caught  in  one  of  these  folds,  and  the  cervical  canal 
is  wholly  normal.  Another  serious  difficulty  is  that,  unless 
the  cervix  is  fixed  per  rectum,  as  suggested,  the  pressure  neces- 
sary to  force  the  finger  or  sound  through  the  canal  causes  the 
cervix  to  bend  acutely,  or  even  at  right  angles,  and  thus  cause 
the  finger  or  sound  to  be  forced  against  the  wall  of  the  cervix. 


Occlnsion  of  the  Os   Uteri  255 

which  has  now  become  perpendicular  to  the  long  axis  of  the 
finger  or  sound.  In  this  way,  we  have  known  the  operator  to 
force  his  finger  through  the  walls  of  the  cervix  into  the 
peritoneal  cavity  while  attempting  to  "open"  a  cervical  canal 
which  was  not  "closed",  but  perfectly  normal. 

The  diagnosis  of  occlusion  of  the  cervical  canal,  as  alread}- 
suggested,  is  all  too  frequently  mythical  and  based  upon  un- 
scientific grounds.  The  occurrence  of  the  condition  is  freely 
admitted  and  verified  by  clinical  and  post  mortem  examinations, 
but  the  frequency  of  pathologic  occlusion,  of  a  degree  to  actually 
constitute  a  fertility  destroying  closure,  is  a  debatable  question 
of  great  significance. 

When  is  the  os  uteri  closed  to  a  degree  to  interfere  with  or 
prevent  fecundation?  Few  will  answer  it  alike.  If  we  knew 
better  the  exact  relation  of  the  organs  during  copulation,  the 
answer  might  be  more  specific. 

Some  claim  that,  during  copulation,  the  glans  penis  enters  the 
OS  uteri.  As  proof,  they  cite  uterine  laceration  or  perforation 
alleged  to  have  resulted  from  copulation,  but  can  adduce  from 
the  pages  of  veterinary  literature  but  one  or  two  cases.  The 
records  are  not  wholly  convincing  in  the  one  case  we  have  found 
recorded.  Even  if  it  occurred,  as  alleged,  the  fact  of  serious  or 
fatal  injury  would  indicate  rather  that  it  was  due  to  abnormal 
copulation. 

It  is  fair  to  assume  that  manual  exploration  of  the  vagina  in 
estrual  animals  induces  conditions  somewhat  analogous  to  those 
obtaining  during  copulation  and  there  is  certainly  little  therein 
to  suggest  that  the  penis  enters  the  cervical  canal.  The  os 
uteri,  while  distinctly  dilated  as  compared  with  the  condition 
observed  during  the  interval  between  estrual  periods,  is  never- 
theless clo.sed  too  firmly  to  make  the  entrance  of  the  penis  into 
it  comprehensible.  It  is  to  be  further  noted  that,  when  the  so- 
called  "  impregnators  "  are  used  in  the  mare  and  in.serted  in  the 
os  uteri  externum  immediately  prior  to  service,  the  apparatus  is 
not  dislodged  by  copulation,  as  would  inevitably  occur  should 
the  penis  enter,  or  even  press  hard  against,  the  os. 

In  the  cow,  the  canal  is  too  small  and  tortuous  to  permit  the 
penis  of  the  bull  to  enter  it,  especially  with  the  sudden  and 
violent  thrust  made  by  that  animal.  The  same  holds  true  for 
other  ruminants. 


256  Veterinary  Obstetrics 

Others  maintain  that,  during  copulation,  the  meatus  urinari us 
of  the  male  penis  is  pressed  against  the  os  uteri  externum  of  the 
female  at  the  moment  of  ejaculation  and  that  the  semen  is  in- 
jected directly  into  the  uterus  through  the  cervical  canal. 
Little  evidence  exists  in  favor  of  such  assumption  and  much 
against  it.  In  the  mare,  it  is  especially  notable  that  large 
quantities  of  semen  are  expelled  from  the  vulva  immediately 
after  the  completion  of  copulation,  which  would  signify  that  it 
had  probably  not  passed  beyond  the  vagina.  If  the  vaginal 
cavity  is  examined  immediately  after  copulation,  large  quantities 
of  semen  will  be  found  in  it,  apparently  the  normal  volume  dis- 
charged at  a  single  copulation.  If  this  is  largely  expelled  frcgn 
the  vagina  immediately  after  ejaculation,  it  would  scarcely 
appear  that  it  was  first  thrown  into  the  uterine  cavity  or  cervical 
canal,  but  that  it  was  discharged  against  the  anterior  wall  of  the 
vagina,  especially  the  os  uteri  externum,  and  that  only  a  very 
small  proportion  of  the  fecundating  cells  pass  beyond  the  vagina 
to  assume  any  important  part  in  the  process  of  fertilization. 
Some  of  the  spermatozoa  pass  through  the  cervical  canal,  uterine 
and  cornual  cavities,  reach  the  oviduct  and  meet  the  ovum  or 
ova,  where  07ie  male  cell  serves  to  fecundate  each  female  cell  or 
ovum,  while  the  other  spermatozoa  perish.  Most  of  the  sperm- 
atozoa are  expelled  from  the  vagina  immediately  after  copulation. 

Occlusion  of  the  os  uteri,  as  a  fundamental  catise  of  sterility,  con- 
sists of  such  complete  atresia,  or  closure,  of  the  cervical  canal  as  to 
render  the  passage  of  the  Tnicroscopic  spematozoa  improbable  or  im- 
possible. In  the  oviduct  tvith  a  canal  admitting  a  large  horsehair, 
the  size  of  the  channel  is  abtindant  for  purposes  of  fecundation  and, 
so  far  as  we  can  determine,  a  like  opening  through  the  cervical 
ca7ial  fulfills  all  demands  for  impregnation. 

According  to  this  view,  the  smallest  recognizable  opening 
through  the  os  uteri  and  cervical  canal  constitutes  a  reproduc- 
tively  normal  condition  and,  ere  we  can  diagnose  occlusion  of  the 
os,  we  need  to  determine  that  the  pa.s.sage  of  microscopic  sperma- 
tozoa, endowed  with  vigorous  motile  power  and  in  their  normal 
element,  is  impracticable.  Hence,  in  our  judgement,  if  the 
.smallest  sound,  po.ssessing  adequate  rigidity  to  render  its  insertion 
practicable,  can  be  passed  through  the  cervical  canal  without 
undue  force,  the  diagnosis  of  occlusion  of  the  os  uteri  is  not 
warranted. 


Occlusion  of  the  Os   Uteri  257 

When  closure  of  the  cervical  canal  has  been  definitely  di- 
agnosed, it  becomes  evident  that  the  most  direct  and  only 
hopeful  method  of  dealing  with  the  consequent  sterility  is  by 
its  artificial  dilation. 

The  manual  dilation  of  the  os  uteri  should  be  carried  out  under 
the  strictest  aseptic  precautions  in  order  to  avoid  an  inflammation 
of  the  parts,  which  must  be  more  or  less  injured  during  the  pro- 
cess. In  the  cow,  the  dilation  must  be  very  gradual  and  its 
accomplishment  requires  much  patience.  As  suggested  above, 
it  is  best,  where  we  wish  to  use  force  in  penetrating  the  cervical 
canal,  to  first  grasp  the  cervix  uteri  per  rectum  with  one  hand 
and  then  carry  out  the  dilating  operation  with  the  other  hand  in 
the  vagina.  The  operator  should  have  the  finger  nails  well 
trimmed  and  perfectly  smooth,  the  hands  clean,  disinfected  and 
well  softened.  The  hand  should  be  oiled  or  should  be  moistened 
with  some  unctuous  substance,  like  a  solution  of  sodium  bicarbon- 
ate or  a  weak  solution  of  salt  at  a  temperature  of  about  100°  F. 
The  index  finger  should  be  pushed  gentl}'  into  the  os  with  a 
rotary  motion  and  advanced  until  resistance  disappears  and  the 
finger  tip  enters  the  uterine  cavity.  After  persisting  in  the  effort 
for  a  considerable  period  of  time,  until  the  finger  becomes  tired 
and  the  animal  considerably  irritated,  it  maybe  best  to  desist  for 
a  while  and  renew  the  operation  some  hours  later  or  upon  the 
following  day. 

Zschokke  condemns  the  use  of  wooden  or  metallic  sounds  in 
bringing  about  this  dilation  because  he  considers  them  dangerous. 
We  hold,  on  the  other  hand,  that  they  are  quite  as  safe  as  the 
finger,  providing,  always,  that  the  precaution  is  taken  to  first 
grasp  and  fix  the  cervix  with  one  hand  per  rectum,  in  which 
case  the  progress  of  the  sound  may  be  constantly  determined  and 
the  operator  can  know  exactly  if  it  is  following  the  central  line, 
that  is,  the  cervical  canal,  and  may  determine  when  it  has  reached 
the  uterine  cavity. 

We  even  regard  a  metallic  sound  as  distinctly  safer,  easier  to 
manipulate,  and  more  effective  than  the  finger,  in  dilating  the 
os  or  diagnosing  its  patency,  because  it  can  be  much  smaller  and 
more  even  than  the  finger.  For  the  cow,  this  instrument  should 
be  of  well  tempered,  plated  steel,  fV  to  \  inch  in  diameter  at  the 
point,  18  to  20  inches  long  and  furnished  with  a  handle  con- 
17 


258  Veierhiary  Obstetrics 

venient  for  inanipulatiou.  Some  writers  advise  a  curved  point, 
but  the  canal  it  is  to  penetrate  is  direct  and  the  instrument 
should  be  straight. 

An  interesting  question  in  the  dilation  of  the  cervical  canal  is 
that  in  relation  to  the  use  of  local  anaesthetics,  such  as  cocaine, 
stovaine  and  others.  We  find  no  records  of  the  use  of  these 
drugs  for  this  purpose.  It  would  seem  to  us,  however,  that  two 
very  marked  advantages  might  result.  First,  the  use  of  these 
substances  might  diminish  the  resistance  and  straining,  by 
obviating  the  pain  incident  to  the  process,  and  thus  do  away 
with  one  of  the  chief  hindrances  in  the  operation.  In  the  second 
place,  we  have  found  that  stovaine,  especially,  paralyzes  motor 
nerves  and  it  would  appear  to  us  that,  if  injected  into  the  walls 
of  the  cervix,  it  might  inhibit  the  muscular  power  and  render 
the  dilation  of  the  canal  easy,  if  not  in  itself  accomplishing  the 
desired  end. 

The  smearing  of  the  cervix  of  the  uterus  with  belladonna  and 
other  similar  substances,  with  a  view  to  relaxing  the  parts,  has 
not  been  followed  by  success,  according  to  our  observations. 

Having  already  indicated  our  skepticism  concerning  the  .scien- 
tific basis  for  attributing  a  large  percentage  of  instances  of 
sterility  to  occlusion  of  the  os  uteri,  it  is  essential  to  discuss 
freely  the  prognosis  of  dilation  in  the  presence  of  this  alleged 
cause.  Numerous  contributions  appear  here  and  there,  in  which 
excellent  results  are  recorded  from  "opening"  the  uterus  and 
it  is  a  common  practice  among  stallion  grooms  to  '  *  open  ' '  the  os 
in  mares  which  fail  to  conceive  at  the  first  or  second  service.  It 
becomes  an  exceedingly  difficult  and  delicate  task  to  differentiate 
between  fact  and  fancy,  between  science  and  mysticism. 

Except  we  have  first  learned  positively  that  a  barrier  to 
fecundation,  not  spontaneously  removable,  exists,  we  are  not 
prepared  to  say  that  a  given  coition  will  or  will  not  prove  suc- 
cessful becau.se  preceding  copulations,  be  they  one  or  many  and 
distributed  over  months  or  years,  have  failed.  Without  "  open- 
ing", without  mystical  concoctions,  without  interference  of  any 
kind,  we  have  observed  the  sudden  and  unexpected  appearance 
of  fertility  after  barrenness,  in  mares,  from  maturity  up  to  the 
age  of  10  or  12  years  or  more.  In  such  cases,  the  reasons  for 
the  final  conception  and  prior  sterility  remained  equally  impene- 
trable enigmas. 


Occlusion  of  the  Os   Uteri  259 

So,  if  a  series  of  females  which  have  failed  to  conceive  are 
"opened",  are  drugged  with  this  or  that  nostrum,  have  j^east 
injected  into  their  vaginae,  have  "  impregnators "  applied,  or 
resort  is  had  to  artificial  impregnation,  some  of  them,  possibh^ 
all,  may  conceive. 

It  is  possible,  though,  we  believe,  highh'  improbable,  that  the 
forcible  dilation  of  the  cervical  canal  may  indirectly  favor  fecun- 
dation. The  discharge  of  viable  ova  into  the  oviducts  is  a  reflex 
act.  We  know  too  little  of  the  causes  of  the  maturation  and 
rupture  of  the  ovisacs  and  the  part  played  therein  by  reflexes 
from  the  other  portions  of  the  genital  apparatus. 

It  is  believed  by  many  breeders,  and  apparently  not  without 
reason,  that  .sexual  excitation  tends  to  hasten  and  even  determine 
ovulation  and  hence  some  breeders  practice  forced  service,  at 
times,  in  order  to  hasten  or  insure  estrum  and  ovulation.  It  is 
common  experience  and  observation  that  the  proximity  of  a  male 
stimulates  sexual  appetite  in  the  female,  and  we  have  good  reason 
to  assume  that,  with  it,  is  associated  the  stimulation  of  ovula- 
tion. If  this  be  true,  we  are  not  in  a  position  to  deny  that  the 
manual  or  instrumental  dilation  of  the  cervical  canal  may  stimu- 
late normal  ovulation  and  hence  indirectly  favor  conception. 

We  cannot,  however,  in  the  present  state  of  our  knowledge, 
place  scientific  reliance  upon  dilation  of  the  os  uteri  as  an  effect- 
ive remedy  for  sterility,  except  in  isolated  cases. 

On  the  other  hand,  there  is  much  in  the  ordinary  "opening 
of  the  uterus"  which  is  in  violation  of  all  surgical  principles. 
Time  and  again  we  have  watched  the  stallion  groom,  without 
any  precautions  whatever,  proceed  with  his  operation.  Some 
dirt\^  water  in  a  filthy  stable  pail,  to  which  is  added  some  irritant 
laundry  soap,  is  used  as  a  lubricant  for  the  dirty  unwashed 
hands  of  the  groom,  while  the  long  and  rough  finger  nails,  con- 
cealing abundant  filth,  receive  no  attention.  The  rough,  dirty 
hand  is  forced  through  the  vulva  and  vagina  with  scant  regard 
for  their  delicacy,  and  is  then  rudely  forced  onwards  through  the 
cervical  canal,  tearing  the  ti.ssues  and  inducing  extensive  hemor- 
rhage so  that  the  hand,  when  withdrawn,  is  covered  with  blood. 
The  character  of  the  uterine  cervix  of  the  cow  renders  such  an 
operation  less  practicable  and  it  is  virtually  impo.ssible,  withitv  a 
reasonable  time,  to  force  the  entire  hand  into  the  uterine  cavitv. 


26o  Veterinary  Obstetrics 

We  have  known,  however,  a  veterinarian  to  force  a  finger 
through  the  cervical  walls  into  the  peritoneal  cavity. 

Sober  consideration  must  convince  anyone  that  such  rough 
methods  are  not  only  antagonistic  to  the  production  of  the  desired 
result,  but  actually  dangerous  for  the  well-being  of  the  patient 
and  profoundly  repulsive  from  a  surgical  standpoint. 

A  rudely  dilated  os  uteri  means  hemorrhage  into  the  cervical 
canal,  with  consequent  blood  coagula  in  the  parts,  which,  if  the 
animal  is  at  once  served,  would  seriously  impede,  or  prevent,  the 
passage  of  .spermatoza  through  the  canal.  At  the  same  time, 
the  pain  from  the  physical  injuries  will  cause  straining  and  tend 
to  result  in  an  unusually  and  injuriously  complete  expulsion  of 
the  semen. 

If  time  is  permitted  to  elapse  after  the  operation  before  serv- 
ice is  permitted,  the  injured  parts  become  inflamed  and  swollen, 
and  the  closed  os  more  tightly  closed  than  before  the  operation. 
Infection  almost  inevitably  contributes  to  the  dangers  to  the  life 
of  the  spermatozoa. 

These  conditions  not  alone  tend  to  prohibit  impregnation,  but 
endanger  the  health  of  the  genital  passages,  by  planting  infec- 
tion in  the  injured  tissues  and,  in  our  clinical  experience,  chronic 
pyometra  has  followed  "  opening  "  so  closely  in  some  cases  as  to 
point  to  the  rude  operation  as  the  probable  basic  cause  of  the 
malady. 

Others,  especially  veterinarians  of  excellent  repute,  instead  of 
resorting  to  these  rude  and  barbarous  means  of  dilation,  apply, 
the  more  scientific  and  far  less  dangerous  expedient  of  intro- 
ducing, into  the  cervical  canal,  sponge  or  kelp  tents,  which, 
through  the  absorption  of  fluids,  swell  up  and  gently  dilate  the 
canal.  Admittedly  they  are  far  milder  and  safer.  But  they  are 
only  applicable  in  those  cases  where  the  canal  is  already  permea- 
ble, as  they  cannot  otherwise  be  inserted.  As  above  suggested, 
when  the  canal  is  penetrable,  the  further  dilation  is,  in  our 
judgment,  unnecessary,  if  not  wholly  unwarranted. 

Nor  is  the  danger  from  infection  wholly  obviated.  Any  foreign 
body,  unless  it  be  permanently  a.septic  or  antiseptic,  invites  infec- 
tion in  the  part  and,  when  the  dilating  body  is  remoVed  and  the 
infection  left  behind,  it  remains  as  a  menace  to  all  .spermatozoa 
which  must  pass  through  the  infected  tract  on  their  way  to  con- 
jugation with  the  ova. 


Aio7iy  of  the  Genital  Tract,  etc.  261 

On  the  whole,  therefore,  we  consider  that  the  manual  or 
mechanical  dilation  of  the  cervix  uteri  should  be  strictly  limited 
to  those  cases  where  the  sterility  is  traceable  to  a  definite  ob- 
struction in  the  canal,  which  it  is  possible  to  overcome  by  the 
operation. 

Hypertrophy  of  the  Os  Uteri. — Aside  from  the  closure  of 
the  OS  uteri,  Zschokke,  Hess  and  others  have  observed  hyper- 
trophy of  the  cervix  as  a  hindrance  to  impregnation.  In  these 
cases,  the  os  uteri  externum  projects  far  into  the  vagina,  and  is 
enlarged  and  firm.  Zschokke  has  found  this  condition  only  in 
old  cows  which  had  repeatedly  given  birth.  Hess  believes  that 
this  condition  may  be  transmitted  to  the  offspring.  The  condi- 
tion con.sists  chiefly  of  a  hypertrophj^  of  the  mucous  membrane 
and  the  folds  may  reach  ten  times  their  normal  size.  Some 
veterinarians  have  recorded  tuberculosis  of  the  cervix  uteri. 
Zschokke  alludes  also  to  the  formation,  about  the  os  uteri  externum 
in  cows,  of  mucous  membrane  flaps  as  much  as  6  cm.  long,  which, 
in  his  judgment,  might  act  as  a  hindrance  to  the  migration  of 
spermatozoa  through  the  cervical  canal.  In  the  mare  this  con- 
dition is  very  common  in  conjunction  with  general  atonic  condi- 
tions of  the  genital  tract,  which  we  consider  below,  where  we 
shall  deal  with  the  problem  of  handling.  The  general  handling 
of  hypertrophy  of  the  os  uteri,  or  vaginal  portion  of  the  cervix 
uteri,  must  usually  be  coupled  with  an  unfavorable  prognosis. 
If  the  condition  is  static,  if  no  active  disease  processes  are  present, 
and  it  is  believed  that  parturition  could  be  .safely  accomplished, 
artificial  insemination  may  be  successfully  applied,  if  a  small- 
caliber  syringe  nozzle  can  be  introduced  through  the  hypertrophied 
organ.  If  active  disease  processes  are  present,  appropriate 
remedies  should  be  applied  for  their  cure.  In  general,  however, 
the  condition  is  beyond  remedy. 

7.  Atony    of  the  Genit.\l   Tract   and   Dilation  of  the 
Cervix  Uteri. 

In  contrast  to  constriction  or  occlusion  of  the  os  uteri  externum, 
we  more  commonly  meet  in  the  mare  with  an  abnormal  dilation 
of  the  passage.  The  os  uteri  is  unusually  wide  open  and  flaccid 
and  readily  admits  of  the  entrance  of  several  fingers  or  of  the 
entire  hand. 


262  Veterhiary  Obsteti'ics 

There  is  present  a  general  flaccidity  of  the  genital  tract,  the 
mucosa  are  somewhat  injected  and  there  is  an  increased  secretion 
of  mucus.  The  malady  occurs  usually  in  adult  or  old  brood 
mares,  but  we  have  observed  it  in  fillies.  As  a  rule  it  is  observed 
in  idle,  highly-fed  animals  which  have  grown  over-fat.  The 
condition  of  the  genital  tract  is  simply  the  result  of  the  general 
atonic  state  of  the  animal,  caused  by  injudicious  management. 

Along  with  this  condition,  the  mucous  membrane  about  the 
OS  uteri  externum  becomes  hypertrophied  and  developes  exten- 
sive flaps  of  mucous  membrane,  which  hang  down  over  the  os 
like  curtains.  The.se  may  mechanically  interfere  with  insemina- 
tion, as  they  act  somewhat  as  valves  and  may  possibly  tend  to 
deflect  the  spermatozoa  from  the  cervical  canal. 

The  handling  of  sterility  due  to  these  causes  must  be  directed 
primarily  to  the  removal  of  the  causes  themselves  and  secondarily 
to  relief  from  the  changes  which  have  occurred  in  the  genital 
canal. 

First,  the  patient  should  be  .so  handled  as  to  restore  the  normal 
systemic  tone.  Idleness  and  obesity  are  to  be  supplanted  by  ex- 
ercise, or  by  work  of  such  a  degree  as  to  restore  the  general 
tonicity.  This  is  not  always  easy  of  accomplishment  in  a  harem 
of  mares  used  wholly  for  breeding.  In  some  manner,  exercise 
should  be  enforced.  When  at  pasture,  the  food  supply  should 
be  reduced,  by  restricting  the  area  or  increasing  the  number  of 
animals  within  the  enclosure,  to  such  a  point  that  the  mare  must 
exert  herself  to  a  reasonable  degree  in  order  to  .secure  the  amount 
of  food  necessary  to  maintain  good  physical  condition,  and  thus 
overcome  the  obesity  and  want  of  tone.  A  quiet  mare,  especially 
of  the  draft  breeds,  will  not  exercise  unless  compelled  to  do  so 
in  order  to  obtain  food,  water  or  shelter.  The  mere  provision  of 
a  sufficient  area,  in  which  exercise  may  be  taken,  by  no  means 
assures  exercise,  except  it  is  made  necessary.  If  abundant  food 
and  water  are  close  at  hand,  the  animal  will  move  far  enough 
to  procure  these  and  generally  stop,  content  with  these. 

Even  greater  care  is  essential  in  order  to  .secure  adequate 
exercise  in  winter.  If  abundant  food  and  water  are  supplied  at 
the  stable,  the  animal  is  often  too  content  to  remain  idly  near 
the  stall,  even  though  a  large  enclosure  is  open  to  her,  wheie 
vigorous  exerci.se  could  be  had. 


Loss  of  Cotyledons  263 

If  the  food  supply  is  limited,  and  an  extensive  field  is  open  to 
the  animal,  in  which  some  food  can  be  procured  only  by  more 
or  less  vigorous  exertion^  she  will  promptly  take  this  exercise  in 
order  to  provide  the  additional  food,  for  which  the  system  craves. 

Best  of  all  is  work.  Mares  moderatel}^  or  even  hard,  worked 
are  ahvaj-s  among  the  most  regular  breeders.  It  is  not  rare  for 
mares,  which  have  long  been  sterile,  to  breed  after  being  placed 
at  steady  work  for  a  long  enough  time  to  bring  them  into  good 
working  condition,  with  a  general  vigorous  tone. 

Locally,  something  may  be  done  to  restore  the  genital  tract 
to  its  normal  tone.  The  congestion  and  atony  ma)'  be  largely 
alleviated  by  astringent  douches,  such  as  solutions  of  alum  or 
tannin.  Should  there  seem  to  be  important  infection,  adequate 
disinfection  should  follow.  Powdered  tannin  and  iodoform  may 
be  introduced  into  the  uterine  cavity  in  gelatin  capsules,  and 
these  crushed  or  opened  .so  that  their  contents  may  at  once  escape. 

The  curtain-like  flaps  of  mucous  membrane  may  be  snipped 
off  with  long  scissors  or  removed  by  other  convenient  means. 
In  all  such  cases  the  ovaries,  oviducts  and  cornua  should  be 
carefully  searched  for  abnormalities,  and  should  any  be  found, 
appropriate  measures  applied. 

8.    Loss    OF    COTVLEDOXS. 

It  has  been  a.ssumed  by  some  that  the  loss  of  the  cotyledons  in 
ruminants  serves  to  cause  sterility,  but  Chauveau  and  others 
have  experimentally  removed  all  the  cotyledons  which  could  be 
recognized,  without  inducing  sterility.  New  cotyledons  were 
formed  to  maintain  the  functions  of  the  uterus. 

Clinically,  the  pathologic  destruction  of  the  cotyledons  does 
not  necessarily  lead  to  sterility.  In  retained  afterbirth,  placen- 
titis frequently  follows  ;  the  cotyledons  may  be  surgically  re- 
moved in  order  to  overcome  the  disease  ;  or  they  may  become 
necrotic  and  slough  off  and  yet  sterility  not  ensue.  We  have 
removed  all  recognizable  cotyledons  in  order  to  overcome  grave 
sepsis  due  to  their  necrosis,  after  which  the  patient  bred  promptly. 
The  complete  necrosis  and  sequestration  of  the  cotyledons  in 
retained  placenta  is  not  rare  in  cows.  We  have  observed  the 
sloughing  off  of,  so  far  as  we  could  recognize,  all  the  cotj'ledons, 
the  greatly  enlarged  structures  lying  in  a  mass  in  the  uterine 
cavity,  still   attached  to  the  secundines.      Following  their  re- 


264  Veterinary  Obstetrics 

moval  and  the  disinfection  of  the  uterine  cavity,  fertilization 
occurred  in  due  season.  Very  frequently,  when  a  retained  fetus 
has  undergone  purulent  decomposition  and  is  later  removed 
surgically,  it  is  found  that  the  cotyledons  are  all  necrotic  and, 
dropping  off,  are  expelled  along  with,  or  following,  the  fetus. 
In  due  time  the  cow  again  conceives.  The  loss  of  the  cotyledons 
does  not  lead  to  sterility  ;  the  septic  metritis  or  other  disease 
accompanying  the  retained  placenta  may  cause  .sterility  by  in- 
ducing .salpingitis  followed  by  occlusion  of  the  oviducts.  Other 
anatomical  changes  may  occur,  rendering  the  patient  sterile. 

Our  attention  is  to  be  directed  to  measures  which  may  prevent 
the  loss  of  the  cotyledons,  or,  if  they  have  sloughed  away,  to  a 
restoration  of  the  uterus  to  its  normal  health. 

9.  Vaginitis. 

Though  the  normal  .secretions  of  the  vagina  are  feebly  alkaline, 
any  disease  which  may  affect  this  organ  and  induce  purulent  or 
other  disease  discharges  tends  to  change  the  reaction  of  these, 
through  bacterial  influence,  and  render  them  acid,  a  condition 
which  is  inimical  to  the  life  of  spermatozoa.  It  is  held  that, 
normally,  the  copulative  tract  of  domestic  animals  contains  more 
or  less  bacteria,  the  number  and  variety  being  quite  abundant  in 
the  vulva,  but  decreasing  both  numerically  and  in  variety  as  the 
OS  uteri  is  approached.  Generally,  also,  it  appears  that  the 
pathogenic  power  of  bacteria  diminishes  as  the  os  uteri  is  ap- 
proached so  that,  in  the  anterior  portions  of  the  vagina,  the  bac- 
teria present  are  largely  saphrophytic.  The  bactericidal  power 
of  the  vaginal  walls  gradually  increases  toward  the  anterior  ex- 
tremity, to  become  complete  in  the  normal  organ  in  the  cervix 
uteri,  beyond  which  the  genital  tract  is  normally  free  from  bac- 
teria. When,  however,  the  copulative  tract  becomes  invaded  by 
pathogenic  bacteria,  their  products,  coming  in  contact  with  the 
-spermatozoa,  tend  to  destroy  the  latter  and  thus  induce  sterility 
by  the  destruction  of  the  male  cells  before  they  have  reached  the 
uterine  cavity. 

It  therefore  becomes  essential  that,  in  cases  of  inflammatory 
disease  of  the  vagina,  the  infection  should  first  be  controlled  and 
eliminated  before  copulation  is  permitted.  Not  only  should  this 
be  done  from  the  standpoint  of  the  fertilization  of  the  ovum,  but 


Persistent  Hymen  265 

also  because  of  the  danger  of  the  transmission  of  disease  to  the 
male  and,  through  him,  to  other  females. 

In  purulent  vaginitis,  sterility  is  the  rule,  if  not  constant. 
Perhaps  the  disease  causing  the  vaginitis  itself  also  involves 
other  organs  and,  independent  of  the  vaginitis,  induces  sterility. 
So  it  is  with  the  granular  or  nodular  venereal  disease  of  cows 
and  other  venereal  infections.  The  handling  of  these  has  al- 
readj'  received  consideration  on  pages  73  to   107. 

During  the  puerperal  period,  acute  vaginitis  may  arise,  caus- 
ing sterility  for  the  time,  or,  becoming  chronic  or  leading  to  adhe- 
sions of  the  vaginal  walls,  the  sterility  may  become  more  or  less 
permanently  fixed.  The  overcoming  or  avoiding  of  sterility  as 
a  result  of  this  affection  is  considered  under  ' '  Puerperal 
Infections. ' ' 

10.  Persistent  Hymen. 

As  already  stated  on  page  32,  the  hj-men  is  a  membranous 
expan.sion,  stretching  across  the  genital  canal  between  the  vulva 
and  vagina,  and  represents  the  remnant  of  tissues  existing  be- 
tween the  proctodeal  pit  and  the  posterior  extremity  of  the 
embryonic  gut.  In  domesticated  animals,  this  membrane  regu- 
larly atrophies  and  disappears  wholly,  or  nearly  so,  before  birth. 
Exceptionally,  it  remains  until  adult  life.  The  persistence  is 
most  common  in  the  mare,  so  far  as  recorded  in  veterinary 
literature.  In  a  large  proportion  of  cases,  the  remnants  con- 
sist of  one  or  more  narrow  bands  stretching  across  the  genital 
passage  from  above  to  below,  not  far  from  the  median  line. 
The  lower  end  is  attached  to  the  vulvo- vaginal  boundary  just 
anterior  to  the  meatus  urinarius  and,  from  that  point,  slopes 
upward  and  more  or  less  backward  to  the  roof  of  the  vagina. 

In  other  cases,  the  hymen  persists  to  a  much  greater  degree 
and,  in  one  instance,  we  ob.served  a  broad  sheet  stretching  from 
above  to  below  and  completely  closing  the  left  half  of  the 
vagina.  In  this  mare  the  hand  could  be  passed  along  the  right 
side  of  the  genital  tract  until  it  had  reached  the  vagina  and 
then,  by  causing  this  organ  to  balloon,  the  hymen  could  be  felt  as 
a  broad  membranous  expan.se  about  7  or  8  inches  in  its  perpen- 
dicular diameter  and  5  or  6  inches  horizontall)^  the  entire 
membrane  tensely  stretched. 

In  another  instance  we  ob.served  a  two-vear-old  fillv  with  the 


266  Veterinary  Obstetrics 

hymen  persisting  entirely  across  the  inferior  portion  of  the 
vagina  and  extending  upward  and  backward  toward  the  vaginal 
roof,  but  not  reaching  it.  On  attempting  to  breed  the  filly,  it 
was  found  that  the  stallion  could  not  copulate  on  account  of 
some  obstruction.  As  soon  as  the  penis  reached  the  region  of 
the  hymen,  progress  was  stopped  and  the  .stallion  dismounted. 
After  several  vain  attempts  at  breeding,  we  were  asked  to  ex- 
amine the  filly.  We  .soon  di.scovered  that  there  was  an  opening 
through  the  hymen  at  the  superior  portion  and  consequently 
advised  the  stallipn  groom  to  see  that  the  penis  was  pushed 
upward  along  the  roof  of  the  vagina,  by  the  hand.  By  this 
means,  copulation  was  successful  and  impregnation  took  place. 

In  other  cases  which  have  been  recorded  in  the  cow,  the 
hymen  has  completelj'^  clo.sed  the  genital  pa.ssage  and  cau.sed  an 
accumulation  of  uterine  discharges  in  the  vagina.  In  all  such 
cases,  copulation  is  evidently  impossible  until  the  membrane  is 
ruptured. 

Bands  of  a  similar  character  are  also  found,  at  times,  represent- 
ing the  embryologic  median  walls  of  the  fused  Miillerian  ducts, 
(see  page  19)  which  have  failed  to  atrophy  and  disappear  com- 
pletely, as  is  normal  in  the  region  of  the  vagina  when  the  ducts 
fuse  properly.  They  may  persist  so  completely  as  to  constitute 
essentially  a  double  vagina. 

In  all  cases  where  copulation  is  interrupted  in  such  a  manner 
as  we  have  described,  a  careful  search  of  the  genital  canal  by  the 
veterinarian  is  demanded.  In  making  this  examination  one  is  to 
keep  constantly  in  mind  the  embr5'ologic  development  of  the 
organs  and  look  carefully  for  persistent  hymen,  which  may  con- 
stitute a  transverse  partition,  as  well  as  for  bands  representing 
the  persistent  median  walls  of  the  ducts  of  Miiller,  in  the  form  of 
longitudinal  septa.  These  conditions  should  always  be  clearly 
differentiated  from  any  acquired  disease  or  deformityof  the  parts. 

They  are  to  be  handled  on  general  surgical  principles  and  as  a 
rule  offer  but  little  difficulty  in  overcoming  them.  The  narrow 
bands  representing  either  of  these  embryologic  structures  rarely 
interfere  with  copulation  and  it  is  only  when  they  are  quite  ex- 
tensive that  the  process  of  coition  is  stopped.  They  may,  as  a 
rule,  be  destroyed  by  rupturing  with  the  hand  or  by  severing 
with  a  scalpel. 


Adhesions  of  the    Vaginal   Walls  267 

ir.  Adhesions  of  the  Vaginal  Walls.     Atresia 
Vagina 

We  have  already  stated  on  page  95,  while  describing  the 
venereal  diseases  of  the  cow,  that  adhesions  sometimes 
occur  between  the  vaginal  walls,  as  a  result  of  these  affections. 
This  seems  to  be  especially  true  of  the  vesicular  venereal  disease 
in  the  cow.  We  have  observed  one  case  of  adhesion  of  the  vagi- 
nal walls  in  the  mare,  but  were  unable  to  procure  a  history  of 
the  case  or  otherwise  determine  its  cause.  In  another  instance 
in  the  mare,  the  vaginal  adhesion  resulted  from  vaginitis  follow- 
ing puerperal  infection. 

In  all  cases  of  firm,  extensive  adhesions  of  the  walls  of  the 
vagina,  copulation  becomes  impossible  and  more  or  less  serious 
injuries  are  liable  to  occur  to  the  female,  and  possibly  also  to  the 
male,  from  any  attempts  at  coition.  One  mare  which  we  ob- 
served was  bred  to  a  stallion  during  estrum  and,  on  account  of 
extensive  vaginal  adhesions,  the  vagina  was  somewhat  lacerated 
and  greatly  irritated.  The  severe  irritation  caused  violent 
straining,  which  brought  about  a  prolapse  of  the  floor  of  the 
vagina  and,  with  it,  the  urinary  bladder  (vesico-vaginocele). 
This  prolapse  persisted  for  some  time  in  spite  of  all  efforts  to  over- 
come it.  At  first  we  attempted  to  overcome  the  prolapse  by  means 
of  a  rope  truss.  This  failed  and  we  resorted  to  vulvar  sutures,  but 
the  straining  was  so  violent  that  they  were  being  torn  out  and 
were  consequently  removed,  in  order  to  avoid  extensive  lacera- 
tions. The  straining  was  finally  controlled  by  producing  deep 
anaesthesia  with  chloral  hydrate,  for  a  period  of  four  or  five 
hours,  during  which  time  the  local  irritation  subsided. 

As  a  general  rule,  these  adhesions  of  the  vagina  are  beyond 
surgical  aid.  In  handling  cases  of  vaginitis,  from  whatever  cau.se, 
highly  irritant  antiseptics,  which  might  injure  or  destroy  the 
external  layers  of  the  mucous  membrane,  should  be  carefully 
avoided,  in  order  to  anticipate  such  adhesions  of  the  parts, 
which  may  permanently  prevent  breeding  by  making  copulation 
impossible. 

12.  Vulvar  Atresia. 

In  some  cases  of  inflammation  of  the  genital  tract  from  vener- 
eal diseases,  as  well  as  from  traumatic  injuries  or  other  diseases 
in  the  parts,  the  opening  of  the  vulva  may  become  .so  constricted 


268  Veterhiary  Obstetrics 

as  to  prevent  the  entrance  of  the  penis.  In  one  case  which  we 
observed  in  a  mare,  a  foal  became  impacted  in  the  passage  during 
the  night  and  remained  until  the  following  morning.  The  pres- 
sure upon  the  vulva  was  so  great  that  gangrene  of  the  vulvar 
lips  ensued,  resulting  eventually  in  such  a  constriction  of  the 
vulvar  opening  that  copulation  was  impossible. 

We  may  rarely  be  able  to  ov^ercome  such  strictures  by  surgical 
means,  but  as  a  rule  they  are  not  subject  to  remedy.  The  possi- 
bility of  such  stricture  should  always  be  borne  in  mind  in  dealing 
with  inflammation  of,  or  injuries  to,  these  parts  in  female  breed- 
ing animals. 

13.  Horizontal  Position  of  the  Vulvar  Opening.* 

When  breeding  females,  especially  cows  and  mares,  become 
aged  and  their  abdomens  enlarged  and  pendulous,  the  pelvic 
organs  drop  forward  and  downward,  and,  dragging  upon  the 
anus  and  vulva,  cause  a  more  or  less  deep  excavation  in 
the  perineal  region.  At  the  same  time  the  posterior  dorsal 
and  lumbar  portions  of  the  spinal  column  become  depressed, 
producing  what  might  be  termed  senile  lordosis,  or  "sway  back." 
The  lumbo-sacral  articulation  becomes  involved  in  the  change 
of  position  of  the  parts  so  that  it  becomes  depressed  along  with 
the  .sacro-iliac  articulation,  which  brings  about  a  relative  eleva- 
tion of  the  ischiatic  tuberosities  and  a  more  nearly  horizontal 
position  of  the  pelvis. 

These  changes  in  anatomical  relations  modify  the  direction  of 
the  vulvo- vaginal  canal  so  that,  instead  of  the  vulvar  opening 
being  approximately  perpendicular,  as  in  the  normal,  it  ap- 
proaches closely  to  the  horizontal.  In  copulating,  the  penis 
tends  to  approach  the  vulvar  opening  in  a  direction  acutely  ob- 
lique, or  well  nigh  perpendicular,  to  the  long  axis  of  the  vulvo- 
vaginal canal,  thus  rendering  successful  copulation  uncertain, 
since  the  penis  tends  to  glide  forward  and  slightly  upward  over 
the  vulva,  against  the  anus,  tail,  or  other  parts. 

We  have  already  drawn  attention  on  page  50  to  the  danger  of 
physical  injuries,  against  which  we  .should  guard,  but  it  is  also 
important  to  bear  in    mind  that,   whether  such  injury  occur  or 


Zschokke,  die  Unfruchtbarkeit  des  Rindes,  page  134. 


Rtipture  of  the  Periiieum  and  Recto-  Vaginal  Fistula        269 

not,  the  abnormal  position  constantly  invites  sterility  by  causing 
a  failure  in  coition. 

The  difficulty  may  be  overcome  in  most  cases,  and  copulation 
rendered  safe,  by  means  of  standing  the  female  with  the  posterior 
feet  somewhat  lower  than  the  anterior  and  having  the  male 
stand  upon  ground  approximately  level  with,  or  higher  than, 
the  ground  upon  which  the  anterior  feet  of  the  female  rest. 
This  position  of  the  female  tends  to  bring  the  vulvar  opening 
somewhat  nearer  the  perpendicular  and  con.sequently  renders 
copulation  more  certain.  In  the  mare,  also,  the  penis  of  the 
stallion  may  be  largely  directed  by  the  groom  in  a  manner  to 
avoid  accident  and  render  copulation  more  secure. 

14.  Rupture  of  the   Perineum   and   Recto-Vaginal 
Fistula. 

Rupture  of  the  perineum  or  of  the  wall  between  the  rectum 
and  the  vagina  is  not  rare  in  the  mare  as  a  result  of  some  por- 
tion of  the  foal,  such  as  the  head  or  a  foot,  pushing  up  into  the 
rectum  and  appearing  at  the  anus,  while  the  other  parts  enter 
the  vulva,  wdien,  unless  prompt  relief  is  given,  a  few  violent  ex- 
pulsive efforts  on  the  part  of  the  mare  forces  the  foal  out  and 
tears  the  perineum  asunder.  If  the  attendance  is  prompt,  the 
mi.sdirected  head  or  foot  may  be  pushed  back  into  the  vagina, 
after  it  has  entered  the  rectum,  and  complete  rupture  of  the 
perineum  averted,  but,  as  a  result  of  the  accident,  a  fistula  gen- 
erally persists,  leading  from  the  rectum  into  the  vagina. 

In  either  case,  fecal  matter  drops  from  the  rectum  into  the  va- 
gina and  maintains  a  constant  irritation  of  the  mucosa  of  the 
vagina,  with  catarrhal  discharge. 

When  the  perineum  is  ruptured,  the  deformity  of  the  part  is 
such  that  copulation  cannot  usually  be  successfully  performed, 
and,  even  if  it  can  be,  the  presence  of  fecal  matter  in  the  vagina, 
with  the  consequent  inflammation  and  catarrh,  generally  prevents 
fertilization. 

Sterility  due  to  this  cause  can  only  be  removed,  with  any  de- 
gree of  certainty,  by  bringing  about  a  recovery  from  the  fistula 
or  rupture.  In  .some  cases  of  this  kind  the  sterility  may  be 
overcome  by  means  of  artificial  impregnation.  The  more  or  less 
befouled  vagina  may  be  flushed  out  with  a  warm  saline  solution 
or  even   with   weak  antiseptics,   after  which  semen,   preferably 


270  Veterinary  Obstetrics 

obtained  from  the  vagina  of  a  healthy  mare  immediately  after 
copulation,  is  to  be  injected  into  the  cervical  canal  or  into  the 
uterine  cavity  of  the  patient.  The  question  of  surgical  treat- 
ment of  these  accidents  is  discussed  under  "  Accidents  of 
Parturition." 

Ill  Impediments  to  Copulation  and  Fecundation  Referable 
to  Nervous  Disorders. 

J  Excitability  and  Timidity.  In  young  heifers,  especially 
if  the  animal  is  very  timid  and  is  approached  by  a  strange  male, 
there  is  a  tendency  to  avoid  coition  if  possible,  although  the 
female  is  properly  in  estrum.  In  such  instances  the  behavior  of 
the  male  has  much  to  do  with  this  state  and,  so  far  as  possible, 
he  should  be  caused  to  approach  the  timid  animal  quietly. 

A  mare  having  a  young  foal  at  her  side  is  sometimes  much 
excited  and  resists  the  stallion  because  of  the  maternal  instinct, 
by  which  she  fears  some  injury  to  her  young.  It  is  usually  de- 
sirable to  keep  the  foal  as  near  as  possible  to  the  mare's  head, 
where  she  can  see  it  and  recognize  its  safety. 

2  Vaginismus.  In  the  cow  there  is  occasionally  ob.served  a 
peculiar  contraction  of  the  vulva,  when  attempts  at  copulation 
are  made,  which  is  referable  to  a  .spasm  of  the  sphincter 
muscles  of  that  organ,  due  to  hypersensitiveness.  In  this  af- 
fection the  vulva  becomes  .so  firmly  clo.sed  that  the  penis  of  the 
male  can  not  enter  and,  consequent!}',  copulation  can  not  occur. 
We  have  seen  no  records  of  this  difficulty  in  the  mare  and  have 
observed  no  cases  where  copulation  failed  because  of  it.  In  one 
case  of  nymphomania  in  a  mare  we  found,  upon  inserting  the 
arm  for  the  purpose  of  spaying,  that  the  sphincter  of  the  vulva 
contracted  so  powerfully  that  it  caused  great  pain  by  crushing 
our  arm,  and  so  injured  it  that  it  was  lame  for  eight  or  ten  hours 
after  the  operation  had  been  completed.  The  condition  might 
have  interfered  wdth  copulation. 

Vaginismus  is  probably  most  generally  connected  with  ovarian 
disorder.  Its  cause  is  to  be  carefully  determined  by  examination. 
If  the  malady  is  of  ovarian  origin,  those  glands  must  receive  atten- 
tion. If  the  condition  appears  to  be  wholly  local,  attempts  may 
be  made  to  overcome  it  by  inducing  fatigue  in  the  animal,  by  the 
internal  administration  of  narcotics  or  by  the  use  of  local  anaes- 
thetics applied  to  the  vulva. 


Extreme    Variations  in  Size  271 

3.   Violent  Expulsive  Efforts  Following  Coition.     lu  the 

mare  and  the  cow  we  occasionally  observe  very  violent  expul- 
sive efforts  immediately  following  copulation.  It  is  apparently 
due,  in  some  cases,  to  an  irritability  of  the  animal.  If  there  has 
been  some  pre-existing  disease  of  the  part,  which  has  caused  a 
stricture  of  the  coital  canal,  injury  may  follow  the  coition  which 
produces  pain  and  is  naturally  accompanied  by  straining.  We 
observe  the  same  results  when  the  penis  of  the  male  is  compara- 
'tively  large  and  the  copulation  causes  laceration  or  rupture  of 
the  vagina.  It  is,  consequently,  most  common  in  those  cases 
where  the  female  is  young  or  is  of  small  size  and  the  male  is 
large,  and  especially  where  tlie  penis  is  of  very  large  size  or  of  ex- 
cessive length.  In  other  animals  the  expulsive  efforts  are  ap- 
parently due  entirely  to  individual  irritability.  In  such  cases, 
innnediately  following  coition,  there  is  severe  straining,  which 
causes  an  immediate  expulsion  of  a  large  part,  or  all,  of  the 
semen  and  may  result,  according  to  Zschokke*  and  others,  in 
sterility. 

In  all  such  cases,  the  cause  of  the  irritation  should  be  discov- 
ered and  removed.  We  have  already  suggested  a  plan  for  pre- 
venting injury  from  the  penis  of  the  stallion  under,  ' '  The  Dangers 
and  Infections  of  Coition  ' '  on  page  50.  We  have  also  pointed  out 
the  danger  of  permitting  copulation  when  the  vagina  is  inflamed. 
If  the  expulsive  efforts  are  due  to  excessive  irritability  of  the 
animal  they  may  be  overcome  or  ameliorated  by  causing  her  to  move 
about  constantly,  or  otherwise  attracting  lier  attention  for  some 
time  after  copulation. 

IV.  Extreme  Variation  in  the  Size  of  the  Male  and  Female. 

Under  "  The  Dangers  and  Infections  of  Coition,"  on  page  50, 
we  have  considered  the  question  of  the  variation  in  the  size  of  the 
male  and  female  with  reference  to  accidents.  Closely  allied  to 
these  accidents  is  the  question  of  sterility  due  to  this  same  lack  of 
correspondence  in  size.  In  all  cases  where  accidents  are  liable 
to  occur  because  of  this  difference  in  size,  sterility  is  likely  to 
result  for  similar  reasons.  If  the  female  is  comparatively  either 
too  large  or  too  small,  sterility  may  ensue  as  a  result  of  imperfect 
or  incomplete  copulation.     The  nature  of  the  cause  suggests  the 

^*Zschokke,  Die  Unfiuchtbarkeit  des  Rindes,  page  137. 


272  Veterhiary  Obstetrics 

reined3\     Artificial  insemination,  as  described  on  page  278,  may 
be  indicated  in  some  cases. 

V.  Infectious  Diseases. 

Infectious  diseases,  as  a  cause  of  sterility,  have  already  re- 
ceived attention  on  pages  68  to  no.  The  venereal  infections 
naturally  tend  to  produce  sterility,  though  in  markedly  varying 
degrees. 

In  addition  to  these,  there  are  various  infections  which  tend 
to  cause  the  death  of  the  fetus,  and  which  we  shall  discuss  in 
the  chapter  upon  Abortion.  Whi^e  abortion  is  not  identical 
with  sterility,  the  results  of  it,  by  causing  the  death  of  the  fetus 
prior  to  its  expulsion,  are  essentially  identical,  from  an  economic 
standpoint,  with  a  failure  of  fertihzation  itself. 


NOSTRUMS     AND     PANACE^E     AGAINST 
STERILITY. 

Few  departments  of  veterinary  practice  oflFer  so  inviting  a  field 
for  the  plying  of  the  sale  of  nostrums  and  the  application  of  more 
or  less  mythical  proceedings,  as  sterility.  To  the  average 
layman,  ovulation,  fertilization  and  the  development  of  the 
embr^-o  are  as  a  mysterious  sealed  book,  which  gives  to  the 
quack  an  open  field  for  plying  his  method  of  chicanery.  Some- 
times the  remedies  are  not  devoid  of  merit  in  proper  cases,  but 
lose  their  value  by  being  applied  uniformly  in  a//  cases  of  sterility, 
regardless  of  the  cause  at  work  in  a  given  case. 

Veterinarians  in  America  indirectly  support  this  chicanery  by 
failure  to  extend  scientific  aid.  Science  and  charlatanism 
are  incompatible  and,  whenever  the  veterinarians  of  breed- 
ing areas  study  and  understand  sterility  and  intelligently 
advise  owners  of  sterile  animals,  quackery  in  this  respect  must 
cease.  The  veterinarian  is  helpless  in  combatting  sterility  until 
he  first  learns  well  the  normal  structure  and  functions  of  the 
genital  system ;  he  must  first  comprehend  fertility  ere  he  can 
understand  sterility.  Not  only  does  he  need  have  a  theoretic 
knowledge  of  normal  breeding,  but  he  must  have  a  clinical 
knowledge.  He  must  be  able,  by  manual  exploration,  to  locate 
and  recognize  the  various  internal  generative  organs  in  our  larger 
domestic  animals  and  to  determine  by  such  examination  whether 
they  be  normal  or  abnormal.  This  does  not  come  by  the  reading 
of  books  nor  by  making  post  mortem  examinations.  The  knowl- 
edge does  not  come  to  a  man  in  an  hour  or  a  day.  It  is  to  be 
learned  by  a  conscientious  study  upon  the  living  animal  and 
competency  is  attained  only  by  long  and  faithful  work. 

When  ability  has  been  acquired,  and  the  veterinarian  can  .say 
that  an  ovarian  abcess  is  present,  and  speak  with  authority  upon 
the  point,  the  intelligent  owner  will  not  resort  to  nostrums,  nor 
cause  the  os  uteri  to  be  dilated.  He  will  not  try  impregnators 
nor  resort  to  artificial  insemination.  So,  in  each  case,  when  the 
veterinarian  is  able  to  point  out  the  difficulty  with  authority, 
the  owner  will  desire  the  application  of  a  remedy  which  will 
reasonably  tend  to  remove  the  cause.  x\s  already  stated,  a  pre- 
viously sterile  animal  may  suddenly  and  unexpectedl)^  conceive. 
18  273 


274  Veterinary  Obstetrics 

Should  an  alleged  remedy  have  been  applied  shortly  before,  it  is 
probable  that  it  will  be  credited  with  a  cure,  though  the  actual 
cause  of  the  sterility  may  have  been  of  such  a  character  that  the 
remedy  applied  could  in  no  conceivable  way  have  affected  it. 

In  addition  to  many  secret  nostrums  which  are  placed  upon 
the  market  and  vigorously  advertised  by  their  promoters,  there 
are  various  remedies,  which  are  not  secret,  but  which  have  been 
lauded  as  sovereign  against  sterility,  regardless  of  the  underlying 
cause  ;  or.  pos.sibly,  we  should  say  they  are  regarded  as  specifics 
against  all  cases  of  sterility,  the  causes  of  which  are  unknown  to 
the  parties  concerned. 

Dilation  of  the  Os  Uteri.  We  have  already  had  occasion  to 
refer  to  this  procedure  while  considering  "  Occlusion  of  the  Os 
Uteri."  Dilation  of  the  os  uteri  has  a  direct  value,  and  is  the 
only  scientific  method  of  handling  an  occlusion  of  the  os  uteri 
externum.  This  much  granted,  it  has  been  seized  upon  by  many 
as  a  universal  remedy.  We  have  also  related  that  the  cervical 
canal  of  the  cow  is  so  narrow,  .so  tortuous,  and  its  mucous  mem- 
brane thrown  into  so  many  folds,  that  it  is  difficult  to  pass  a 
finger  or  a  sound  through  the  canal.  This  difficulty  is  made 
greater  by  the  vigorous  contraction  of  the  po^verful  circular 
muscles  of  the  cervix. 

So  it  is  easy  to  say  that  the  os  uteri  is  closed,  much  easier  for 
a  careless  veterinarian  to  make  the  statement  than  to  prove  its 
untruth  by  passing  a  sound  through  into  the  uterine  cavity. 

Of  course  some  females,  previously  sterile,  will  breed  after 
"opening"  the  os,  which  was  not  closed:  so  might  the  same 
animals  have  bred  had  their  tails  been  split,  or  their  horns  bored. 

Impregnators.  A  few  years  ago  there  was  an  an  extensive 
interest  shown  in  impregnators  as  a  soverign  remedy  for  sterility 
in  mares.  Some  prominent  American  practitioners,  deeply  im- 
pres.sed  with  the  idea,  bent  their  energies  to  overcome  sterility 
in  this  manner  and  devised  and  patented  impregnators  of  various 
types.  Generally  they  consisted  of  hollow  tubes  of  .soft  rubber, 
3  to  4  inches  in  length,  having  an  opening  of  variable  size, 
usually  y^  to  yi  inc]?.  The  out.side  of  the  tube  was  con.stricted 
in  its  center,  and  the  posterior  end  was  armed  with  a  broad 
flange  to  prevent  its  falling  into  the  uterine  cavity.  This  ap- 
paratus was  inserted  in  the  os  uteri  externum  just  before  the 
stallion  mounted.     The  theory  of  use  was  that  the  "  impregna- 


Nostr2i7ns  a?id  Panacece  against  Sterility  275 

tor  "  held  the  canal  open  and  that,  during  ejaculation,  the  semen 
was  thrown  directly  into  the  uterine  cavity,  the  urethal  opening 
of  the  penis  coming  into  direct  apposition  to  the  open  tube. 

Evidently  the  os  uteri  was  open,  as,  otherwise,  the  "  impreg- 
nator  "  could  not  have  been  inserted.  The  advocates  of  its  use 
have  not  shown  why  semen  pas.sed  through  a  rubber  tube  should 
have  its  virility  increased.  But  mares,  which  had  been  sterile  pre- 
viously, conceived  at  the  first  service,  and  statements  to  that  ef- 
fect, by  owners  of  mares,  were  freely  used  by  makers  of  "  im- 
pregnators  "  to  show  their  infallibility.  What  influence,  if  any, 
was  exerted  by  the  "  impregnator,"  is  not  wholly  clear,  but  gen- 
erally it  may  be  regarded  as  a  harmless  diversion,  which  ordina- 
rily will  not  prevent  conception.  In  rare  cases,  the}'  may  be  of 
actual  value. 

Incidentally,  experience  with  "  impregnators  "  teaches  that, 
contrary  to  the  views  of  some,  the  penis  of  the  stallion  does  not 
enter  the  cervical  canal  of  the  mare  during  normal  copulation. 
If  it  did,  the  "  impregnator  "  would  inevitably  be  displaced  into 
the  uterine  cavity. 

Injections  of  Yeast  Solution  into  the  Vagina.  Another 
method  of  handling  sterility  in  cows,  which  acquired,  for  a  time, 
a  favorable  reputation,  was  the  injection  into  the  vagina  of  a 
solution  of  yeast  or  the  introduction,  by  other  means,  of  yeast 
into  the  vaginal  cavity.  Cows  previously  sterile,  in  some  cases, 
promptly  conceived  and  these  cases  were  naturally  reported. 
Those  which  did  not  conceive  after  the  treatment  were  generally 
not  mentioned. 

There  may  be  conditions  of  the  vagina,  chronic  infections  of 
the  mucosa,  or  other  disease,  which  the  application  of  yeast  may 
overcome,  but  this  has  not  been  determined.  It  is  inconceivable, 
in  our  present  state  of  knowledge,  that  yeast  introduced  into  the 
vagina  could  overcome  cj'stic  degeneration,  sclerosis  or  abscess 
of  the  ovaries,  or,  indeed,  many  of  the  conditions  named  in  the 
preceding  pages  as  causes  of  sterility. 

Aphrodisiacs.  Yohimbin  Spiegel.  For  many  years 
numerous  drugs  have  been  credited  with  the  power  of  arousing 
the  sexual  appetite  and,  through  this  agency,  the  sexual  powers. 
Among  these  drugs  are  :  cantharides,  turpentine  and  the  balsams 
and  re-sins  and,  more  recently,  a  new  drug,  yohimbin,    has  been 


276  Veterinary  Obstetrics 

introduced  to  overcome  sterility.  In  large  doses,  these  drugs 
induce  more  or  less  irritation  of  the  urino-genital  tract  and 
stimulation  of  the  sexual  desire. 

To  what  extent  aphrodisiacs  stimulate  ovulation  and  spermato- 
genesis has  not  been  determined.  It  is  possible  that  indirectly, 
through  irritation  of  the  genital-tract,  they  stimulate  the  ripen- 
ing and  discharge  of  ova  and  spermatozoa  but,  from  all  data  at 
hand,  they  merely  arouse  the  .sexual  appetite  without  increasing 
the  sexual  powers.  In  the  minds  of  some,  vigorous  .sexual 
desire  signifies  exalted  breeding  powers,  but  this  is  a  false 
assumption.  In  n>mphomania,  for  example,  the  sexual  appe- 
tite is  intense  and  the  breeding  power  almost  nil.  Sexual  ap- 
petite, without  normal  ovulation  in  the  female  and  the  forma- 
tion of  normal  spermatozoa  in  the  male,  has  no  value  for  breed- 
ing purposes,  but  is  rather  a  harm,  frequently  leading  the  owner 
astray  and  diminishing  the  value  of  the  patient  for  other 
purposes. 

Yohimbin  has  recently  acquired  a  high  repute,  in  some  quar- 
ters, as  a  remedy  against  sterility,  both  in  human  and  in  veterinary 
practice.  It  has  been  commended  chiefly  for  arousing  the 
sexual  appetite,  when  absent  in  either  sex.  Its  efficacy  is  in 
vigorous  controversy  and  the  cost  of  the  drug  is  at  present  pro- 
hibitive except  in  unusually  valuable  animals. 

Holterbach  (Berlin  Tierarztliche  Wochenschrift,  No.  9,  1908), 
in  an  exhaustive  article,  champions  the  use  of  the  drug. 

He  u.sed  the  drug  in  37  cases  of  absence  of  sexual  desire  : 
22  cows,  9  bitches,  3  bulls  and  3  sows.  In  his  observation,  the 
drug  has  a  greater  affinity  for  the  female  than  for  the  male 
genitalia.  A  five  j'ear  old  Simmerthal  cow  calved  normally  in 
June,  1906,  but  estrum  did  not  follow.  All  other  drugs,  in- 
cluding cantharides,  proved  useless.  In  August,  1907,  14 
months  after  calving,  16  tablets  of  yohimbin  chlorid,  each  con- 
taining 0.1  gram  of  the  alkaloid,  were  prescribed,  one  tablet  to 
be  given  three  times  daily  in  the  drinking  water.  On  the  third 
day  there  was  excitement,  bellowing,  uneasy  stepping  about, 
frequent  urination  and  decreased  milk  flow.  On  the  fourth  day 
there  was  a  muco-sanguineous  discharge  from  the  vulva 
(menstruation?)  and  dn  the  fifth  day  the  owner  noted  expulsive 
efforts   resembling   labor   pains.      The   external    genitals  were 


Nostrtims  a7id  Panacece  agahist  Sterility  277 

swollen  and  hyperaemic,  but  no  estrum  was  present.  The 
uterus  was  large.  The  ovaries  were  enlarged,  but  not  cystic. 
Six  weeks  later,  the  cow,  showing  violent  estrum,  was  bred  and 
the  owner  "  believed  "  her  in  calf. 

Another  cow,  nine  months  post  partum,  without  estrum,  and 
having  cystic  ovaries,  was  treated  in  the  same  way,  developed 
estrum  10  weeks  later,  was  bred  and  the  owner  "  believed  "  her 
to  be  pregnant. 

Frubinger  ( D.  M.  W.  No.  7,  1907)  condemns  the  drug  as 
worthless  and  attributes  the  alleged  cures  in  man  to  suggestion. 

Miiller  (Arch.  Internat.  Phar.  et  de  Therap.  Vol.  XVII,  p. 
81)  considers  it  an  erratic  aphrodisiac,  acting  differently  on 
different  individuals.  Daels,  quoted  by  Holterbach,  experi- 
mentally caused  menstruation  in  a  bitch  already  in  estrum,  but 
bitches  usually  menstruate  at  this  time  anyhow.  In  another, 
not  in  estrum,  but  date  of  probable  normal  estrum  not  named, 
menstruation  occurred  in  four  days.-  A  third  bitch  showed  a 
mucous  discharge.  Later,  bloody  feces  were  voided  and  the 
animal  died  from  the  toxic  effects  of  the  drug.  Autopsy  .showed 
enlarged,  congested  genital  canals,  prominent  ripe  ova,  etc. 

In  experiments  with  young  bitches,  less  than  nine  months 
old,  the  drug,  in  fatal  toxic  doses,  failed  to  cause  reactions  in 
the  genital  organs. 

So  far  as  we  have  been  able  to  determine,  the  drug  has  not 
induced  estrum  in  any  case  where  estrum  ma}^  not  have  occured 
without  it,  nor  impregnation  where  such  a  result  was  not  per- 
fectly possible  without  the  drug. 

The  alleged  estrum  induced  was  of  doubtful  character.  vSwell- 
ing  of  the  vulva  occurs  without  estrum.  A  bloody  discharge 
from  the  vulva  may  not  be  menstruation.  The  bloody  feces 
following  the  administration  of  the  drug  might  be  called  men- 
struation with  equal  right. 

Further  authentic  data  are  essential  to  a  reliable  conclusion. 
Until  these  are  at  hand,  the  administration  of  the  drug  should 
"be  regarded  as  a  very  expensive  experiment  of  exceedingly 
doubtful  value.  It  has  a  possible  value  in  cases  where  sterility 
exists  as  a  consequence  of  the  absence  of  sexual  desire  without 
organic  disease  of  the  genital  glands. 


ARTIFICIAL  IMPREGNATION. 

Undoubtedly  efficient  in  some  cases,  artificial  insemination  has 
been  advocated  as  a  widely  applicable  remedy  for  sterility,  ap- 
parently upon  the  theory  that  sterility  is  usually  based  upon 
mechanical  impediment. 

Artificial  insemination  is  an  easy  and  successful  operation  in 
fertile  mares  and  other  females  with  readily  penetrable  os  uteri. 
It  is  difficult  of  application  in  the  cow  because  of  the  narrow, 
tortuous,  obstructed  cervical  canal.  It  is  a  valuable  remedy  in 
cases  due  to  physical  impediments  to  natural  insemination,  in  so 
far  as  obstacles  are  surmountable  by  this  means.  It  is  incon- 
ceivable, in  the  present  state  of  our  knowledge,  how  the  opera- 
tion can  otherwise  exert  a  favorable  influence  upon  sterility, 
unless  we  admit  that  in  some  cases,  owing  to  nervous  causes, 
insemination  without  copulation,  by  avoiding  the  nerve-reflexes 
of  that  act,  may  favor  fertilization.     This  has  not  been  shown. 

Some  exaggerated  statements  have  been  made  regarding  its 
efficiency.  It  has  been  asserted  that  50  %,  60  %,  or  more,  of 
mares,,  taken  in  large  numbers,  regardless  of  the  presence,  near- 
ness or  remoteness  of  estrum,  will  be  fertilized  by  this  process. 
Upon  its  face,  the  contention  is  absurd.  There  is  a  belief,  to 
which  some  embryologists  have  lent  weight,  that  spermatozoa 
will  live  for  days  and  weeks  in  the  genital  tube  awaiting  the  ap- 
pearance of  an  ovum.  We  have  found  no  convincing  data,  how- 
ever, to  indicate  that,  in  a  fertile  animal,  coming  regularly  in 
estrum  and  artificially  inseminated  shortly  after  a  normal  estrual 
period,  the  spermatozoa  have  remained  in  the  genital  canal  until 
the  next  ovulation  and  induced  fertilization.  If  the  mares  are 
fertile  and  the  artificial  insemination  is  carefully  made  at  the 
proper  time  in  relation  to  ovulation,  there  is  no  reason  to  doubt 
that  60  %  or  100  %  may  be  fertilized. 

In  occlusion  of  the  cervical  canal,  in  deformities  and  defects  of 
the  OS  uteri,  which  may  inhibit  or  render  uncertain  the  passage 
of  the  spermatozoa  into  the  uterine  cavity,  artificial  insemination 
constitutes  a  rational  and  valuable  remedy.  In  some  diseases  of 
the  vagina  and  of  the  vaginal  portion  of  the  uterus,  artificial 
insemination  offers  possibilities  which  should  hot  be  ignored. 
In  recto-vaginal  fistula  and  in    rupture  of  the  perineum,  where 


Artificial  Impreg7iation  279 

copulation  is  rendered  difficult  or  uncertain,  the  operation  is  in- 
dicated. The  limitations  of  artificial  impregnation  as  a  remedy 
against  sterility  should  be  fully  recognized,  and  the  value  of  the 
process  should  not  be  discredited  by  its  application  in  improper 
cases. 

It  has  been  urged,  and  with  some  reason,  in  cases  of  deformity 
of  the  penis  in  stallions,  by  which  the  semen  is  ejaculated  in 
some  other  direction  than  forwards,  that  the  fertility  of  the  male 
may  be  greatly  heightened  by  artificial  insemination  added  to 
the  imperfect  copulation. 


There  is  a  commercial  feature,  in  connection  with  artificial  in- 
semination, which  interests  the  breeder  rather  than  the  veterin- 
arian and  has  no  relation  to  sterility.  Throughout  nature  there 
is  a  superabundance  of  male  fecundating  cells.  In  a  normal  ejac- 
ulation of  a  healthy  adult  male,  there  are  sufficient  spermatozoa 
to  fecundate  innumerable  females.  It  has,  consequently,  been 
proposed  to  extend  the  procreative  power  of  a  valuable  breeding 
male  by  artificial  insemination — by  collecting  some  of  the  semen 
from  the  vagina  of  the  female  just  served  and  transferring  it,  un- 
der proper  precautions,  to  the  vaginae  of  other  females,  to  cause 
one   copulation   to  answer  for  several  or  many  fertilizations. 

The  operation  of  artificial  insemination  is  simple.  It  may  be 
practiced  as  an  adjunct  to  copulation.  In  such  case,  the  male  is 
permitted  to  serve  the  female,  and  promptly  thereafter  the 
operator  inserts  his  hand  into  the  vagina,  picks  up  some  of  the 
semen  and  introduces  it  into  the  cervical  canal.  This  may  be 
done  with  the  aid  of  a  short  spoon,  in  which  the  semen  may  be 
picked  up  and  inserted  through  the  os.  A  syringe,  of  almost 
any  type,  may  be  used  to  pick  up  the  semen  and  then  inject  it 
into  the  uterus.  The  operator  may  simply  use  his  hand.  Even 
one  finger  immersed  in  the  seminal  fluid  and  pushed  into  the 
cervical  canal  would,  ordinarily,  carry  sufficient  spermatozoa  to 
accomplish  the  purpose.  This  plan  of  in.semination  is  applicable 
in  those  cases  where  some  physical  hindrance  to  natural  insemi- 
nation exists, of  a  character  surmountable  by  the  artificial  method. 

A  second  method  of  artificial  insemination  is  the  transfer  of 
the  semen  from  the  vagina  of  a  female,  with  which  the  male  has 
recently  copulated,  to    another   female.     If  the  two  females  are 


28o  Veteri7iary  Ohsfeirics 

in  close  proximity,  the  operation  is  readily  carried  out  by  means 
of  any  of  the  impregnation  syringes,  or  otherwise.  It  is  essen- 
tial merely  that  the  transfer  be  made  promptly  and  without  se- 
rious damage  to  the  seminal  fluid. 

By  this  method,  females  incapable  of  copulation  may  be  im- 
pregnated, such  as  those  suffering  from  ruptured  perineum  or 
other  obstructions  in  the  vagina  or  vulva.  It  may  also  be  re- 
sorted to  in  order  to  avoid  the  dangers  of  copulation  between 
animals  in  which  there  is  too  gross  a  variation  in  size,  either  the 
male  or  the  female  being  too  large  to  safely  copulate  with  the 
desired  mate. 

The  chief  essentials  in  artificial  insemination  are  cleanliness 
(a.sepsis),  reasonable  promptness,  the  protection  of  the  semen 
against  extremes  of  temperature  and  its  .secure  lodgment  in  the 
uterus  or  cervical  canal. 

The  hands,  vessels  and  apparatus  are  to  be  made  clean — a.sep- 
tically  clean— and  every  precaution  taken  against  the  transfer 
of  dangerous  infection.  The  possibilities  of  transferring  infec- 
tious disea.ses  by  this  means  should  not  be  underestimated. 

The  duration  of  the  vitality  of  the  spermatozoa  has  not  been 
fully  determined.  They  can  be  kept  alive  in  a  warm  saline  .so- 
lution for  days,  but  it  is  doubtful  if  their  fertilizing  power  can 
be  maintained,  with  practical  certainty,  for  a  long  period  of  time. 
The  transfer  should  consequently,  in  the  interests  of  efficiency, 
be  made  as  promptly  as  pos.sible.  While,  experimentally,  artifi- 
cial fertilization  may  be  induced  after  carrying  the  semen  a  long 
distance  and  keeping  it  many  hours,  the  intervening  time  sub- 
jects it  to  many  unfavorable  circumstances.  If  to  be  carried,  it 
may  be  placed  in  a  rubber  bag  or  wide  mouthed  bottle,  the  ves- 
sel being  immersed  in  water  at  a  temperature  of  about  lOo  °  F. 
and  maintained  at  about  this  temperature  until  the  .semen  has 
been  used. 


EMBRYOLOGY.     SEGMENTATION  OF  THE  EGG 

We  have  already  suggested  in  a  preceding  chapter  that  fertili- 
zation of  the  egg,  under  normal  conditions,  occurs  in  the 
oviduct,  immediately  after  the  rupture  of  the  ovisac  and  the 
discharge  of  the  egg  into  the  tube.  The  observations  upon  this 
point  have  been  carried  out  largely  upon  the  rabbit  as  a  repre- 
sentative of  mammalia  and  it  is  assumed  that  the  phenomena  oc- 
curring in  this  animal  are  largely  typical  of  the  entire  mammalian 
group.  In  the  observations  upon  fertilization  in  the  rabbit,  cop- 
ulation has  generally  ensued  immediately  after  the  doe  has  given 
birth  to  young  and  from  8-12  hours  prior  to  the  rupture  of  the 
Graafian  follicles.  Under  these  conditions,  when  the  ovisacs  rup- 
ture, the  spermatozoa  have  already  passed  through  the  uterus  and 
the  oviduct  and  have  reached  the  ampulla  of  the  tube,  so  they  may 
at  once  meet  the  egg  when  it  is  discharged  and  fertilization  im- 
mediately follow.  The  spermatozoa  may  even  have  reached  the 
ovum  while  yet  in  the  ruptured  ovisac,  before  its  discharge  into 
the  Fallopian  tube  as  shown  in  Fig.  20. 


Fig.   20.  A  fully  formed  ovum  of  the  Rabbit  shortly  before  its    discharge 
from   the   ovary.       Marshall   after  BischofF. 

Fig.    21.    Ovum    of   Rabbit   from   the  upper  end  of  the  oviduct  after  ex- 
trusion of  the  two   polar   bodies.     Marshall  after  BischoflF. 

MO,  Spermatozoon.   N,  nucleus  or  germinal  vesicle.     NU,   Nucleolus  or 
germinal   spot.     PB,    Polar  bodies.     Z,  zona  radiata. 

This  rule  is  probably  true  in  our  larger  domestic  animals,  but 
it  is  possible  that  copulation  may  sometimes  be  delayed  until 
after  the  rupture  of  the  ovisac  and  the  discharge  of  the  ovum 
into  the  tube  so  that,  before   it   meets  with   the  spermatozoa,  it 


28a  Vefen'fiarv  Obstetrics 

may  have  travelled  some  distance  along  the  oviduct  toward  the 
uterus. 

In  the  typical  fertilization  of  the  ovum  in  the  rabbit,  where 
the  spermatozoa  have  already  reached  the  anterior  end  of  the 
oviduct  when  the  Graafian  follicle  ruptures,  the  ovum  undergoes 
segmentation  or  division  during  its  passage  toward  the  uterus. 
According  to  Van  Beneden,  the  segmentation  of  the  ovum  begins 
lo  or  12  hours  after  fertilization  or  18-24  hours  after  copulation 
and  continues  for  the  next  two  days  or  until  about  the  end  of 
the  third  day,  at  which  time  the  ovum  reaches  the  uterus  and 
its  segmentation  has  been  completed.  At  this  time  it  is  about 
the  same  size  as  the  original  ovum  or  possibly  somewhat  smaller, 
but  has  acquired,  during  its  passage  through  the  oviduct,  a  laj-er 
of  albumen  on  its  exterior,  which  increases  the  total  size  very 
considerably. 


Fig.  22.  A  rabit's  ovum  from  the  middle  of  the  length  of  the  oviduct, 
about  22  hours  after  copulation,  showing  division  of  the  ovum  into  two 
cells.     X   200.     Marshall  after  Bischoff. 

CB,  Blastomere,  or  segmentation  cell,  MO,  Spermatozoon  imbedded  in  the 
zona  radiata.    N,  Nucleus.    Z,  Zona  radiata. 

The  length  of  the  time  required  for  the  passage  of  the  ovum 
from  the  ovary  to  the  uterus  has  not  been  determined  for  most 
animals,  but,  reasoning  from  other  data  in  embryology,  it 
would  appear  possible  that,  in  the  larger  animals,  it  may  require 
a  longer  period  of  time  for  travelling  through  the  tube  than  in 
small  ones  like  the  rabbit.  If  we  are  to  judge  of  the  time  re- 
quired for  the  passage  of  the  ovum  through  the  oviduct  by  the 
appearance  of  estrum  and  menstruation,  we  would  be  led  to  assume 
that,  in.  the  cow,  it  is  quite  as  rapid   as  in   the   rabbit.     Some 


Segmentation  of  the  Egg 


283 


authors  estimate  that  in  woman  the  period  is  probably  five  to 
eight  days,  but  we  are  aware  of  no  definite  data  upon  which  to 
base  this  assumption. 

About  10-12  hours  after  the  fertilization  of  the  egg  of  the 
rabbit,  the  ovum  undergoes  cleavage,  by  which  there  arise  two 
spherical  cells,  which  are  essentially  alike  in  all  respects  except 
that  some  observers  beHeve  that  the  one  is  slightly  smaller  than 
the  other.     See  Fig.  22. 

Each  of  these  two  cells,  after  a  brief  pause  of  a  few  hours, 
divides  again  into  two  cells,  constituting  a  mass  of  4  ovoid  cells, 
which  again  subdivide  to  constitute  a  group  of  8  cells,  those  de- 
rived from  the  larger  of  the  two  first  cells  being  now  more  clearly 
larger  than  the  others,  the  larger  ones  grouped  together  cen- 
trally, while  the  smaller  rest  upon  them  as  a  cap.  Later  the 
segmentation  of  the  small  cells  proceeds  somewhat  more  rapidly 
than  that  of  the  larger  and  they  tend  to  grow  around  and  enclose 
the  latter.     According  to  Marshall,  when  the  ovum  of  the  rabbit 


Fig.  23.  A  rabit's  ovum  from  the  lower  end  of  the  oviduct,  about  the 
middle  of  the  third  day ;  showing  the  morula  stage,  shortly  before  the 
completion  of  segmentation.  X200.     Marshall  after  Bishoflf. 

Fig.  24.  A  rabbit's  ovum  seventy  hours  after  copulation,  taken  from  the 
lower  end  of  the  oviduct  just  before  entering  the  uterus  and  showing  the 
condition  at  the  close  of  segmentation.  X  200.  Marshall  after  Van- 
Beneden. 

has  reached  the  70th  hour  after  fertilization,  its  segmentation 
has  been  completed  and  it  passes  from  the  oviduct  into  the  uterus. 
At  this  time  it  is  a  spherical  mass  consisting  of  an  exterior  layer 
of  small,  nearly  spherical,  transparent  cells,  enclosing  almost 
completely  the  group  of  larger,  more  granular  cells  ;  it  has 
reached  what  is  known  as  the  morula  or  mulberry  stage.  See 
Figs.  23  and  24. 


284  Veterinary  Obstetrics 

At  this  stage  the  external  layer,  consisting  of  the  smaller  cells, 
and  the  internal  mass  of  larger  ones  are  firmly  attached  to  each 
other  at  one  point  only.  The  segmented  ovum  is  still  surrounded 
by  the  vitelline  membrane,  the  zona  radiata  and  the  layer  of  al- 
bumen which  ^t  had  acquired  during  its  progress  through  the 
oviduct. 

Within  a  few  hours  after  entering  the  uterus  the  ovum  has  be- 
come greatl}^  enlarged,  owing  to  the  accumulation  of  a  fluid  be- 
tween the  external  layer  of  small  cells  and  the  mass  of  larger  in- 
ner cells,  except  at  the  point  of  attachment  between  the  two,  so 
that  the  inner  mass  occupies  a  comparatively  small  area  at  the 
superior  pole  of  the  ovuni.  This  stage  in  the  development  of 
the  ovum  is  known  as  the  blastodermic  vesicle.  The  vesicle  con- 
sists of  an  outer  wall  of  flattened,  polygonal  cells,  which  have 
been  formed  from  the  outer  cells  of  the  previous  stages,  to  which 
is  attached,  at  one  of  its  poles,  the  small  mass  of  large  cells. 
Separating  the  two  layers  of  cells,  except  at  the  polar  point  of  at- 
tachment, is  a  relatively  large  quantity  of  fluid,  which  greatly  dis- 
tends and  increases  the  size  of  the  vesicle.  The  mass  of  inner 
cells  is  flattened  out  in  the  form  of  a  disk,  consisting  of  several 
la3'ers  of  somewhat  spherical  cells  at  the  center,  which  is  known 
as  the  embryonal  or  germinal  area,  while,  at  the  pheriphery, 
they  are  but  one  or  two  layers  in  thickness.  As  the  vesicle  in- 
creases rapidly  in  size  the  vitelline  membrane  disappears,  while 
the  zona  radiata  and  the  albuminous  layer  become  greatly  at- 
tenuated by  being  stretched  out. 

During  this  stage  of  development,  which  continues  in  the  rab- 
bit to  about  the  seventh  day,  the  ovum  lies  free  within  the  uter- 
ine cavity  and,  in  case  of  multiparous  animals,  the  ova,  which 
enter  the  uterus  almost  simultaneously,  tend  to  distribute  them- 
selves at  more  or  less  uniform  distances  apart  throughout  the  or- 
gan and  assume  the  positions  which  they  are  to  retain  through- 
out their  period  of  intra-uterine  development,  the  location  of 
each  being  early  indicated  by  a  bulging  of  the  uterine  walls. 

Germinal  Layers. 

Toward  the  close  of  the  developement  of  the  blastoderm,  im- 
portant changes  take  place,  by  which  there  are  established  three 
distinct  germinal  layers,  each  of  which  is  destined  to  take  a  spe- 


The  Primative  Streak.      The  Primative  Groove  285 

cial  part  in  the  formation  of  certain  tissues  of  the  embryo.  These 
changes  affect  chiefly  the  embryonal  area  or  that  point  in  the 
blastoderm  at  which  the  various  layers  are  united,  and  the  inter- 
nal cells  are  massed. 

The  exact  method  of  the  formation  of  the  germinal  layers  is 
not  wholly  free  from  controversy.  In  the  embryonal  area,  which 
is  a  circular  or  discoid  patch,  three  la^^ers  of  cells  may  be  recog- 
nized :  an  upper  or  external  la^^er  of  pavement  cells,  the  epiblast  ; 
a  middle  layer  of  larger,  cuboidal  cells,  the  mesoblast  ;  and  a 
lower  stratum  of  pavement  cells,  the  hypoblast. 

At  the  margin  of  the  embryonal  area,  the  walls  of  the  blas- 
todermic vesicle  consist  of  two  layers  of  cells  representing  the 
external  and  internal  germinal  layers,  while,  passing  slightly  be- 
yond this,  the  remainder  of  the  blastodermic  vesicle,  constituting 
about  3/4  of  its  total  surface,  consists  of  a  single  layer  of  cells,  the 
epiblast. 

According  to  Rauber  and  Kolliker,  the  uppermost  layer  of  the 
blastodermic  vesicle,  the  primitive  epiblast,  disappears  from  the 
embryonal  area,  to  be  succeeded  by  a  new  epiblast  arising  from 
the  mesoblatt  so  that,  according  to  these,  the  entire  embryonal 
area  is  ultimately  derived  from  the  inner  hypoblast,  which,  in 
the  morula,  consisted  of  the  larger,  granular,  slowly  multiplying 
mass  of  cells. 

Late  in  the  blastodermic  stage,  the  embryonal  area  becomes 
pyriform,  its  greater  diameter  corresponding  to  the  long  axis  of 
the  blastodermic  vesicle,  which  has  now  assumed  the  eliptical 
form.  The  broader  end  of  the  embryonal  area  may  be  desig- 
nated the  anterior,  or  head,  end  and  the  narrower  the  posterior, 
or  tail,  end. 

The  Primitive  Streak.      The  Primitive  Groove 

As  the  blastodermic  vesicle  approaches  the  completion  of  its 
development,  there  appears  the  primitive  streak,  consisting  of  an 
axial  thickening  of  the  epiblast,  at  the  posterior,  or  tail,  end  of 
the  embryonal  area.  This  thickening  extends  longitudinally 
and  finally  equals  about  two-thirds  of  the  length  of  the  area  and 
has  a  faint  longitudinal  depression  known  as  \.\\^  primitive  groove. 
A  cross-section  of  the  primitive  streak  shows  it  to  consist  of  a 
multiplication  of  the  deeper  cells  of  the  epiblast  on  the  median 


286 


Veterinary  Obstetrics 


line.  From  the  deeper  layers  of  this  thickened,  dense,  primitive 
streak,  the  cells  grow  out  in  lateral  plates  between  the  epiblast 
and  hypoblast,  to  constitute  the  permanent  mesoblast.  See 
Fig.   25. 


\ 


Fig.  25.  A  transverse  section  across  the  hinder  part  of  the  em- 
bryonal area  of  a  rabbit  embryo  at  the  end  of  the  seventh  day, 
the  section  passing  through  the  primitive  streak.  X  80  Mar- 
shall after  Kolliker. 

E,  Epiblast.  H,  Hypoblast.  M,  Mesoblast. 

PG,   Primitive  groove.  PS,   Primitive  streak. 

Formation  of  the  Embryo 

The  embryo  is  formed  in  the  embryonal,  or  germinal,  area.  A 
longitudinal  depression  known  as  the  neural  groove  is  formed 
immediately  in  front  of  the  primitive  .streak,  the  long  axes  of  the^ 
two  structures  being  parallel.  The  neural  groove  is  bordered  on 
the  sides  by  the  neural  folds,  which  grow  upward  from  the  epi- 
blast and  then  approach  each  other  to  become  united  into  a  tube, 
in  which,  eventually,  the  central  nervous  system  is  formed  and 
soon  shows,  in  its  anterior  or  head-end,  the  brain  vesicles. 

By  an  infolding  of  the  walls  of  the  blastodermic  vesicle  about 
the  margins  of  the  embryonic  area,  the  latter  becomes  con- 
stricted off  from  the  rest  of  the  vesicle,  which  then  constitutes 
the  vitelline,  or  yolk  .sack.  The  yolk  sack  of  the  mammalian 
embryo  is  small  and  of  little  consequence,  as  it  contains  no  ap- 
preciable amount  of  nutriment  for  the  embryo,  but  simply  a 
quantity  of  a  presumably  inert  fluid.  After  this  constriction 
forms,  dividing  the  embryo  from  the  yolk  sac,  the  dorsal  surface 
of  the  embryo  grows  much  more  rapidly  than  the  ventral,  which 
causes  it  to  bend  ventralwards  very  rapidly,  so  that  the  head-end 
is  soon  at  right  angles  to  the  remainder  of  the  embr^^o.  The 
head-end  of  the  embryo,  by  becoming  flexed,  is  bent  downward 


The  Ccrlom  or  Body  Cavity  287 

into  the  yolk  sac  and  pushes  the  walls  of  the  latter  before  it. 
The  different  parts  of  the  brain  soon  become  recognizable  and 
the  nose,  ej^es  and  ears  are  also  quite  apparent,  while,  upon  the 
sides  of  the  head  and  neck,  the  visceral  arches  and  clefts  are 
seen. 

The   Ccelom  or  Body  Cavity 

On  the  eighth  or  ninth  day  after  fertilization  in  small  animals, 
perhaps  somewhat  later  in  the  larger  ones,  the  ccelom,  or  body 
cavity,  is  formed  as  a  cleft  or  rearrangement  of  the  cells  of  the 
mesoblast,  by  which  an  extensive  cavity  is  formed,  radiating 
outwards  from  the  region  of  the  notocord,  to  pass  beyond  the 
embryo  itself  and  extend  outward  in  the  walls  of  the  blastoderm 
to  near  the  margin  of  the  mesoblastic  area.  This  change  serves 
to  divide  the  mesoblast  into  two  layers,  the  external  of  which  is 
closely  adherent  to  the  epiblast,  the  two  constituting  the  somata- 
pleur,  while  the  inner  mesoblastic  layer  and  the  endoblast,  with 
which  it  is  intimately  related,  constitute  the  splanchnopleur. 

From  the  epiblast  arise  finally  the  epidermis,  the  hair,  nails, 
hoof,  horns,  etc.,  and  the  cerebro-spinal  nervous  system.  From 
the  mesoblast  arise  the  muscles,  bones,  connective  and  other 
skeletal  tissues  and  the  deeper  layers  of  the  skin. 

The  mesoblast  of  the  splanchnopleur  gives  origin  to  the  heart 
and  the  muscular  portions  of  the  digestive,  respiratory  and  urino- 
genital  organs  and,  in  a  general  way,  to  the  pale,  or  unstriped, 
muscle  fibers,  while  the  somatopleuric  mesoblast  forms  the 
striped,  or  voluntary,  muscles.  The  endoblast  of  the  splanchno- 
pleur forms  the  epithelium  of  the  digestive  and  respiratory  tracts. 
The  origin  of  the  various  tissues  from  the  three  embryonic  layers 
is  of  great  interest  in  the  study  of  medicine  and  surgery  and 
numerous  functions  can  only  be  understood  by  recalling  the  em- 
bryonic origin  of  certain  tissues  in  the  adult.  A  wound  of  the 
epithelium  can  be  repaired  by  epithelial  tissues  only.  Cells 
originating  from  the  mesoblast  have  not  the  power  to  repair  the 
epiblastic  injury. 

Ere  the  blastoderm  can  proceed  far  in  its  development,  new 
provi.sion  must  be  made  for  its  nutrition,  which,  in  mammalia, 
must  be  derived  from  the  mother  through  an  intimate  relation 
between  her  uterine  mucosa  and  special  organs  of  the  fetus, 
the  fetal  envelops,  especially  the  placenta. 


288  Veterhiary  Obstetrics 

At  a  very  early  period,  this  nutritive  relationship  between  the 
mother  and  the  fertilized  ovum  is  established  by  two  outgrowths  : 
one  of  the  extra-embryonal  somatopleur,  to  constitute  the  am- 
nion ;  the  other  from  thesplanchnopleur,  to  constitute  the  allau- 
tois,  both  of  which  we  shall  describe  later. 

The  Nervous  Svstem 

We  have  already  intimated  that  the  neural  groove  of  the  blas- 
toderm marks  the  beginning,  location  and  direction  of  the  future 
cerebro-spinal  nervous  system.  Consisting  of  thickened  epiblast, 
the  neural  folds  increase  in  prominence,  while  the  groove  between 
them  deepens  and  the  summits  of  the  folds  approach  each  other 
as  segments  of  an  arch,  to  finally  meet  and  fuse  above  the  groove, 
converting  it  into  a  closed  tube  which,  lined  with  ciliated  epi- 
blastic  cells  and  filled  with  fluid,  is  to  persist  throughout  the  life 
of  the  animal  as  the  central  canal  in  the  spinal  cord  and  as  the 
ventricles  of  the  brain,  while,  from  the  deeper  epiblastic  cells  in 
the  walls  of  the  tube,  are  to  develop  the  nerve  cells  and  fibers  of 
the  cerebro-spinal  axis.  Under  normal  conditions,  the  neural 
groove  grows  rapidly  in  length  and  depth  and,  in  the  rabbit,  its 
lips  have  met  and  fused  to  constitute  a  complete  tube  by  the  end 
of  the  ninth  day.  At  this  time  one  can  distinguish  the  spinal 
cord,  the  fore-brain,  the  mid-brain  and  the  hind-brain. 

The  cerebro-spinal  nervous  system  of  mammalian  animals  con- 
stitutes the  central  organ,  about  which  the  other  portions  of  the 
embryo  develop  in  more  or  less  complete  harmony.  Any  inter- 
ruption in  the  normal  development  of  the  cerebro-spinal  axis  in- 
terrupts or  vitiates  the  proper  growth  of  other  parts  of  the  body. 
Should  the  neural  groove  become  branched  and  double  at  its 
anterior  end,  there  forms  in  the  embryo  two  heads  instead  of  one, 
constituting  a  double-headed  monster  or  bicephalus  ;  (See  Fig.  35) 
or  the  fission  may  extend  more  posteriorly  to  constitute  double 
neck  or  chest.  Should  the  posterior  end  of  the  neural  groove 
undergo  division  into  two  parts,  we  have  a  monster  in  which 
the  po.sterior  parts  of  the  body  are  double,  while  the  anterior 
may  remain  single  and  normal.  Should  two  neural  grooves  form 
side  by  side  and  in  intimate  contact  with  each  other,  there 
may  result  a  double  monster,  of  two  more  or  less  separate 
bodies  as  in  Figs.  126  and  127.  Finally,  the  division 
between    the    two  neural  grooves   may    be   complete    and  two 


The  Nervous  System 


289 


embryos  form  which  are  wholly  separate,  but  have  common  en- 
velops and  umbilic  cords.  In  the  cow  not  rarely  we  find  one  of 
the  two  embryos  so  aberrant  in  form  as  to  constitute  a  well  nigh 
shapeless  mass  like  Figs.  26  and  27,  known  as  artiorphus, 
acardia,  or  a  "mole." 


Fig.  26.     ":\IoLK,"  OR  .A.CARDIA.      From  Cow. 
M,  Muzzle.     SM,  SM,  Superior  maxilla,  showing  white  denticles. 
IM,  IM,  Inferior  maxilla  showing  denticular  masses  (grinders). 
BM,  Buccal  mucosa  showing  papilla. 
T,  Tongue.     I,  Incisors. 
One-half  size. 

The  fusion  of  the  lips  of  the  neural  canal  may  become  inter- 
rupted at  various  points  and  the  canal  may  remain  open  even  to 
the  time  of  birth,  to  constitute  spinal  bifida.  An  instance  of 
this  occurring  in  the  dorsal  region  (dorsal  .spinal  bifida)  is  shown 
in  Fig.  28,  in  which  the  superior  wall  of  the  spinal  canal  is  want- 
ing from  the  dorsal  region,  backward.  A  similar  persistence  of 
the  neural  groove  may  occur  at  any  point  in  its  entire  length, 
producing  cervical,  dorsal,  lumbar  or  .sacral  .spinal  bifida,  accord- 
ing to  location. 
19 


290 


Veterinary  Obstetrics 

L 


^-'B 


Fig.   27.     vSai.iiiai,  v->i'.i.  i  ii):n   ui-    Fiu.    jo. 

I,  Incisors.     T,  Tongue.     INI,  Muzzle. 

B,  Bone    (skull?).      B',   Bone  (sternum?).      R-',  Bone  (pelvis: 

L,  Lung.     R.  Rumen  and  reticulum. 

U,  Umbilicus.     O,  Omasum. 

One-half  size. 


\SC    cv 


^J^s 


IPS 


Fig.  2.S.     Si'iNA  Bifida  with  Si'INal  Flkxure. 
CV,  CV,  Cervical  vertebrte.     R,  ribs. 
SC,  Spinal  cord   ending  in  anterior  dorsal  region. 
DLV,   Dorso-lumbar  vertebra.   S,  Sacrum. 
IPS,   Ischio-pubic  symphysis. 


The  Brain 


291 


The  Brain. 

The  brain  commences  to  form  and  is  recognizable  before  the 
neural  canal  has  been  completed.  It  consists  at  first  chiefly  of  a 
series  of  vesicles  which  are  known  as  the  fore-brain,  mid-brain, 
and  hind-brain.  The  anterior  cerebral  vesicle,  or  fore-brain,  gives 
rise  very  early  in  its  development  to  the  optic  vesicles,  as  lateral 
outgrowths,  which  are  ultimately  converted  into  the  essential 
parts  of  the  eye. 

Normalh',  there  are  two  of  these  outgrowths,  which,  under 
aberration  in  development,  may  fuse  or  grow  out  as  single  pro- 
jections on  the  median  line,  to  constitute  the  one-eyed  monster, 


MP 


4-  SM 


IM 


Fig.  29.     Skull  of  Cyclops.     I'oal. 


Oc,  Occiput.     O,  Single  orbital  cavity. 

MP,  Coronoid  process  of  inferior  maxilla. 

SM,  Superior  grinders. 

SI,  Superior  incisors  fused  into  a  single  organ. 

IM,  Inferior  grinders.     T,  Tongue. 

11,   Inferior  incisors. 


292 


Veten'jiarv  Obstetrics 


or  Cyclops.  In  case  of  this  fusion  of  the  optic  resides,  the  de- 
velopment of  a  single  vesicle  on  the  median  line,  there  is  a  ten- 
dency towards  the  inhibition  of  the  development  of  the  olfactory 
vesicles. 


^.:^.- 


•'?^^fl^ 


H..,,..., 


Fig.  30.     Cyclops.    Lamb. 
A,  Head  and  neck,  seen  from  below.      B,   vSagittal  section. 
M,   Mouth.     Ea,  Ear. 

N,  Nostril.     P,  Dilated  pharynx.     ON,  Olfactory  nerve. 
OpN,  Optic  nerve.     Ep,  Epiglottis.     O,  Oesophagus. 


The  Brain 


293 


The  cerebral  hemispheres  are  developed  first  as  a  median  pro- 
longation at  the  anterior  end  of  the  fore-brain,  which  later  be- 
comes divided  into  the  two  hemispheres  by  its  anterior  wall 
growing  back  into  it  from  the  front.  These  two  hemispheres 
appear  first  as  large  vesicles  with  verj-  thin  walls  and  these  cavi- 
ties persist  throughout  life  as  the  lateral  ventricles  of  the  brain, 
which  communicate,  through  the  foramina  of  Munro,  with  the 
third  ventricle.     See  Figs.  41  and  60. 


Fig.  31.     Hydroceph.\lu.s.     Calf,     i  After  photograph). 

In  some  ca.ses  the  fluid  in  these  cerebral  hemispheres  becomes 
enormously  increa.sed.  to  constitute  the  fetal  disease  of  hj^dro- 
cephalus  as  indicated  in  Fig.  31.     In  other  instances  the  cerebral 


294 


Vcterinarv  Obstetrics 


hemispheres  grow  rapidly  and  the  walls  of  the  skull  fail  to  close 
over  them,  so  that  they  protrude,  to  constitute  hcniia  cerebri,  as 
shown  in  Fig.  32. 

From  these  cerebral  hemispheres,  there  grow  out  early  in  their 
development  the  olfactory  vesicles,  which  are  later  to  develop 
into  the  olfactory  lobes,  from  which  the  olfactory  nerves  pass  to 
the  nose.  These  .sometimes  fail  to  appear  if  the  optic  vesicles  are 
represented  by  a  single  vesicle,  to  constitute  a  cyclopean  monstros- 
ity as  shown  in  Figs.  29  and  30. 


Fig.  32.     Herni.-v  Cicrebri.     Pig. 

Lateral  view  of  brain,  seen  from  the  left. 

A,  Segment  of  .skin  covering  theherniate<1  portion  of  the  brain,  B. 

CC,   Cerebrum.     D,  Cerebellum.     E,  Medulla  oblongata. 


Thp:  Spinal  Cord. 

As  already  suggested,  the  spinal  cord  develops  from  the  pos- 
terior portion  of  the  neural  groove.  The  neural  folds  grow  up- 
ward and  their  borders  approach  each  other,  to  finally  fuse  at 
their  margins,  leaving  a  cavity  within,  which  constitutes  the 
central  cavity  of  the  spinal  cord,  and  persists  throughout  the 
life  of  the  animal.  The  neural  canal  is  lined  by  columnar,  cili- 
ated epithelium  which  persists  throughout  life,  to  constitute  the 
epithelium  of  the  central  canal.     The    deeper    layers  of  epithe- 


The  Spinal  Cord  295 

Hum  about  the  spinal  canal  go  to  form  the  skeletal  frame-work  and 
the  nerve  cells  grow  out  into  these  deeper  parts  from  the  col- 
umnar epitheliutn  which  lines  the  cavitj.  These  nerve  cells, 
or  neuroblasts,  are  at  first  spheroidal  in  form  and  show  upon 
their  surface  one  to  several  prolongations,  which  are  later  to 
constitute  the  polar  elongations,  or  axis  cylinders,  of  the  nerves. 
The  spinal  nerves  develop  first  by  the  formation  of  the  spinal 
ganglia,  which  appear  in  the  neural  folds  at  a  very  early  period, 
and  from  the  inner  sides  of  which  there  grow  out  nerve  fibers 
into  the  spinal  cord,  to  constitute  the  superior,  or  dorsal,  roots  of 
the  spinal  nerves.  They  become  the  centripetal,  or  sensory, 
roots  of  the  nerves.  The  ventral,  or  motor,  nerves  arise  very 
early  as  small  outgrowths  from  the  lower  part  of  the  sides  of  the 
spinal  cord,  in  the  position  they  occupy  during  adult  life.  These 
ventral  roots  grow  outward  to  meet  the  dorsal  roots  just  beyond 
the  ganglia  and  fuse  with  them,  after  which  they  again  divide 
into  dorsal  and  ventral  twigs,  which  are  mixed  nerves. 


DEVELOPMENT  OF  THE  ORGANS  OF  SPECIAL  SENSE 

A  The  Olfactory  Organs- 

The  Xosiv. 

The  olfactory  organs  appear  early  in  enil)ryonic  life  as  thick- 
ened patches  of  epiblast  upon  the  antero-inferior  part  of  the 
head,  which  patches  soon  sink  inwards  to  constitute  the  olfactory 
pits,  into  the  bottom  of  which  the  nerves  of  smell  grow  out  from 
the  olfactory  bulbs  of  the  brain. 


Fig.  33.  The  under  surface  of  the  head  of  a  human  embryo,  let- 
tered by  Professor  His,  Hn,  and  estimated  as  about  twenty-nine 
days  old.     X  7>^-     From  Marshall  after  His. 

BS,  Cerebral  hemisphere.  D.S,  Stomatodeum.  FO,  Processus 
globularis,  or  lateral  portion  of  fronto-nasal  process.  HM,  hyo- 
mandibular  cleft.  MN,  Mandibular  .irch.  MX,  Maxillary  arch. 
OC,  Eye.     OK,  Olfactory  pit. 

The  olfactory  pits  are  at  first  incomplete,  their  lower  borders 
being  deeply  notched,  and  communicate  with  the  stomatodeum, 
somewhat  as  an  extension  of  that  cavity.  The  olfactory  pits 
and  the  stomatodeum  are  connected  by  a  narrow  isthmus, 
bordered  inwardly  by  Wi^  processus  globiilares  of  the  fronto-nasal 
process  and  externally  by  the  maxillary  processes  of  the  maxillary 
arch.  Soon  the  maxillary  processes  approach  and  fuse  with  the 
processus  globulares  anteriorly,  to  complete  the  circumference 
of  the  olfactory  pits  and,  by  .separating  them  from  the  mouth,  to 
constitute  the  nostrils.  For  a  short  distance  anteriorly,  as 
far  as  to  the  incisive  foramen  of  the  adult,  the  processus  globulares 
send  projections  inwards  to  constitute  the  anterior  portion  of 
the  palate,  while,  behind  the  foramen,  the  maxillary  processes 
send  out  .shelf-like  projections,  which  meet  on  the  median  line  to 
296 


The  Olfactory  Organs 


297 


constitute  the  posterior  portion  of  the  palate  and,  from  their  fus- 
ing borders,  send  projections  upward  to  eventually  reach  and  fuse 
with  the  lower  surface  of  the  fronto-nasal  process,  to  constitute 
the  nasal  septum,  dividing  the  nasal  chamber  into  two  distinct 
cavities.     The   nasal   passages  are  at  first  very  short  but,   as  the 


FlO.   34.      SCHISTOCEPHALUS    BiFIDUS.       (Gurlt). 

nose  elongates,  the  palatine  processes  from  the  maxillary  arch 
grow  backward  and,  fusing  on  the  median  line,  completely  separ- 
ate the  oral  and  nasal  cavities  so  that  the  latter  finally  open 
posteriorly,  through  the  posterior  nares,  into  the  pharynx. 

The  upper  lip  is  formed  by  a  fusion  of  the  fronto-nasal  pro- 
cesses with  the  maxillary  arch.  Aberrations  in  the  development 
of  the  anterior  nares  and  upper  lip  are  not  rare,  especially  in  bo- 
vidse,  where,  in  some  instances,  the  processus  globulares  fail  to 
fuse  with  the  maxillary  processes,  constituting  hair  lip  (Schisto- 
cephalus  fissilabrus).  In  other  instances  as  in  Fig,  34,  fis- 
sion on  the  median  line  through  the  fronto-nasal  process  occurs, 
so  that  the  maxilla  is  divided,  with  the  mandible  curved   up- 


298  Veterifiary  Obstetrics 

ward  between  the  two  lateral  halves,  to  constitute  schistoceph- 
alus  bifid  us. 

In  dealing  with  diseases  of  the  septum  nasi,  its  origin  should 
always  be  recalled  and  it  should  be  remembered  that,  in  some 
forms  of  disease,  fluids  may  collect  or  new  tissues  may  develop  be- 
tween the  two  laminre,   from  which   the  septum  takes  its  origin. 


Fig.  35.     CivKFT  Pakath:.     Foal.     ( From  photograph). 

In  some  ca.ses  these  margins  fail  to  fu.se  and  result  in  a  cleft 
palate,  as  shown  in  Fig.  35.  In  other  instances  the  fusion  ex- 
tends too  far  backward  a. id,  passing  across  the  pharynx,  com- 
pletely separates  the  nasal  chamber  from  the  mouth  and  pharynx, 
constituting  atresia  of  the  po.sterior  nares,  by  which  arrest  in 
development  the  animal  is  unable  to  breathe  through  the  nostrils 
and  must  respire  entirely  through  the  mouth.  With  the  greatly 
elongated  soft  palate  of  the  hor.se,  which  renders  oral  breathing 
extremely  difficult,  the  animal  can  not  live  if  both  posterior  nares  are 
closed,  while,  if  the  atresia  affects  but  one  nostril,  the  animal 
can  breathe  readily  when  not  .severely  exerted,  but,  if  put  to 
hard  work,  shows  extreme  dyspnoea  as  a  result  of  the  restricted 
breathing  room. 

The  Eyk. 

The  eyes  originate  partly  from  the  optic  vesicles  of  the  brain 
and  partly  from  the  optic  pits  in  the  epiblast  upon  the  sides  of 
the  head. 

The  optic  nerve  develops  from  the  optic  vesicles,  which  ap- 
pear as  lateral   outgrowths  of  the   fore-brain  early  during  em- 


The   Eye  299 

bryonic  life,  varying  apparently  in  species  from  10-20  days  after 
fertilization.  The  optic  vesicles  appear  first  as  tubular  out- 
growths from  theforebrain,  but  the  distal  end  of  each  soon  becomes 
enlarged,  while  the  connecting  stalk  remains  a  narrow  tube.  Later, 
the  enlarged  distal  end  becomes  invaginated  within  itself  to  con- 
stitute the  optic  cup,  which  is  later  to  form  the  retina  and  within 
which  the  vitreous  body  develops.  The  lens  develops  somewhat 
later,  first  appearing  as  a  pit  in  the  epiblast  upon  the  side  of  the 
head.  This  pit  gradually  sinks  deeper  and  its  mouth  narrows, 
until  it  finally  closes  to  constitute  the  vesicle  of  the  lens. 

The  vesicle  sinks  into  the  optic  cup  and  the  margins  of  the  latter 
come  in  close  contact  with  it  except  at  one  point  on  the  ventral 
surface,  where  there  is  a  distinct  groove,  the  choroidal  fissure. 
Within  the  vesicle  the  lens  becomes  elaborated  from  the  enclosed 
epiblastic  cells. 

The  vitreous  body  is  derived  from  an  ingrowth  of  me.soblast, 
which  enters  the  optic  cup  through  the  choroidal  fissure. 

As  the  lens  becomes  invaginated  and  separated  from  the 
external  epiblast,  a  layer  of  mesoblast  extends  across  between 
the  vesicle  and  the  external  epiblast,  constituting  the  cornea,  the 
tissues  of  which  become  transparent,  The  choroid  and  sclerotic 
coats  develop  from  the  mesoblastic  tissues'  surrounding  the  optic 
cup  ;  the  iris  is  formed  by  a  forward  growth  of  the  margins  of  the 
optic  cup;  and  the  anterior  chamber  appears  somewhat  later  as  an 
excavation  between  the  cornea  and  lens.  The  eyelids  are  the  last 
structures  to  form  in  connection  with  the  ej'e  and  consist  of 
folds  of  the  skin  from  abov^e  and  below.  These  extend  over  the 
eyeball  to  finally  meet  and  become  fused  together,  without  adher- 
ing to  the  surface  of  the  cornea,  so  that  they  create  a  closed  sac, 
the  lacrymal  sac,  between  their  internal  surfaces  and  the  cornea. 
In  the  rabbit  and  carnivora,  the  eyelids  remain  closed  for  a  short 
time  after  birth,  while,  in  ruminants  and  solipeds,  the  eyelids 
open  .somewhat  prior  to  birth. 

The  membrana  nictatans,  or  third  eyelid,  is  formed  from  a  fold 
of  skin  in  a  similar  manner  to  the  two  ordinary  eyelids  and  ex- 
ists in  all  domestic  mannuals. 

The  lacrymal  duct  is  formed  in  the  groove  existing  between 
the  external  nasal  process  and  the  maxillary  arch. 

In  the  domestic  animals,  we  occasionall}'  meet  with  aberrations 
in  the  development  of  the  eye.     Sometimes  the  eyelids  have  be- 


300  Veterhiary  Obstetrics 

come  so  intimately  fused  that  they  fail  to  open  at  the  proper 
time,  a  condition  which  is  not  usually  subject  to  remedy.  In 
other  cases,  the  cornea  fails  to  undergo  the  normal  transforma- 
tion into  a  transparent  body,  but  remains  opaque.  In  yet  other 
instances,  there  is  seen  growing  from  the  neighborhood  of  the 
lacrymal  duct  long  hairs,  which  irritate  the  eye  but  which  are, 
at  times,  subject  to  surgical  removal.  In  still  other  instances, 
there  is  a  contraction  of  the  inner,  or  mucous,  layer  of  the  eye- 
lid or  a  comparative  overgrowth  of  the  external  skin,  by  which 
means  the  eyelids  are  inverted,  producing  entropium. 

Thk  E.\r. 

The  first  traces  of  the  ears  consist  of  open  pits  opposite  to  the 
hind-brain  at  an  early  period  in  the  life  of  the  mammalian  em- 
bryo, usually  at  about  ten  to  fifteen  days.  These  pits  .sink  in 
deeply  until  they  come  in  close  contact  with  the  hind-brain  and 
early  acquire  a  communication  with  the  auditory  nerves.  The 
mouths  of  the  pits  soon  close  and  the  invaginated  portion  be- 
comes separated  from  the  external  epiblast,  to  constitute  the 
auditory  vesicles,  in  which  the  essential  parts  of  the  ear,  the 
semicircular  canals,  vestibule,  cochlea,  etc.,  are  developed. 

The  Eustachian  tube  is  formed  from  the  hyomandibular  pouch, 
which  extends  out  from  the  pharynx  as  a  diverticulum.  At  one 
time  it  pushes  out  against  the  epiblast  and  is  .separated  from  the 
exterior  by  a  very  thin  membrane  consisting  of  epiblast  exter- 
nally, in  immediate  contact  with  the  inner  layer  of  hypoblast, 
with  no  mesoblast  between.  Later,  a  layer  of  mesoblast  grows 
in  between  the  epiblast  and  hypoblast  and  the",  three  constitute 
the  tympanic  membrane.  This  pouch  does  not  normally  reach 
the  surface  at  any  time  during  fetal  life,  but  occasionally  opens 
abnormally  in  various  mammalian  animals,  to  constitute  gill-slit 
fistula,  which  rarely  persists  at  the  time  of  birth  in  a  manner  an- 
alogous to  the  open  gills  of  fishes  and  other  similar  animals.  In 
the  solid  ungulates,  there  is  a  large  infundibulum  formed  in  con- 
nection with  the  Eu.stachian  tube,  which  is  known  as  the  guttural 
pouch,  or  air  sac.  The  slit-like  communication  of  this  guttural 
pouch  with  the  pharynx  is  sometimes  abnormal  in  the  new-born 
foal,  which  causes  air  to  become  impacted  in  it  (tympany  of  the 
guttural  pouch),  which  may  so  press  upon  the  larynx  as  to 
strangle  the  young  animal. 


The  Ear  301 

The  formation  of  the  external  ear,  or  pinna,  has  not  been  so 
well  studied  in  domestic  animals  as  in  man.  The  conchal  carti- 
lage arises  from  the  mandibular  and  hj-oid  arches,  which  bound 
on  either  side  the  hyomandibular  cleft.  As  shown  in  Fig.  36  in 
the  human  ear,  the  concha  consists  of  a  series  of  tubercles  with 
deep  fissures  extending  between  them.  We  have  no  data  to 
show  that  the  early  stages  of  development  of  the  concha  in  our 
domestic  animals  are  precisely  parallel,  but  they  are  presumably 


Fig.  36.  The  left  ear  of  a  human  embryo,  lettered  by  Professor 
His,  Br.  2,  and  estimated  as  thirty-five  days  old.  From  ]\Iar- 
shall,  after  His.     X  20. 

I,  tuberculum  tragicum.  2,  tuberculum  anterius  helicis.  3, 
tuberculum  intermedium  helicis.  3  and  3c,  cauda  helicis.  4,  tuber- 
culum anthelicis.  5,  tuberculum  anti.ragicum.  6,  tubercu- 
lum lobulare. 

essentially  so.  B}^  observing  Fig.  36,  it  will  be  seen  that  be- 
tween I  and  2  there  is  a  deep  fissure  which,  in  the  ear  of  the 
horse,  is  apparentl}-  marked  by  an  important  ridge  inside  the 
concha.  It  is  interesting,  in  connection  with  this  fissure,  to  ob- 
serve that  foals  are  frequently  born  with  a  deep  invagination  of 
the  epiblast  at  this  point,  causing  a  long,  narrow  fistula  which 
extends  downwards  from  about  the  middle  of  the  internal  border 
of  the  concha  to  near  its  base,  and  from  which  there  exudes  a 
viscid  mticus.  In  other  cases,  this  invagination  extends  more 
deeply  and  penetrates  the  squamous  temporal  bone  and,  in  the 
•development  of  the  osseous  tissues,  the  invagination  is  inter- 
rupted and  a  closed  sac  formed  at  the  distal  end,  in  which, 
ordinarily,  one  or  more  teeth  are  formed  (ear  teeth)  which 
resemble  more  or  less  closely  the  molars  of  the  horse  and  may 
grow  to  almost  any  size,  projecting  far  above  the  external  sur- 
face or  growing  inward,  causing  an  inward  bulging  of  the  skull 
into  the  cranial  cavity.    (See  Figs.  37  A  and  B.)    Various  authors 


302 


Veterinary   Obstetrics 


ascribe  these  formations  to  outgrowths  from  the  buccal  mucous 
membrane.  A  glance  at  the  figure,  prepared  from  a  clinical 
case,  indicates  otherwise,  and  that  it  arises  from  the  epiblast  of 
the  conchal  region  in  a  manner  parallel  to  the  formation  of  the 
teeth  \vit1iin  the  mouth  from  the  stomatodeal  epiblast. 


Fi('..  37  A. 


The  Ear 


303 


Fig.  37  B. 
FiG.?37.  Dermoid  Cyst  or  "Ear  Tooth"  in  Foal. 
Indicating  the  method  of  the  formation,  from  invagination  of  the  epiderm. 
O,  Orifice  of  invaginated  area.  FW,  Fibrous  wall  of  invaginated  canal. 
EC,  Epiblastic  cavity.  I),  Tooth.  vST,  Squamous  temporal  bone. 
ST',  ST'^,  Incarcerating  outgrowths  of  squamousbone  tending  to  isolate 
EC  from  D.  GD,  Persistent  fibrous  cord  connecting  EC  with  the  cap- 
sule of  D  ;  the  epiblastic  canal  in  this  cord  has  been  obliterated.  PB, 
Petrous  temporal  or  ear  bone,  which  constitutes  a  separate  bone  in 
the  horse.  AM,  Anditory  meatus.  MA,  Maxillo-mandibular  articula- 
tion. 


304  Vctcrhiaty  Obstetrics 

FORMATION    OF    THK    DIGESTIVK    APPARATUS. 

The  alimentary  canal  of  the  embryo  at  first  consists  of  that 
portion  of  the  blastoderm  which  is  included  within  the  embryo 
in  the  process  of  infolding  and  finally  becomes  constricted  off 
from  the  yolk  sac  by  the  gradual  folding  inward  of  the  embry- 
onal area  at  its  margins.  For  a  time  the  alimentary  tract  con- 
tinues to  communicate  with  the  extra-embryonal  portion  of  the 
blastoderm,  or  yolk  .sac,  by  means  of  the  yolk-stalk  or  vitelline 
duct.  In  some  species  of  animals,  this  tube  remains  open  until  a 
comparatively  late  period  in  embryonic  life  and  traces  of  it  may 
be  found  in  some  of  them  in  the  umbilical  cord  at  the  time  of 
birth,  but  it  does  not  normally  retain  its  relation  with  the 
intestines. 

The  intestinal  tract,  during  the  early  life  of  the  embryo,  is 
divided  into  three  sections,  known  respectively  as  the  fore-,  mid-, 
and  hind-gut ;  the  first  comprising  that  portion  anterior  to  the 
communication  with  the  yolk-sac,  the  second,  the  middle  portion 
of  the  area  occupied  by  the  yolk-stalk  and  the  third  portion,  or 
hind-gut,  that  which  projects  from  the  yolk-stalk  posteriorly. 
In  the  fore-gut  there  early  appear  two  dilations,  the  pharynx 
and  the  stomach.  The  gut  is  at  first  clo.sed  both  anteriorly  and 
posteriori}'  and  the  communications  with  the  exterior  beqome 
established  later.     The  anterior  end  opens  first. 

There  appears,  in  that  region  of  the  eml)ryo  which  is  later  to 
constitute  the  mouth,  a  depression  known  as  the  stomatodeal  pit, 
by  which  the  epiblast  sinks  inward  in  the  direction  of  the  pharynx 
until  finally  the  two  cavities  are  separated  merely  by  a  thin  layer 
of  epiblast  and  one  of  hypoblast,  the  intervening  mesoblastic  tis- 
sues having  been  absorbed.  Eventually,  the  thin  membrane 
gives  way  and  the  mouth  communicates  with  the  anterior  end  of 
the  fore-gut,  or  pharynx. 

The  pharynx  shows  a  marked  dilation  in  comparison  with  the 
other  parts  of  the  digestive  tube.  In  .sagittal  section,  the  inter- 
nal surface  shows  the  prominent  visceral  arches,  between  which 
extend  the  visceral  pouches,  Among  these  visceral  pouches,  the 
hyomandibular  and  first  branchial  are  the  most  prominent  and 
have,  oji  the  outer  surface,  corresponding  visceral  grooves,  which 
do  not  normally  open  upon  the  exterior,  but  the  hyomandibular 
groove  becomes  very  thin  and  ultimately  forms  the   tympanum^ 


Formation  of  the  Digestive  Apparatus 


305 


/  r 


o 


■\jK 


3o6  Veterinary  Obstetrics 

or  eardrum.  Rarely  the  hyomandibular  gill-slit  opens  com- 
pletely upon  the  exterior  to  constitute  gill-slit  fistula  of  the  new 
born. 

The  embryonic  line  of  demarcation  between  the  stomatodeum 
and  fore-gut  is  not  perfectly  known  in  the  adult,  but  is  in  the 
immediate  vicinity  of  the  soft  palate,  the  buccal  mucosa  and  the 
teeth  being  derived  from  the  stomatodeal  epiblast,  the  tongue 
growing  forward  from  the  hypoblast  of  the  floor  of  the  fore-gut. 

Later  in  the  life  of  the  embryo,  varying  according  to  species, 
there  appears,  opposite  the  posterior  end  of  the  hind-gut,  a  dis- 
tinct depression  in  the  epiblast,  the  proctodeal  pit.  The  invagi- 
nation of  this  pit  is  of  a  similar  character  to  that  of  the  stomato- 
deum and  soon  extends  sufficiently  toward  the  hind-gut  that 
only  a  thin  membrane  remains  between  them,  consisting  exter- 
nally of  a  layer  of  epiblast  and  internally  of  hypoblast.  Nor- 
mally, this  pit  soon  opens  into  the  hind-gut  and  the  alimentary 
canal  now  communicates  with  the  exterior,  both  anteriorly  and 
posteriorly. 

Various  aberrations  in  the  development  of  these  parts  occur. 
The  most  common  is  an  arrest  in  the  development  of  the  hind- 
gut,  by  which  a  portion  of  it  is  wanting  and  it  consequently  does 
not  become  connected  with  the  proctodeal  pit  and  does  not  open 
exteriorly.  In  such  cases,  the  young  animal  is  born  devoid  of 
a  rectum.  In  other  cases,  the  membrane  between  the  proctodeal 
pit  and  the  hind-gut  fails  to  disappear  and  the  young  animal  is 
born  without  an  anus,  as  shown  in  Fig.  42.  In  still  other  in- 
stances, as  recorded  by  Gurlt,  the  intestine  ceases  at  the  vitelline 
stalk,  passing  out  through  the  umbilicus,  where  it  ends  blindly. 

A  highly  interesting  aberration  involving  the  digestive  tract, 
and  spinal  column,  is  that  recorded  by  Gurlt  and  illustrated 
in  Fig.  38,  which  he  designates  as  Schistocormus  fissi-dorsiialis 
siibecostatus  and  describes  as  a  cleft  in  the  dorsal  wall  of  the  body, 
beneath  the  spinal  column  on  the  left  side,  through  which  the 
.stomachs  and  other  abdominal  viscera  prolapse. 

Gurlt  remarks  that  the  aberration  is  very  rare,  he  having 
known  of  three  instances,  one  in  the  calf,  two  in  lambs — all  in 
ruminants. 

We  have  ob.served  a  single  case,  resembling  that  of  Gurlt  in 
many  respects  but  .showing  important  differences.  "Figs.  39  and 
40  delineate  briefly  its  character.     In  this  instance,  the  omasum, 


Formation  of  the  Digestive  Apparatits  2)^'j 

M,  and  the  spleen,  S,  are  protruding  from  a  crater-like  open- 
ing in  the  head,  through  the  occiput.  The  rumen  and  reticu- 
lum are  wanting  in  the  specimen,  fragmentary  shreds  indicating 
that  the}^  had  been  torn  away  accidentally  or  eaten  away  by 
some  animal  before  the  specimen  came  into  our  hands.  In  this 
case,  the  prolapse  of  the  alimentary  tract  is  not  lateral,  but  dor- 
sal, immediately  upon  the  median  line,  obliterating  for  a  distance 
the  cerebro-spinal  axis. 


Fig.  39.    ScHisTocoRMus  Fissidorsualis. 
Showing  crater-like  opening  in  the  occipital  region. 

Since  the  notochord  becomes  established  prior  to  the  formation 
of  the  gut,  it  would  seem  improbable  that  the  prolapse  would 
occur  through  that  organ,  but  rather  that  it  would  pass  in  front 
of  it,  and  this  is  apparently  what  has  occurred.  A  study  of  Fig. 
41,  /A^and  PT,  shows  that,  just  anterior  to  the  end  of  the  noto- 
chord, there  is  an  infundibulum  growing  down  from  the  thala- 
mencephalon,  or  midbrain,  while,  just  opposite,  growing  upward 
from  the  posterior  border  of  the  stomatodeum,  is  the  pituitary 
pouch,  which  later  becomes  the  pituitary  body,  the  two  infundi- 
buli  coming  into  immediate  contact  with  each  other.  The 
fore  gut  has  pushed  forward  and  upward,  to  escape  through 
this  area  of  low  resistance,  upon  the  back  of  the  head.  The 
fore-gut  escaping,  no  neck  has  developed,  and  the  sternum,  ST, 
extends  forward  beneath  the  pharynx,  P,  and  the  basi 
occipital  bone,  BS.  The  illustration  from  Gurlt  likewise  indi- 
cates a  virtual  absence  of  neck,  though  less  pronounced. 

At  first  the  alimentary  canal  is  of  the  same  length  as  the  body 
and   forms  immediately   beneath   the   notochord,  but  later  it  in- 


3o8 


Veten'7iarv  Obstetrics 


5  <"'  y 


2^  »- 


.3  ^S 


~  §  l^s"*/ 


5  s 


■H(/3  0i> 


o  „•  y 

.Ho  o 

a  Or— r^  a; 

iJ  i!  C  i-  . 


"u  O 

^  a 

S  o  ss 
a;  °  O 

(2W  a 


S  o     .  «       §  g 


.    -^  ■*"  ^   rt   O.ii 


:  H  w  u:  'A  o  c/^ 


Fig.  41.  A  median  longitudinal,  or  sagittal  section  through  a  rabbit  em- 
bryo, at  the  end  of  the  twelfth  day.  The  section  is  a  strictly  median  one 
except  in  two  respects ,  the  cerebral  hemisphere  of  the  left  .side  has  been 
introduced  in  order  to  render  the  figure  more  complete  ;  and  the  Wolffian 
body  and  ureter  of  the  right  side.  The  terminal  portion  of  the  tail  has 
been  removed. 

BF,  Cavity  of  fore-brain  or  tbalamencephalon. 

BH,  Cavity  of  hind  brain,  or  fourth  ventricle.     BL,  Cerebellum 

BM,   Cavity  of  mid-brain.     BS,  Cavity  of  cerebral  hemisphere     or 

lateral  ventricle.     CH,  Notochord.     GP,  Post-anal  gut. 
IN,  Finger-like  process  of  infundibulum.     KC,  Wolffian  duct 
KD,  Ureter.     KM,  Wolffian  bodv.     LE,   Epiglottis 
LG,  Lung.     LR,  Trachea.     PN,  Pineal  bodv.     PT,  Pituitary  body 
RS,  vSinus  venosus.      RT,  Truncus  arteriosus. 

RV,  Ventricle  of  heart.  T,  Glottis.  TA,  Stalk  of  allantois,  cut  short 
TC,  Cloaca.  TA,  Thyroid  body.  TO,  CEsophagus.  TP  Pharynx 
W,  Liver.     WD,  Bile  duct.     YK,  Yolk  stalk,  cut  short. 

(Marshall). 


3IO 


Veterinary  Obstetrics 


creases  in  length  far  more  rapidly  than  the  body  and  drops  away 
from  the  dorsal  portion  of  the  body  cavity  to  float  freely,  con- 
fined in  position  only  by  the  mesentery,  which  it  has  derived 
from  the  superior  wall  of  the  abdomen  and  carried  with  it  in  its 
descent. 

At  first  the  posterior  gut  of  the  embryo  represents  jointly  the 
intestine  and  the  genito-urinary  passages  and  constitutes  a  sin- 
gle dilated  chamber,  or  cloaca,  but  later  there  grows  back,  from 
the  angle  between  the  stalk  of  the  allantois  and  the  gut,  a  parti- 
tion which  serves  to  separate  the  digestive  tube  from  the  genito- 
urinary tract.  This  partition  is  sometimes  incomplete,  especially 
in  the  female  when  the  proctodeal  opening  fails  in  the  upper 
portion  and  causes  a  closed  anus,  when  the  feces  from  the 
intestine  drop  into  the  vagina,  to  be  expelled  through  the  vulva, 
as  indicated  in  Fig.  42. 


Fig.  42.     Atresia  Ani.     Lamb. 

R,  Rectum.     P,  Closed  proctodeal  pit.     C,  Cloaca. 
Ur,  Urethra.     U,  Uterus.     B,  Bladder.     V,  Vagina. 

The  Lungs. 

The  lungs  are  formed  as  an  outgrowth  from  the  floor  of  the 
pharynx  in  the  region  of  the  first  to  third  branchial  arches  and 
begin  as  a  longitudinal  groove,  which  soon  develops  into  a  blind 
pouch.  This  evagination  extends  backward  beneath  the  pharynx 
and  at  its  distal  end  .soon  splits  into  right  and  left  halves,  to  con- 
stitute the  two  lobes  of  the  lungs.     The  growth  continues  back- 


The  Teeth 


311 


ward  beneath  the  oesophagus  and  above  the  heart  and  the  distal 
ends  of  the  two  lobes  become  enlarged  and  commence  dividing 
into  small  lobes.  The  lobes  elongate  greatly  and  give  rise  to 
buds  which  end  in  somewhat  enlarged  ampullae,  which  continue 
to  subdivide  in  this  manner,  the  terminal  infundibuli  constitut- 
ing the  air  cells,  while  the  tubes  leading  from  them  are  the 
bronchioles,  the  larger  ones  are  the  bronchii,  the  original  tube 
leading  from  the  floor  of  the  pharynx  becomes  the  trachea,  and 
the  slit  which  first  appeared  in  the  bottom  of  the  pharynx  forms 
the  glottis. 

The  Teeth. 

The  teeth  appear  very  early  in  the  life  of  the  embryo  and  orig- 
inate from  the  epiblast  of  the  stomatodeum  in  the  form  of  a  lon- 
gitudinal invagination  of  thickened  epithelium  along  the  border 
of  the  jaw,  which  eventually  sinks  down  into  the  substance  of 
the  jaw  as  a  continuous  ridge,  known  as  the  common  enamel 
germ.  Later,  the  ridges  become  enlarged  at  intervals,  to  consti- 
tute  the  individual  enamel  organs,   while  the  portions  between 


Fig.  43.  Tl.:  -ive  sta,tcesin  the  development  of  a  tooth- 

germ  of  a  pig  embryo  ( after  Frey  and  Thiersch):  a,  b,  c,  layers 
of  thickened  oral  epithelium,  showing  dental  groove  on  sur- 
face in  3  ;  e,  enamel  organ  ;  f,  dental  papilla  ;  g,  h,  internal  and 
external  layers  of  follicle  wall  ;  i,  blood-vessel  ;  k,  maxilla;  d, 
epithelial  ingrowth,  the  end  of  which  expands  into  the  enamel 
sac.      (Heisler). 


312  Veterinary  Obstetrics 

these  enlargements  tend  to  atrophy  and  finally  to  completely  dis- 
appear. 

Each  enamel  organ  soon  consists  of  a  flask-like  Vesicle  of  epi- 
blast  with  a  narrow  neck,  which  is  still  continuous  with  the  epi- 
thelium of  the  mouth  by  a  cord- like  constriction,  while  the 
distal  end,  or  fundus,  of  the  flask  is  enlarged  and  spherical. 
Beneath  this  enamel  organ,  there  soon  forms,  from  the  meso- 
bla.stic  connective  tissue,  the  dental  papilla,  which  pushes  up 
into  the  sac,  causing  an  invagination  of  its  base.  The  enamel 
sac  now  invests  the  top  of  the  papilla  as  a  cap  and  soon  takes 
on  the  form  of  the  future  tooth.  The  enamel  organ  is  then  in 
the  form  of  a  flattened  sac,  the  distal  end  invaginated,  so  that 
the  two  walls  are  brought  into  close  proximity.    See  Fig.  43. 

Upon  the  external  surface  of  the  dental  papillae,  odontoblasts 
arise,  from  which  the  dentine  of  the  tooth  is  formed.  The 
enamel  prisms  are  formed  from  the  epithelium  of  that  part  of 
the  walls  of  theenamel  sac  which  lie  in  immediate  contact  with  the 
dental  papilla,  while  the  superficial  wall,  i.  e.  that  portion  con- 
tinuous with  the  neck-like  mass  of  epithelial  cells  still  maintain- 
ing connection  with  the  mouth  cavity,  disappears  without  tak- 
ing any  recognized  part  in  the  formation  of  the  enamel  tissue. 
The  dentine,  forming  from  the  odontoblasts  upon  the  apex  and 
sides  of  the  papilla,  soon  invests  these  portions  in  the  hard  ivory 
substance,  while  the  base  and  center  of  the  dental  papilla  con- 
tinue as  the  tooth  pulp.  The  base  is  at  first  wide  open,  but,  as 
the  tooth  develops,  it  gradually  contracts  and  finally,  in  some 
teeth,  there  grow  out  projections  or  septa  of  dentine,  to  consti- 
tute the  roots  or  fangs,  which  divide  this  cavity  into  two  or 
more  distinct  openings,  according  to  the  individual  tooth  or 
species,  and,  through  these  apertures,  the  blood  vessels  and 
nerves  pass  to  the  pulp  of  the  tooth.     See  Fig.  44. 

As  the  enamel  organ  sinks  down  into  the  jaw,  there  occurs  a 
conden.sation  of  the  surrounding  mesoblastic  connective  tissue  to 
constitute  a  capsule,  the  tooth  follicle,  which  closely  invests  the 
enamel  organ  and  papilla.  When  the  bony  tissue  of  the  jaw 
forms,  the  follicle  serves  as  periosteum  for  the  tooth  and  alveolus, 
while,  from  its  inner  layers,  the  external  tooth  tissue,  the 
cement,  is  developed.  The  origin  of  the  dental  tissues  is  then  : 
I,  the  enamel  from  the  invaginated  epiblastic  cells;  2,  the  pa- 
pilla, vessels,  nerves  and  dentinal  tubules  from   the  mesoblastic 


The   Teeth 


313 


connective  tissue,  and,  3,  the  cementum  and  dental  and  alveolar 
periosteum  from  the  mesoblastic  dental  follicle. 


Fig.  44.  Sagittal  section  through  an  inferior  grinder  of  an  equine 
embryo,  4  inches  long.  ect,  ectoderm  of  mouth  cavity  ;  mes, 
mesoderm ;  eo,  enamel  organ  ;  ec,  enamel  cells  ;  d,  den- 
tine ;  eb,  embryonic  bone. 

The  enamel  cap  is  at  most  points  detached  from  the  dentine 
papillae.  The  .section  through  the  tooth  follicle  is  so  made  that 
the  plicae  of  the  enamel  cap  have  split  each  of  the  dentine 
papillae  so  that  there  are  four  instead  of  two. 

When  the  bony  jaws  form  later,  the  teeth  are  at  first  in  con- 
tinuotis  grooves,  but  transverse  osseous  partitions  later  extend 
between  the  tooth  germs  and  finall}'  constitute  separate  compart- 
ments, or  alveoli,  for  each.  The  permanent  teeth  are  developed 
as  outgrowths  from  the  enamel  organs  of  the  temporary  set  in 
those  cases  where  they  are  preceded  by  such ;  in  the  others  they 
are  formed  the  same  as  the  temporary  teeth  from  a  backward 
growth  of  the  common  enamel  germ. 

The  teeth  of  domestic  animals,  and  especially  of  the  horse,  are 
subject  to  many  aberrations  in  development.  The  mesoblastic 
connective  tissue  follicle,  under  disturbances,  ma}-  undergo  seri- 
ous aberration  during  its  developmental  stages.     There  may  be  a 


314 


Veterinary  Obstetrics 


large  amount  of  fluid  formed  within  the  folHcle,  which  may  cause 
the  destruction  of  the  tooth  germ  and  may  become  enormously 
increased,  to  the  extent  of  one,  two  or  more  pints  of  fluid  and, 
when  in  the  upper  jaw,  may  cause  serious  distress  to  the  animal 
by  projecting  into  the  sinuses  and  interfering   with  respiration. 


Fig.  45- 
Fig.  45.  Sa<jittal  section  of  superior  molar^i  of  adult  horse  show- 
ing on  the  left,  normal  development,  on  the  right,  arrested  de- 
velopment of  the  cement  area. 

Fig.  46.  A,  Crown,  and  B,  Longitudinal  cross  section  of  a  super- 
ior grinder  of  adult  horse  showing  absence  of  cement  in  central 
infundibulum  and  erosion  of  the  enamel  and  dentinal  plates. 

C,  External  cement.     C^,  Central  cement  area. 

E,  External  enamel  layer.  E',  Central  enamel.  E'^,  Ex- 
ternal enamel  at  point  of  contact  between  adjacent  molars. 
The  adjacent  enamel  laminiu  project  above  the  surround- 
ing tissues,  have  no  cement  between  them  and  are  so  ar- 
ranged as  to  prevent  the  impaction  of  food  particles  be- 
tween. 

D,  Dentine.  Er,  Erosion  area.  Er',  Erosion  canal  penetrat- 
ing the  tooth  fang. 

P,  Pulp  cavity.     S,  vSuperior  maxillary  bone. 

These  aberrations  we  know  as  follicular  cysts.  In  other  cases, 
the  walls  of  the  follicle  form  an  abnormal  amount  of  cement, 
which  causes  a  very  great  accumulation  of  this  substance,  to 
constitute  what  we  know  as  a  cement  tumor,  or  cementoma. 


The  Teeth  315 

Sometimes  there  is  a  distension  of  the  follicle  with  fluid,  ac- 
companied b)'  a  growth  of  cement  upon  its  inner  surface,  giving 
rise  to  what  we  know  as  compound  follicular  cysts. 

At  other  times  the  walls  of  the  tooth  follicle  become  greatly 
thickened  b}^  an  abnormal  growth  of  connective  tissue,  to  con- 
stitute what  is  known  as  a  fibrous  odontome. 

Finally,  in  the  horse,  and  to  a  less  extent  in  other  animals, 
where  there  are  deep  invaginations  from  the  sides  or  upon  the 
crown  of  the  enamel  organ  into  the  dental  papilla,  there  is 
normally  formed  in  the  grinders  a  sufficient  amount  of  cement 
to  completely  close  the  spaces  between  the  infolded  layers  of 
enamel.  In  some  instances  this  formation  of  cement  is  in- 
complete and  an  opening  is  left  through  the  central  portion  of 
this  substance,  from  the  grinding  surface  of  the  tooth  down  to 
the  bottom  of  the  infundibulum,  in  close  contact  with  the 
enamel.  Through  this  cleft,  food  particles  pass  and,  becoming 
lodged  in  the  deepest  part,  undergo  bacterial  decomposition, 
which  causes  a  solution  of  the  enamel  and  dentine  and,  finally,  a 
perforation  of  the  pulp  cavity,  leading  to  a  purulent  inflamma- 
tion of  the  tooth  pulp  and  a  destruction  of  the  life  of  the  organ, 
with  many  complications  of  a  highly  important  character.  See 
C  Figs.  45  and  46. 

The  enamel  organ  is  subject  to  aberrations  in  its  develop- 
ment by  which  a  tumor  is  formed,  which  may  prevent  the 
eruption  of  the  tooth  and  lead  to  what  is  known  as  a  multilocular 
cvst. 


Fig.  47.    Cross    section   of    molar 
of  adult  horse. 

C,  External  cement.  C,  Cen- 
tral cement.  E,  External 
enamel.  E^,  Central  enamel. 
P,  Pulp  cavit}'  surrounded 
by  dentine. 


The  dental  papilla  may  undergo  two  important  forms  of  fetal 
aberration  or  arrest  in  development.  First,  there  ma^'  be  an  ex- 
cessive development  of  the  dentinal  substance  to  constitute  an 


3i6 


Veten'7iarv  Obstetrics 


ivory  tumor,  or  radicular  odontome.     Occasionally  such   tumors 
in  the  horse  reach  a  weight  of  five  pounds  or  more. 

There  is  frequently  an  arrest  in  the  development  of  dentine  at 
the  wearing  surface  of  the  tooth.  In  the  grinder  of  the  horse, 
where  the  enamel  dips  down  into  the  body  of  the  tooth,  it  serves 
to  bring  two  lamellae  of  dentinal    substance  into  close  contact. 


Fig.  4S.  A  and  B.  Table  surface  and  section  of  inferior  molar  of 
adult  horse,  showing  non-fusion  of  dentinal  lamellae,  followed 
by  infection  and  purulent  pulpitis. 

C,  External  cement.     C,  Central  cement.   E,  External  enamel. 
E',  Central  enamel.     P,  Pulp  cavity  .surrounded  by  dentine. 

In  the  complex  grinder  of  the  horse,  the  papilla  or  radicle  of 
the  tooth,  d,  Fig.  44,  .splits  up  into  several  sharp  elevations 
which  push  their  way  up  into  the  enamel  organ.  The  dentine 
forms  from  the  ondontoblasts  upon  the  exterior  of  these  pro- 
jections, and  the  .soft  tissues,  or  tooth  pulp,  occupy  the  interior 
of  these  elevations  so  that  at  their  apexes  the  inner,  or  pulp, 
surfaces  of  the  dentinal  plates  come  in  immediate  contact. 
Normally  the  opposing  faces  of  these  two  plates  should  fuse 
at  the  grinding  surface  and  hermetically  seal  the  pulp  cavity  as 


The  Teeth  317 

shown  between  Cand  C  in  Fig.  46  B,  and  atZ>  in  Figs.  45  and  46  A, 
before  the  time  when  the  tooth  comes  into  wear,  and  the  dentinal 
summit  is  worn  awaj-.  In  some  cases,  as  shown  in  Fig.  48,  this 
fusion  fails  to  occur  and  results  in  an  opening  into  the  pulp  cavity, 
with  food  particles  passing  through  between  the  laminae 
into  the  pulp,  causing  a  purulent  inflammation  of  it,  with 
destruction  of  the  tooth  and  other  important  complications. 
Thus,  in  the  early  stages  of  embryonic  life,  aberrations  in  the 
formation  of  the  tooth  germs  serve  in  a  variety  of  ways  to  in- 
duce defects  in  these  organs  which  lead  to  their  early  di.sease 
and  destruction,  accompanied  by  an  endless  variety  of  com- 
plications of  more  or  le.ss  serious  importance  for  the  well-being  of 
the  animal. 

The  mammalian  tooth,  the  hardest  tissue  in  the  body,  is  nor- 
mally a  product  of  epiblastic  growth  from  the  stomatodeum, 
which  has  become  invaginated  into  the  bones  of  the  maxilla  and 
mandible,  but  tooth  tissues  are  not  confined  to  these  parts. 
We  have  already  related  on  page  301  that  tooth  tissue,  histo- 
logically and  anatomically,  is  also  formed  in  the  squamous  por- 
tion of  the  temporal  bone  of  the  equine  embryo,  but  here  the 
conditions  closely  simulate  those  obtaining  in  the  oral  cavity 
itself,  that  is,  epiblastic  cells  are  invaginated  into  the  deeper 
layers  of  mesoblast.  From  the  mesoblastic  bone,  the  squamous 
temporal  is  formed,  while  the  incarcerated  epiblast,  as  in  the 
jaws,  develops  into  enamel  tissue. 

From  these  considerations  one  might  be  led  to  state  that  the 
invagination  of  epiblast  into  embryonic  tissues  which  are  later  to 
form  bone  leads  to  the  development  of  teeth  and  that  this  condi- 
tion is  essential  to  their  origin.  This,  however,  is  not  wholly  true. 
Somewhat  rarely  in  horses,  and  yet  more  infrequently  in  other 
animals,  we  meet  with  dental  substances  in  the  ovaries  and  testi- 
cles, and  here  the  condition  of  the  invagination  of  epiblast  into 
mesoblast,  with  the  incarceration  of  the  former  in  mesoblastic  tis- 
sue which  is  to  ossify,  does  not  occur.  Possibly,  here,  the  epiblast 
becomes  invaginated  through  the  giibernacuhini  testis  or  the  cor- 
responding ligament  of  the  ovarj^  into  the  mesoblastic  genital 
gland,  or  it  may  reach  the  genital  gland  through  the  Wolffian 
duct,  which,  according  to  some  embryologists,  arises  by  a  longi- 
tudinal invagination  of  the  epiblast,  and,  while  the  tissues  of  the 


31 8  Veterinary  Obstetrics 

gland  do  not  ossify,  the  very  dense  tunica  albuginea  affords  a 
degree  of  compression  of  a  somewhat  analogous  character. 

We  may  then  state  that,  so  far  as  we  know,  teeth  are  always 
liable  to  result  whenever  limited  sacs  of  epiblast  become  invagi- 
nated  into  mesoblast,  and  become  incarcerated  and  separated 
from  the  general  epiblastic  layer,  while  the  surrounding  meso- 
blast is  converted  into  bone  or  is  bound  down  by  firm  layers  of 
unyielding  connective  or  other  dense  tissues. 

The  Liver. 

The  liver  of  the  embryo  appears  about  the  end  of  the  second 
week  as  an  outgrowth  from  the  inferior  wall  of  the  intestine  just 
beyond  the  dilation  which  marks  the  future  stomach.  The  for- 
mation of  the  liver  resembles  in  many  respects  that  of  the  lungs, 
the  outgrowth  becoming  enlarged  at  its  distal  end,  while  the 
proximal  portion  becomes  narrowed  to  constitute  the  bile  duct. 
The  liver  is  the  most  conspicuous  of  all  the  glands  in  the  embryo 
and,  at  the  time  of  birth,  constitutes  the  largest  and  heaviest 
portion  of  the  internal  viscera.  In  volume  and  weight,  it  is  equal 
to  the  entire  intestinal  tract,  with  the  lungs  and  heart  added. 

The  Pancreas. 

The  pancreas  arises  at  about  the  same  time  as  the  liver,  as  an 
infundibulum  from  the  anterior  wall  of  the  duodenum,  and  is 
lodged  in  the  tissue  of  the  mesentery  between  the  intestine  and 
dorsal  wall.  The  gland  quickl}-  divides  up  into  lobules,  from 
which  the  acini  and  ducts  are  formed. 


THE  CIRCULATORY  SYSTEM. 

During  the  second  week  in  the  life  of  the  embryo,  the  heart  is 
recognizable  as  two  symmetrical  and  distinct  halves,  which  con- 
sist at  this  time  of  two  straight  tubes,  lying  along  the  head-end 
of  the  embryo  between  the  yolk-sac  and  the  neural  folds  and 
connected  at  their  posterior  ends  with  the  vitelline  vessels. 
These  two  tubes  soon  unite  to  form  a  single  one,  which  becomes 
twisted  upon  itself  and  forms  a  prominent  swelling  on  the  ventral 
surface  of  the  embryo  in  the  region  of  the  pharynx.  It  is 
twisted  in  an  S-shaped  loop  and  is  free  in  its  middle  portion, 
while  the  ends  are  attached  anteriorly  and  posteriorly  to  the 
ventral  surface  of  the  fore-gut.  The  posterior,  or  dorsal,  portion 
of  the  heart  represents  the  future  auricles  and  is  separated  by  a 
somewhat  marked  constriction  from  the  ventral  portion,  which 
is  to  become  the  ventricles.  The  anterior  end  of  the  loop  is 
somewhat  enlarged  to  constitute  the  triuiais  arteriosus,  which  is 
attached  to  the  fore-gut  in  the  vicinity  of  the  mandibular  arches. 

The  heart  increases  rapidh'  in  size  and,  within  a  week  from 
the  first  traces  of  its  formation,  the  constriction  between  the  au- 
ricular and  ventricular  portions  has  become  very  narrow,  the 
auricles  have  assumed  their  ear-like  form,  and  the  ventricular 
portion  lies  transversely  across  the  body,  shaped  somewhat  like 
the  adult  stomach. 

The  Sinus  Venosus. 

The  blood  is  returned  to  the  heart  by  three  .symmetrical  pairs 
of  veins  :  the  Cuvierian  vein  from  the  body  of  the  embryo,  the 
vitelline  vein  from  the  yolk-sac,  and  the  allantoic  vein  from  the 
placenta.  These  three  pairs  unite  to  constitute  the  sinus  veno- 
sus, lying  transversely  across  the  body  and  opening  into  the 
auricular  portion  of  the  heart.  The  sinus  venosus  ultimately 
becomes  a  part  of  the  auricle  and  disappears  as  a  separate 
structure. 

The  auricular  chamber  becomes  imperfectly  divided  into  the 
two  auricles,  at  an  early  date,  by  outgrowths  from  the  walls, 
which  finally  separate  the  two  chambers.  The  septum  between 
the  two  auricles  does  not  become  complete  during  fetal  life,  but 
closes  normally  at  the  time  of  birth  ;  abnormally,  it  may  persist 

319 


320  Veterinary  Obstetrics 

after  birth,  giving  rise  to  the  affection  known  as  persistent  fora- 
men ovale,  or  cyanosis  of  the  newborn,  by  which  the  blood  re- 
mains mixed,  as  in  the  serpent,  giving  a  bluish  color  to  the  skin 
and  mucous  membranes,  usually  ending  in  the  early  death  of  the 
young  animal. 

The  constriction  between  the  auricular  and  ventricular  por- 
tions gradually  develops  to  form  the  septum  between  these  cavi- 
ties and,  from  these  also,  the  auriculo- ventricular  valves  are 
formed. 

The  ventricular  cavity  becomes  divided  into  two  somewhat 
unequal  halves  toward  the  close  of  the  first  month.  There  also 
forms  in  the  trimciis  arteriosus,  ta,  Fig.  49,  a  median  partition, 
which,  growing  backwards,  divides  the  vessel  into  two  parts, 
which  are  to  represent  in  the  future  the  common  aorta  and  the 
pulmonary  arter}^  The  septum  between  the  two  ventricles  is 
for  a  time  incomplete  and  both  the  aorta  and  pulmonary  artery 
are  connected  with  the  right  ventricle  only,  so  that  the  left 
cavity  communicates  with  the  arteries  only  through  the  opening 
in  the  ventricular  septum. 

The  ArteriEvS. 

A  series  of  aortic  arches,  see  between  va  and  da,  Fig.  49, 
ari.se  early  in  the  third  week  of  embryonic  life  from  the  anterior 
extremit}^  of  the  truncus  arteriosus,  one  for  each  of  the  visceral 
arches,  the  more  anterior  appearing  first.  At  first  there  are  two 
wholly  separate  aortae,  which  run  parallel  to  each  other  through- 
out the  length  of  the  body  just  beneath  the  notochord,  but  they 
soon  become  fused  po.steriorly  to  constitute  the  dorsal  aorta, 
from  which  is  given  off  the  vitelline  arteries  to  the  vitelline  sac. 
Further  back  it  divides  into  the  two  allantoic  arteries,  which 
carry  the  blood  to  the  allantois.  The  aortic  arches  pass  from  the 
floor  of  the  pharynx  up  through  the  visceral  arches  on  either 
side  and  open  into  the  aorta.  They  are  soon  complete,  five,  or^ 
according  to  some  authors,  six  pairs,  being  present,  one  for  each, 
branchial  arch,  and  all  connected  above  with  the  dorsal  aorta. 

The  attachment  of  the  truncus  arteriosus  begins  to  shift  back- 
ward along  the  floor  of  the  mouth  and  divides  into  two  branches, 
the  anterior  of  which  maintains  connection  with  the  mandibular 
and  hyoidean  aortic  arches,  w^hile  the  posterior  is  connected  with 
the  three,  or  four,  remaining  vessels. 


The  Arteries 


321 


Fio.  I'l.  Ri  I otistruction  of  human  einl>i\<)  df  about  17  days 
(His):  ov,  optic  vesicle,  ot,  otic  vesicle;  nc,  nc',  notochord ; 
hdg,  head  gut ;  vs,  vitelline  sac  ;  1,  liver;  v,  ta,  primitive  ven- 
tricle and  truncus  arteriosus ;  va  and  da,  ventral  and  dorsal 
aorta; ;  aa,  aortic  arches  ;  jv,  primitive  juglar  vein  ;  cv,  cardinal 
vein  ;  dC,  duct  of  Cuvier  ;  uv,ua,  umbilical  vein  and  artery  ;  al, 
allantois  ;  uc,  umbilical  cord.     (Heisler). 


322 


Veterinary  Obstetrics 


The  aortse  continue  forward  beyond  the  aortic  arches  and  run 
alongside  the  brain,  to  constitute  the  internal  carotid  arteries. 

Changes  now  begin  to  appear,  looking  toward  the  foundation 
of  the  adult  plan  of  circulation.  The  middle  portions  of  the 
aortic  arches  in  the  mandibular  and  hyoidean  arches  disappear  ; 
the  connection  between  the  truncus  arteriosus  and  the  aortae, 
through  these  arches,  ceases  to  exist  and  the  proximal  ends  of 
these  vessels  remain  as  the  external  carotid  arteries. 

The  third  aortic  arch  remains  and  retains  its  connection  with 
the  anterior  portion  of  the  aorta  and  its  proximal  end  or  stem 
constitutes  the  common  carotid  artery.  The  connection  between 
the  portion  of  the  aorta  posterior  to  the  junction  with  the  third 
aortic  arch  and  anterior  to  the  fourth  disappears,  thus  .separating 
the  carotid  system  from  the  aortic  vessels. 


Common  carotid    — ;- 
Recurrent  laryngeal 
nerve  (right) 
Right  subclavian 


innominate  artery 
Ascending  aorta 


Internal  carotid 

I  erf ebral artery 
Arch  of  aorta 
Left  subclavian 
Ductus  arteriosus 


Pulmonary  trunk 


Fig.  50.     Diagram  illustrating  the  fate  of  the  aortic  arches. 
( Modified  from  Heisler. ) 

The  left  fourth  aortic  arch  persists,  to  eventually  become  the 
aorta,  while  the  fifth,  or,  according  to  those  authors  who  re- 
cognize six  aortic  arches,  the  .sixth,  arch  ultimately  becomes  the 
pulmonary  artery.     See  Figs.  49  and  50. 


The  Arteries 


323 


At  approximately  the  fifth  or  sixth  week  of  embryonic  life, 
the  heart  leaves  the  region  of  the  pharynx  and  passes  backward, 
while  the  neck  becomes  elongated  and  the  head  extended  for- 
ward, which  causes  a  great  lengthening  of  the  common  carotid 
artery. 


OCL 


Fig.  51.  Arrested  Development  of  the  Uterus  .\nd  Vagina.    Cow. 

O,  Ovary.  CL,  Corpus  hiteum.  UC,  Uterine  cornua. 
U,  Cordiform  Mullerian  ducts  representing  the  uterus. 
Va,  Vagina.     H,  Hymen.     V,  Vulva.     MU,  Meatus  urinarius. 


During  the  formation  of  the  cranial  nerves,  the  inferior  laryn- 
geal divisions  of  the  pneumogastric  nerves  cross  behind  the 
fourth,  or  permanent,  aortic  arches  between  the  aorta  and 
truncus  arteriosus,  to  reach  their  destination  in  the  muscles  of 
the  larynx.  As  the  heart  recedes  toward  the  chest  and  the 
head  grows  forward,  the  laryngeal  nerves  are  necessarily  caught 
and  dragged  along  with  the  aortse  into  the  chest  cavity,  thus 
bringing  about  their  recurrent  course. 

While  the  heart  is  moving  backward,  the  right  aortic,  or  sys- 
temic, arch  becomes  smaller  and  finally  disappears.  As  a  result, 
the  right  laryngeal  nerve  is  released  from  the  dragging  of  the 
aorta  but  still  passes  around  the  right  subclavian  artery,  while  the 
persistence  of  the  left  arch,  with  its  increased  size,  to  become  the 
common  aorta  continues  the  dragging  upon  the  left  recurrent 
nerve,  which,  throughout  the  life  of  the  animal,  must  pass  into 
the  chest,  around  the  aorta,  and  retrace  its  way  back  to  the 
larynx.  This  essential  difference  in  the  course  of  the  two  in- 
ferior laryngeal  nerves  is  by  some  presumed  to  have  a  funda- 
mental relation  to  the  fact  that,  in  the  affection  of  "  roaring  " 
in  horses,  it  is  regularly  the  left  nerve  which  becomes  degenerated, 


324 


Veterinary  Obstetrics 


^ 


.^•> 


Fig.  52.     FissicoLi.is.     Cervical  Ectopia  Cordis. 

(Gurlt. ) 


Fig.  53.     Cervical  Ectopia  Cordis  in  an  Adult  Stker.     A,  Ectopic  heart. 
( Kansas  City  Veteriuary  College.  ) 


The   Arteries 


325 


though  the  essential  relation  of  this  to  the  disease  is  unknown, 
nor  is  there  any  explanation  whj-  the  recurrent  character  of  the 
nerve  should  cause  disease  in  the  horse  and  not  in  other  animals. 


Fig.  54.     Ectopia  Cordis;  vSchistocormus  Fi.ssisternai,is. 
After  Hering. 

It  should  be  noted  here  also  that  the  heart  sometimes  becomes 
arrested  in  its  movement  backward  and  remains  in  the  cervical 
or  pharyngeal  region.  It  thus  occurs,  especially  in  bovidse, 
that  the  young  may  be  born  with  the  heart  just  beneath  the 
pharynx  or  at  any  point  between  this  and  the  first  rib,  as  shown 
in  Figs.  52  and  53,  thus  graphically  reminding  one  of  the  normal 
shifting  of  the  location  of  the  heart  from  its  first  position  along 
the  floor  of  the  pharynx,  in  the  embryo,  toward  the  posterior 
portion  of  the  body,  to  become  lodged  within  the  chest  cavity. 

In  other  cases,  the  aberration  in  the  location  of  the  heart 
may  occur  in  connection  with  a  fissure  of  the  sternum,  through 
which  the  heart  becomes  herniated,  as  in  Fig.   54. 

The  fifth  aortic  arch  gives  off  a  branch,  before  joining  the 
aorta,  to  go  to  the  lungs  and  constitute  the  pulmonary  artery. 
In  the  right  vessel,  the  arch  disappears  between  the  pulmonary 
artery  and  the  aorta,  while,  in  the  left,  it  continues  up  to  the 
close  of  fetal  life,  as  the  ductus  arteriosus,  which,  up  to  the  time 
of  birth,  maintains  the  indirect  communication  between  the  right 
ventricle  and  the  posterior  aorta,  and  persists  throughout  life  as 
a  fibrous  cord,  the  ligamentum  arteriosum. 


326  Veterinary   Obstetrics 

Thk  Veins. 

When  the  mammalian  embryo  is  about  three  weeks  old,  there  are 
three  pairs  of  veins  :  the  Cuvierian,  the  vitelline  and  the  allantoic. 
The  first  of  these  return  the  blood  from  the  embryo  itself  and 
are  formed  by  the  union  of  the  cardinal  veins.  The  vitelline 
veins  are  formed  in  the  walls  of  the  yolk-sac  and  carry  blood 
from  it  along  the  vitelline  stalk  to  the  heart,  while  the  third 
pair  return  blood  from  the  placenta  along  the  stalk  of  the  allantois. 

The  vitelline  veins  of  mammals  are  naturally  small,  since  the 
vitellus,  or  yolk,  contains  essentially  no  nutriment  and,  hence, 
affords  small  opportunity  for  any  important  functions  in  these 
veins,  so  long  as  they  merely  carry  blood  from  the  yolk-sac  to 
the  heart.  They  are  situated  in  the  mesoblast  of  the  splanchno- 
pleure,  enter  the  embryo  at  the  umbilicus  and,  passing  forward 
along  the  sides  of  the  alimentary  canal,  empty  into  the  sinus 
venosus. 

In  growing  out  from  the  intestine,  the  liver  surrounds  the  vitel- 
line veins  before  they  empty  into  the  sinus  venosus.  Here  the  veins 
break  up  into  a  series  of  capillaries,  converging  later  to  form  the 
efferent  hepatic  vessels.  In  this  way,  the  capillary  system  of  the 
liver  is  formed  and  we  have  a  vein  dividing  up  into  capillaries  in 
the  same  way  as  arteries  usually  do,  and  converging  again  to  form 
a  second  venous  trunk.  At  about  the  same  period  that  the  vitelline 
veins  are  breaking  up  to  constitute  the  functional  circulation  of 
the  liver,  they  become  connected  with  each  other  just  before 
their  entrance  into  that  gland,  by  three  communicating  branches, 
two  of  which  pass  beneath  the  duodenum  and  one  over  it, 
and  thus  form  venous  rings  surrounding  the  intestine.  From 
the  anterior  ring,  there  arise  veins  which  carry  the  blood  into 
the  liver.  The  right  and  left  vitelline  veins  soon  unite  to  form 
a  single  trunk,  which,  a  little  later,  is  joined  by  veins  returning 
blood  from  the  intestine,  after  which  it  is  known  as  the  hepatic 
portal  vein. 

The  veins  which  previou.sIy  established  the  communication 
between  the  right  and  left  vitelline  veins  disappear  in  part  in 
such  a  way  that  the  remaining  portions,  which  constitute  later 
the  direct  trunk,  are  twisted  about  the  duodenum  in  a  manner 
similar  to  that  seen  in  adult  life. 


The    Veins  327 

The  allantoic  veins  are  at  first  paired,  but  they  undergo  a 
variable  extent  of  fusion  in  the  different  species  of  animals  ;  in 
our  domestic  animals  they  are  usually  united  into  a  single  vein 
within  the  body  of  the  fetus  at  an  early  date,  while  externally, 
in  the  umbilical  cord,  they  usually  remain  separate.  These 
veins,  arising  from  the  placenta,  pass  along  the  sides  of  the 
allantoic  stalk,  or  urachus,  and  eventually  reach  the  sinus 
venosus  and  empty  into  that  cavity.  Later,  they  lose  their 
connection  with  the  sinus  venosus,  the  right  vein  becomes 
smaller  and  finally  disappears,  while  the  left  increases  mvich  in 
volume  and  gives  off  some  vessels  as  it  nears  the  liver,  which 
enter  it  directly,  while  the  main  portion  of  the  vessel  joins  the 
hepatic  portal  vein  prior  to  its  entrance  into  that  gland. 

At  a  slightly  later  date,  when  both  vitelline  and  allantoic 
vessels  have  ceased  to  empty  into  the  shuis  venosus,  all  the  blood 
from  these  two  vessels  must  pass  through  the  capillaries  of  the 
liver  before  it  can  reach  the  heart.  At  this  period,  a  communi- 
cation, the  ductus  venosus,  is  established  between  the  right 
hepatic  and  portal  veins,  by  which  the  blood  may  pass  from  the 
vitelline  and  allantoic  vessels  across  to  the  hepatic  vein,  without 
passing  through  the  capillaries  of  the  liver.  This  ductus  vetiosus 
grows  rapidly  and  affords  a  commodious  and  direct  path,  through 
which  the  blood  may  pass  at  once  from  the  placenta  to  the  heart, 
without  going  through  the  liver.  It  becomes  obliterated  in  the 
foal  some  time  prior  to  birth  so  that,  in  this  animal,  all  blood 
from  the  allantois  must  pass  through  the  liver. 

The  posterior  vena  cava  does  not  acquire  much  size  until  the 
hind  limbs  begin  to  form  and  the  iliac  veins  unite  to  constitute 
its  principal  branches.  It  enters  into  the  ductus  venosus  near  its 
termination  in  the  hepatic  vein. 

The  anterior  and  posterior  cardinal  veins  unite  to  form  the 
Cuvierian  veins.  The  anterior  cardinal  vein  persists  in  some  of 
our  adult  domestic  animals,  such  as  the  cow,  as  the  external 
jugular  vein.  The  posterior  cardinal  vein  disappears  in  its 
middle  and  the  posterior  end  becomes  the  internal  iliac  vein,  while 
the  anterior  portion  of  the  right  posterior  cardinal  vein  persists 
as  the  vena  azygos. 

The  anterior  vena  cava  represents  the  right  anterior  Cuvierian 
vein,  while  the  left  vein  disappears  completely,  with  the  possible 
exception  of  the  coronary  sinus  of  the  heart. 


328  l^e/en'narj'  Obstetrics 

The  Fetal  Circilatiox. 

In  the  earlier  stages  of  the  fetal  circulation,  all  the  blood  re- 
turned to  the  heart,  whether  from  the  embryo,  the  placenta  or 
the  vitelline  sac,  is  emptied  into  the  sinus  venosus,  from  which 
it  passes  into  the  cavity  of  the  common  auricle.  In  this  way  a 
complete  mixture  of  the  blood  from  all  sources  necessarily 
occurs.  This  mixed  blood  is  then  forced  out  by  the  auricle, 
through  the  truncus  arteriosus,  toward  the  head  of  the  fetus. 

The  sinus  venosus  later  becomes  a  part  of  the  auricle  and  into 
it  empty  the  Cuvierian  veins  and  the  posterior  vena  cava.  The 
septum  between  the  two  auricles  is  gradually  formed,  but  there 
remains  the  foramen  ovale,  through  which  the  blood  can  pass 
with  more  or  less  freedom.  The  posterior  vena  cava  opens  very 
near  to  the  foramen  ovale  and  a  small  valve  at  this  point  tends 
to  cause  the  blood  to  flow  from  the  posterior  vena  cava  to  the 
left  auricle,  by  way  of  the  foramen.  In  this  way,  considerable 
admixture  of  blood  from  the  three  different  vessels  still  ensues. 
Later,  as  the  left  Cuvierian  vein  disappears,  the  blood  from  the 
head  and  anterior  limbs  is  all  returned  through  the  right  vein, 
or  anterior  vena  cava,  .so  that  there  are  now  only  two  vessels, 
both  of  which  empty  into  the  right  auricle.  At  this  period,  the 
blood  which  enters  the  auricle  from  the  anterior  vena  cava,  com- 
ing from,  the  head  and  both  fore-limbs,  is  entirely  venous  in 
character,  while  that  from  the  posterior  vena  cava  is  chiefly 
arterial,  or  red,  blood  coming  irom  the  placenta,  with  a  small 
portion  of  venous  blood  added  from  the  posterior  limbs  and 
other  parts  of  the  body. 

By  an  elaboration  of  the  valve  in  the  foramen  ovale  and  a 
valvular  fold  at  the  opening  of  the  posterior  vena  cava,  the 
blood  from  this  vein  is  finally  all  carried  directly  across  the 
right  auricle  into  the  left  auricular  chamber. 

The  right  auricle  now  receives  blood  from  the  anterior  and 
posterior  vena  cavse  and  a  small  amount  from  the  coronary 
sinus.  The  blood  comes  respectively  from  the  head  and  fore- 
limbs,  from  the  hinder  part  of  the  body,  the  placenta,  the  intes- 
tine and  the  liver  and  from  the  walls  of  the  heart  itself.  The 
blood  entering  the  heart  through  the  posterior  vena  cava  de- 
serves special  consideration.  The  right  allantoic  vein  disappears 
early  in  fetal  life,  while  the  left  persists    and  enters    the  body 


The  Fetal.  Circulation  329 

through  the  umbilicus,  to  pass  forward  to  the  posterior  border 
of  the  liver,  where  it  unites  with  the  hepatic  portal  vein,  so  that 
the  combined  vessel  now  carries  blood  from  the  intestine,  from 
the  vitelline  veins  of  the  earlier  period  and  from  the  placenta. 

For  a  period  of  time,  generall}^  extending  to  the  date  of  birth, 
the  blood  may  pass  either  through  the  capillary  system  of  the 
liver  or,  entering  the  ductus  venosus,  may  pass  directly  to  the 
posterior  vena  cava  without  going  through  that  gland. 

The  blood  which  is  carried  to  the  heart  by  the  posterior  vena 
cava  is  largely  arterial  in  character,  that  is,  it  has  given  up  its 
carbon  dioxide  and  other  waste  material  in  the  placenta  and  has 
derived,  from  the  blood  of  the  mother,  oxygen  and  nutritive 
materials,  which  these  veins  carry  to  the  heart.  Into  this 
posterior  vena  cava,  there  also  enters  the  blood  which  has  been 
to  some  degree  favorably  modified  by  passing  through  the  kidneys 
and  the  liver,  in  which  glands  certain  deleterious  substances 
have  been  removed.  The  blood  from  the  posterior  vena  cava 
consequently  presents  a  marked  contrast  to  that  from  the  anterior 
vessel,  which  returns  only  the  blood  sent  through  the  arteries  to 
the  head,  neck  and  anterior  limbs  after  it  has  performed  its 
nutritive  office  to  those  parts  and,  consequently,  comes  back 
charged  with  waste  materials,  without  having  received  in  its 
course  any  additional  nutrient  matter  or  having  undergone  any 
purification  in  passing  through  the  tissues  or  organs.  The 
blood  brought  by  the  anterior  vena  cava  passes  into  the  right 
auricle  and  thence  into  the  right  ventricle,  from  which  it  is 
driven  along  the  pulmonary  artery.  Since  the  lungs  are  not  yet 
functioning,  only  a  small  portion  of  it  enters  these  organs  and 
virtually  all  of  it  pas.ses  through  the  ductus  arteriosus  to  the 
dorsal,  or  posterior,  aorta.  Connecting  with  the  latter  at  an 
acute  angle,  the  blood  is  directed  backward  toward  the  posterior 
part  of  the  body,  whence  it  largely  passes  to  the  placenta,  through 
the  umbilical  arteries,  where  it  is  relieved  of  its  waste  matters 
and,  in  exchange,  receives  oxygen  and  nutrient  material.  On 
the  return  of  this  arterial  blood  from  the  placental  capillaries, 
along  the  umbilic  veins,  with  its  small  admixture  of  venous 
blood  along  with  that  which  has  been  somewhat  modified  by 
passing  through  the  kidneys  and  liver,  it  re-enters  the  right 
auricle,  to  at  once  pass  over  into  the  left  auricle  and  thence  into 


330  Veterinary  Obstetrics 

the  left  ventricle.  From  this  latter  cavit3%  it  is  driven  along  the 
common  aorta  until  it  reaches  the  carotid  and  subclavian  arteries, 
through  which  it  is  carried  almost  wholly  to  the  head  and  an- 
terior limbs. 

While  the  aorta  is  freely  open  from  the  heart  along  the  poster- 
ior aorta  toward  the  posterior  portions  of  the  body,  it  seems  that 
very  little  of  the  blood  from  the  left  ventricle  passes  backward. 
This  is  largel}^  because  the  blood  from  the  right  ventricle, 
which,  at  this  period,  is  as  strong  as  the  left,  has  already  filled 
that  portion  of  the  po.sterior  aorta  posterior  to  the  juncture  of 
the  ductus  arteriosus  with  that  vessel.  Consequently,  the  blood 
pressure  in  the  two  portions  of  the  vessel  is  approximately  equal, 
so  that  there  is  as  great  a  tendency  for  the  blood  from  the  right 
ventricle  to  pass  forward  from  the  ductus  arteriosus  as  for  that 
from  the  left  to  pa.ss  backward  from  the  opening  of  the  ductus 
arteriosus  when  propelled  through  the  common  aorta. 

In  some  cases,  it  has  been  found  that  the  aorta  has  become 
obliterated  during  embryonic  life  at  a  point  just  anterior  to  its 
juncture  with  the  ductus  arteriosus  and  posterior  to  the  fourth 
aortic  arch,  so  that  all  the  blood  to  the  posterior  end  of  the  fetus 
must  pass  through  this  vessel.  This  condition  of  independent 
anterior  and  posterior  circulations  has  not  interfered  with  the 
development  of  the  fetus,  but,  at  the  time  of  birth,  the  circulation 
is  at  once  blocked  to  all  the  posterior  portions  of  the  body,  so  that 
the  new-born  young  must  promptly  perish. 

The  plan  of  the  fetal  circulation  is  in  a  measure  the  reverse  of 
that  after  birth,  the  purified  or  red  blood  coming  from  the  pla- 
centa along  the  posterior  systemic  veins  to  the  right  auricle, 
thence  pa.ssing  largely  to  the  head,  neck  and  anterior  limbs 
through  the  right  ventricle,  ductus  arteriosus,  carotid  and  sub- 
clavian arteries.  This  would  suggest  .that  the  head  received 
purer  blood  of  higher  nutritive  value  and  that,  consequently,  the 
head  end  of  the  fetus  should  develop  most  rapidly.  In  the  earlier 
stages  of  fetal  life,  this  apparently  holds  true  but  later,  in  the 
larger  herbivora  at  least,  the  development  of  each  of  the  two 
ends  of  the  body  becomes  approximately  equal.  Throughout 
fetal  life,  the  blood  of  the  entire  body  is  of  a  mixed  character, 
the  red  blood  of  the  umbilic  veins  becoming  mixed  with  venous 
blood  before  reaching  the  heart. 


The  Fetal  Circidatioyi  331 

Prior  to  birth,  the  vitelline  vessels  have  disappeared  except  in 
so  far  as  the}^  have  persisted  as  portions  of  other  vessels  within 
the  body.  As  soon  as  birth  takes  place  and  the  umbilical  cord 
is  ruptured  or  the  placenta  detached  from  the  uterus,  the  allantoic 
circulation  must  abruptly  cease,  while  the  pulmonary  circulation 
must  be  promptly  established  because  the  respiratory  functions 
have  been  shifted  from  the  placenta  to  the  lungs. 

As  soon  as  the  animal  begins  to  breathe,  the  lungs  must  at 
once  commence  to  function  and,  while,  prior  to  birth,  no  blood 
of  any  note  has  passed  through  the  pulmonary  arteries  and  capil- 
laries, they  must  now  promptly  become  active.  In  order  that 
the  blood  from  the  right  ventricle  shall  pass  through  the  pulmon- 
ary arteries  to  the  lungs,  instead  of  through  the  ductus  arteri- 
osus into  the  aorta,  it  is  essential  that  the  latter  becomes 
promptly  obliterated. 

The  rupture  of  the  umbilical  cord  finally  interrupts  the  pla- 
cental circulation  and  renders  useless  all  those  vessels  within  the 
fetal  body  whose  sole  office  was  dependent  upon  the  fetal  circu- 
lation. To  this  end,  the  intra-fetal  portion  of  the  umbilical 
vein,  with  the  ductus  venosus,  needs  to  close  and  disappear. 
Vestiges  of  the  umbilical  vein  persist,  but  its  channel  becomes 
occluded  within  a  very  few  da3'S  after  birth,  unless  interrupted 
by  disease  processes.  The  allantoic,  or  umbilical,  arteries  must 
likewise  undergo  a  partial  degeneration  and  complete  loss  of 
function.  When  ruptured  in  the  natural  way,  they  usually  part 
just  outside  the  abdomen,  though  some  writers  (Carsten- Harms) 
allege  that  these  arteries  occasionally  rupture  within  the  ab- 
dominal cavit}',  especially  in  the  cow.  This  is  not  wholly  clear 
and  is  .somewhat  difficult  of  proof.  In  the  foal,  where  it  is 
generally  admitted  that  they  divide  outside  the  abdominal  cavity, 
the  torn  ends  promptly  retract  within  the  bod}'  and,  dragging 
with  them  the  connective  tissue  surrounding  their  walls, 
normally  retreat  from  the  surface  in  such  a  manner  as  to  pre- 
clude the  possibility  of  hemorrhage  and  to  greatly  diminish  any 
danger  from  infection  in  these  vessels.  (See  Fig.  56.)  A 
little  later  their  ruptured  ends  retract  to  the  vicinity  of  the 
anterior  portion,  or  fundus,  of  the  urinary  bladder,  from  whence 
they  may  be  traced  throughout  life  as  connective  tissue  cords, 
passing  from  this  point  to  the  internal  iliac  arteries  to  constitute 
the  round  ligaments  of  the  bladder  of  the  adult. 


THE      DEVELOPMENT      OF      THE      URINO-GENITAL 
SYSTEM. 

The  urinary  and  genital  sj'Stems  are  closely  allied  in  their 
origin  and  are  both  preceded  by  the  Wolffian  bodies  and  ducts, 
which  for  a  time  perform  the  excretory  office  of  the  kidneys  and 
finall}^  take  prominent  parts  in  the  origin  of  both  the  urinary 
and  genital  organs. 

The  Wolffian   Ducts  and  Wolffian  Bodies. 

The  Wolffian  ducts  are  claimed  by  some  embryologists  to  orig- 
inate, as  a  pair  of  longitudinal  grooves,  in  the  epiblast  on  the 
lateral  surface  of  the  body,  at  about  the  level  of  the  notochord 
or  somewhat  below.  The  invaginations  of  epiblast  continue  to 
sink  inward  into  the  me.soblast  of  the  somatopleure  until  they 
attain  the  inner  surface  of  the  body  cavity,  in  contact  with  the 
peritoneum.  Other  investigators,  and  apparently  the  majority, 
hold  that  the  Wolffian  ducts  are  wholly  of  mesoblastic  origin, 
though  at  first  lying  immediately  against  the  epiblast,  as  solid 
rods;  which  later  become  excavated  in  their  center  to  constitute 
their  cavity.  For  a  time  the  Wolffian  ducts  end  blindly  be- 
hind, but  later  they  open  into  the  cloaca. 

The  Wolffian  bodies  are  first  recognizable,  during  the  third 
week  of  the  embryo,  as  longitudinal  thickenings  in  the  dorsal 
surface  of  the  body  cavity,  there  being  one  of  these  ridges  on 
either  side  of  the  mesentery.  They  develop  rapidly  and  become 
greatly  elongated  so  that  they  soon  reach  from  the  posterior  por- 
tion of  the  cervical  region  back  to  the  end  of  the  lumbar  region. 

The  essential  tissues  of  the  Wolffian  bodies  appear  to  develop, 
independently  of  the  Wolffian  ducts,  from  the  mesoblast,  in  the 
form  of  rods  and  cells.  The  rods  coil  somewhat  upon  them- 
selves and  become  excavated  to  constitute  tubes  and,  growing 
toward  the  Wolffian  duct,  empty  into  it  at  one  end,  while  the 
other  end  becomes  dilated,  and  then  invaginated,  to  constitute 
the  Malphigian  bodies,  or  glomeruli.  Into  these  glomeruli, 
branches  of  the  aorta  penetrate  to  furnish  the  functional  blood 
supply.  The  veins  from  these  glands  empty  into  the  posterior 
cardinal  veins. 
332 


Fig.  55  C. 


Fig.  55  A. 


FIG.  50,  A,  B,  C.     Parovarian  Tumor  of  Mare,  Incarcerating 
Rectum. 

.\,  View  from  right  side  with  a  tumor,  T,  almost  hidden  by  the  con- 
striction caused  by  the  pedicle.  B,  View  from  left  side,  the  tumor  ex- 
posed by  cutting  away  part  of  mesentery.  C,  Schematic  illustration 
of  method  of  incarceration.  I,  Intestine.  M,  Mesentery,  O,  Ovary. 
T,   Parovarian  tumor  or  cyst.     P,  Pedicle  of  tumor.     R,  Rectum. 


FIG.   55  B. 


334  Veterinary  Obstetrics 

Later  the  Wolffian  bodies  commence  to  degenerate  and»atrophy 
and  finally  the  essential  tissues  of  the  organs  almost  wholly 
disappear  and  the  Wolffian  bodies,  with  their  ducts,  become 
concerned  in  the  origin  of  accessory  portions  of  the  reproductive 
apparatus. 

In  the  female,  the  Wolffian  bodies  play  no  important  part  in 
the  formation  of  the  ovaries,  but  they  send  some  outgrowths 
into  these  glands,  which  persist  for  a  time  without  playing  any 
essential  part.  vSome  remnants  of  the  Wolffian  bodies  persist, 
however,  as  the  parovarium,  or  organ  of  Ro.senmueller,  and  from 
these  vestigial  portions  of  the  Wolffian  body  the  large  peduncu- 
lated cystic  tumors,  occasionally  .seen  in  the  mare,  appear  to 
arise.  In  rare  cases  these  pedunculated  par-ovarian  tumors  be- 
come looped  about  the  rectum,  inducing  fatal  incarceration,  as 
shown  in  Fig.  55. 

In  the  female,  some  traces  of  the  Wolffian  duct  may  remain  at 
its  anterior  end.  In  its  posterior  portion  we  do  not  observe 
remains  of  this  duct  in  most  animals,  but,  in  the  cow,  the^^ 
usually  persist  as  Gaertner's  canals,  which  sometimes  become 
blocked  at  their  mouths  to  constitute  retention  cy.sts.  These 
present  themselves  as  elongated  sacs,  arising  close  to  the  meatus 
urinarius  on  either  side  and  extending  upward  and  forward  along 
the  walls  of  the  vagina.  When  they  become  very  greatly  dis- 
tended, they  serve  to  interfere  with  copulation  and,  if  very  large, 
possibly  with  parturition. 

The  Wolffian  bodies  largely  di.sappear  in  the  male  but  take  a 
somewhat  prominent  part  in  the  formation  of  the  testicles  and 
thus  in  part  persist  throughout  life.  Tubules  grow  out  from 
the  Wolffian  tubules  in  the  anterior  part  of  the  Wolffian  bodies 
and  finally  enter  the  substance  of  the  testicle  to  constitute  the 
vasa  eflFerentia,  which  eventually  become  connected  wntli  the 
seminal  tubes.  The  coni  vasculosi  are  derived  from  the  anterior 
Wolffian  tubules  and  the  Wolffian  duct  is  finally  converted  into 
the  epididymis  and  vas  deferens. 

The  Kidneys,  Ureters  and  Bladder. 
Before  the  disappearance  of  the  Wolffian  body,  there  appears 
tow^ard  the  po.sterior  end  of  the  Wolffian  duct  an  outgrowth  or 
diverticulum,  which  is  later  to  constitute  the  ureter  and  which, 
passing  backward  toward  the  cloaca,  finally  acquires  an  inde- 
pendent opening  a  little  way  behind  that  of  the  Wolffian  duct. 


The  Reprodjutivc  Organs  335 

At  the  anterior  end,  this  infundibulum  grows  forward  beneath 
the  Wolffian  body  and  dilates  to  form  a  sac  which  is  to  constitute 
the  pelvis  of  the*  kidney,  while,  from  its  walls,  a  number  of 
branching  tubules  grow  out  to  constitute  the  uninary  tubules 
and,  at  their  ends,  they  enlarge  to  constitute  the  glomeruli  of 
the  kidney. 

At  the  point  of  communication  between  the  ureter  and  the 
allantois  the  latter  tube  becomes  dilated  to  constitute  the  urinary 
bladder.  Behind,  the  allantois  is  constricted  to  constitute  the 
urethra,  while,  in  front,  the  narrowed  portion  which  pas.ses  out 
through  the  umbilicus  is  known  as  the  urachus.  During  the 
life  of  the  fetus,  the  urine  chiefly  passes  through  the  urachus, 
which  opening  normally  closes  at  the  time  of  birth.    " 

The  Reproductive  Organs. 

The  development  of  the  reproductive  organs  of  the  female  has 
already  been  described  on  page  11,  to  which  the  reader  is  re- 
ferred. The}-  undergo  many  aberrations  in  their  development, 
due  to  arrests,  some  of  which  have  alread}-  been  noted  on  page 
247.  Fig.  51  on  page  323  illustrates  an  interesting  form  of 
arrested  development  of  the  uterus  and  vagina,  in  which  these 
organs  are  represented  by  enlarged,  solid  cords. 

The  Male  Reproductive  Organs. 
The  Testicles. 

The  testes  form,  like  the  ovaries,  in  the  genital  ridges  and  in 
the  earliest  stages  the  mode  of  origin  or  development  can  not  be 
differentiated  in  the  two  sexes.  Later  the  differentiation  occurs 
through  the  development  of  some  parts  of  the  undifferentiated 
genital  gland  and  the  atrophy  of  others.  The  Wolffian  bodies 
and  ducts  play  an  important  part  in  the  development  of  the  ex- 
cretory apparatus  of  the  testicles.  In  the  indifferent  gland  the 
mesoblastic  cells  become  grouped  in  cords  containing  small 
cells,  along  with  the  larger  and  more  numerous  primitive 
sexual  cells.  These  sexual  cords  are  formed  from  the  roundish 
masses  of  cells,  separated  from  each  other  by  connective  tissue 
sheaths.  They  eventually  become  elongated  and  hollowed  out  to 
constitute  the  seminiferous  tubules. 

From  the  Wolffian  bodies,  cell  cords  grow  out  and  fuse  with 
the  semeniferous  tubules  to  constitute  the  vasa  recta  and  rete 


336  V^eterinary  Obstetrics 

testes  and  the  latter,  by  further  growth,  form  the  head  of  the 
epididymis.  The  upper,  or  anterior,  end  of  the  Wolffian  duct  is 
modified  to  constitute  the  body  and  tail  of  the  epididymis,  while 
the  posterior  portions  form  the  vas  deferens,  seminal  vesicle  and 
ejaculator}'  duct. 

Early  in  fetal  life,  the  developing  testicle  shifts  its  location 
from  its  primary  lumbar  position  toward  its  final  normal  resting 
place,  in  most  animals  in  the  scrotum.  Formed  in  the  per- 
itoneum of  the  body  wall  in  the  sub-lumbar  region,  the  gland  is 
outside  or  behind  the  parietal  peritoneum  and,  as  it  shifts  its  po- 
sition and  descends  into  the  cavity  of  the  abdomen  toward  the  in- 
ternal abdominal  ring,  it  necessarily  carries  with  it  a  peritoneal 
covering  and  remains  attached  to  its  point  of  origin  by  a  double 
peritoneal  fold,  mesentery  or  mesorchon,  between  which  its  vessels 
and  nerves  pass. 

In  the  formation  of  the  Wolffian  body,  there  arises,  in  con- 
nection with  it,  the  inguinal  ligament,  which  pas.ses  from  the 
fundus  of  the  .scrotum  through  the  inguinal  ring  up  to  the 
Wolffian  body.  When  this  atrophies  and  di.sappears,  the  cord 
persists  and  maintains  a  connection  with  the  te.sticle,  as  the 
gubernacuhini  testis,  or  with  the  ovar}-,  as  the  round  ligament. 
The  gubernaculum  testis  consists  of  connective  tissue  and  un- 
striped  muscle  fibers,  surrounded  by  peritoneal  coverings.  Since 
the  testicle,  the  gubernaculum  testis,  and  the  vas  deferens,  origi- 
nating from  the  Wolffian  duct,  form  outside  of  or  behind  the 
peritoneum,  as  the  organ  descends  each  of  the  three  structures 
must  drag  with  it  a  double  peritoneal  fold,  so  that  finally  there 
appear  three  peritoneal  folds,  as  shown  in  Figs.  56  and  57  :  one  for 
the  testicle  and  its  artery,  A  ;  one  for  the  vas  deferens,  V,  and  a 
third  for  the  gubernaculum  testis,  G,  G',  and  G",  all  of  which 
are  continuous. 

As  the  organ  continues  to  descend  toward  the  inguinal  ring, 
the  peritoneum  of  the  abdominal  floor,  which  stretches  across  the 
ring,  evaginates  through  it  as  the  processus  vaginalis  at  P.  in 
Figs.  56  and  57,  into  which  pouch  the  epididymis,  E,  descends, 
followed  later  by  the  gland,  T.  The  testis  having  formed  on 
the  median  side  of  the  Wolffian  duct,  which  later  forms  the 
epididymis,  the  two  structures  maintain  this  original  relation 
throughout  and,  when  the  testicle  comes  to  rest  in  the  scrotum, 


The  Reproductive  Organs 


337 


the  epididymis  lies  upon  its  external  face,  above  the  gland.  The 
relation  as  to  elevation  between  the  testicle  and  epididymis  be- 
comes reversed.  In  the  abdomen,  processus  vaginalis  and  in- 
guinal canal,  the  epididymis  is  beneath  the  testicle  and  precedes 
it  in  the  descent  but,  when  the  testicle  finally  reaches  the  bottom 
of  the  scrotum,  it  performs  a  partial  revolution  forwards  on  its 
long  axis,  which  reverses  the  relation  and  brings  the  epididymis 


Fig.  56.     Genitourinary  system  of  a  foal,  24  hrs.  old,  to  illustrate  descent 
of  testicles  and  behavior  of  ruptured  unibilic  arteries. 

The  central  portion  of  the  abdominal  floor  has  been   partly  excised  and 
laid  back.     Seen  from  below. 

T,  Testicle.     A,  Artery  of  testicle.     G,  (iubernaculum  te.stis.     V.  Vas  def- 
erens.    B,  Bladder.     UA,  Ruptured  ends  of  umbilic  arteries  retracted  within 
abdomen.     P,  Processus  vaginalis      UV,  UmV)ilic  artery. 
22 


338 


Veterinary  Obstetrics 


above  the  testicle  in  the  horse.  In  ruminants,  this  reversal  of 
relation  does  not  occur,  as  the  long  diameter  remains  perpendicu- 
lar. The  processus  vaginalis  remains  normally  open  throughout 
life  in  the  domestic  animals,  but  in  the  adult  it  is  so  narrow  that 
abdominal  viscera  may  not  escape  through  it. 

When  the  testicle  has  descended  into  the  scrotum,  it  is  attached 
posteriorly  at  the  bottom  to  the  fundus  of  the  sac  by  the  guber- 
naculum  and  upwards  along  the  posterior  wall  of  the  scrotum  and 
inguinal  canal  by  the  frenum,  consi.sting  of  the  peritoneal  dupli- 
cature  between  V  and  G  in  Fig.  57  ;  above,  the  gland  is  connected 
by  means  of  the  testicular  or  spermatic  cord,  consisting  of  the 
vas  deferens,  arteries,  veins  and  lymphatics  covered  by  peritoneum. 
In  the  foal,  pig,  and  more  rarely  in  other  species,  at  the  time  of 
birth,  we  frequently  meet  with  a  hernia  (congenital  scrotal 
hernia)  of  intestines  or  omentum  through  an  abnormally  large 
processus  vaginalis,  alongside  the  spermatic  cord. 


UA<::^ 


Fig.  57.     Right  Inguinai,  Region  of  Foai.,  24  Hrs.  Old 
Illustrating  descent   of   testicle,   viewed  from  below,    the  testicle 

lifted  upwards  to  reveal  attachmeuts. 
P,  Processus  vaginalis,  surrounded  by  a  dotted  line  and  contain- 
ing a  curved  sound,  S.  G,  Gubernaculuin  testis  emerging  from 
the  internal  inguinal  ring  and  reaching  to  the  larger  portion, 
G'',  which  extends  to  the  epididymis,  E,  and  is  succeeded  by 
the  final  or  third  section  of  the  gubernaculum,  G^'.  reaching 
from  E  to  the  testicle,  T. 
A,  Artery  of  testicle.  V,  Vas  deferens.  H,  Hladder.  UA,  Um- 
bilic  arteries. 


The  Repi'odtidive  Organs  339 

In  some  instances,  the  epididymis,  E,  Fig.  57,  descends  into 
the  scrotal  sac,  while  the  gland  remains  in  the  abdomen  or  in- 
carcerated in  the  internal  ring.  Far  more  frequenth^  both  gland 
and  epididymis  are  retained  within  the  peritoneal  cavity  to  con- 
stitute cryptorchidy.  The  successful  castration  of  cryptorchid 
animals  depends  fundamentally  upon  a  practical  knowledge  of 
the  track  and  mode  of  descent  of  the  testicle,  and  of  itsattachments, 
through  the  medium  of  the  gubernaculum  testis,  vas  deferens 
and  testicular  artery. 

The  Wolflfian  ducts  open  early,  at  their  posterior  ends,  into  the 
terminal  portion  of  the  allantoic  stalk,  which  is  later  to  consti- 
tute the  urethra,  which,  in  the  male,  elongates  backward  to  ex- 
tend to  the  distal  end  of  the  penis.  The  penis  of  the  male  and 
clitoris  of  the  female  arise  alike  as  outgrowths  from  the  ischial 
arch  ;  in  the  female  it  stops  short  in  its  growth  as  a  non-essen- 
tial erectile  organ,  without  acquiring  any  relationship  with  the 
urethra,  while,  in  the  male,  it  becomes  greatly  elongated  and, 
curving  downwards  and  then  forwards,  passes  between  the  thighs 
to  end  in  a  .special  sheath  and  prepuce.  The  urethra  extends 
throughout  its  entire  length  to  open  at  the  extremity  of  the  glans 
penis. 

Arrests  or  aberrations  in  development  of  the  penis  occur,  con- 
sisting usually  of  an  abbreviation  in  its  length,  suggesting  a 
graduation  in  extent  between  a  normal  penis  and  clitoris. 
Sometimes  the  defective  penis  is  directed  more  or  less  backwards, 
leading  to  a  backward  direction  of  the  urinary  stream.  In  other 
instances,  the  formation  of  the  urethra  is  aberrant  and  it  opens 
at  the  ischial  arch  or  lower  down  along  the  penis,  to  constitute 
hypospadius  or  epispadius. 

Defects  in  the  development  of  the  penis  and  clitoris  are  largely 
associated  with  aberrations  in  the  essential  genital  organs  them- 
selves, partaking  more  or  less  of  hermaphroditism  or  bi-sexual 
character.  Hermaphroditism  varies  greatly  in  character  and 
extent  and  tends  largely  to  follow  certain  types  for  each  species 
of  animals.  In  the  horse,  it  is  not  rare  to  meet  with  an  animal 
having  a  well  developed  vulva,  vagina  and  uterus,  the  vulva 
and  vagina  functioning,  the  latter  ballooning  under  manual  ex- 
ploration, as  in  a  normal  mare.  No  ovaries  are  present  but, 
instead,    typical  cryptorchid    testicles    producing    the    ordinary 


The  Limbs 


341 


cryptorchid  sexual  reflex,  a  male  voice,  form  and  behavior. 
Such  a  case  was  readily  castrated  by  us  through  the  ample 
vagina  in  the  same  manner  as  spaying  a  mare.  (Fig.  58).  The 
elongated  clitoris,  which  projected  2  or  3  inches  beyond  the 
vulva,  was  amputated.  The  udder  was  well  developed.  In 
other  cases  in  the  horse,  we  have  observed  well  developed  mam- 
m«  with  testicles  resting  just  above  and  to  the  outer  side  of 
them,  an  abbreviated  penis  and  no  vulva.  Between  these  types 
various  gradations  appear.  In  a  boar,  as  shown  in  Fig.  14,  we 
found  a  male  gland  (testicle)  on  one  side  and  a  female,  (ovary) 
on  the  other. 

The  Limbs. 

In  a  rabbit  eml^ryo  of  about  the  tenth  day,  the  mesoblastic 
cells  on  either  side  of  the  notochord  become  grouped  into  cuboid- 
al  masses,  divided  from  each  other  by  transverse  lines,  which 
are  known  as  somites  or  primitive  segments.  The  first  pair  ap- 
pears in  the  cervical  region  prior  to  the  closure  of  the  neural 
tube  and  additional  somites  appear,  extending  forward  toward 
the  head  end  and  backward  toward  the  tail.      From  these  somites 


Fig.  59.  Rabbit  embryo  of  the  ninth  .lay  ;  seen  from  the  donsal 
side  (after  Kolliker.)     X^i.  . 

stz.  Stem  zone,  pz.  Parietal  zone.  In  the  stem  zone  S  pairs  of 
somites  appear  on  either  side  of  the  chorda  dorsahs  and  nenral 
tube. 

ap.  Area  pellucida.     rf,  Medullary  groove,     vh,  Fore-bram. 

ab.  Eye  vesicle,     mh,  ]Mid-brain.     hb.  Hind-brain. 

uw.  Primitive  segment,     h.  Heart. 

ph,  Pericardial  portion  of  body  cavity. 

vd.  Margin  of  entrance  to  foregut.     af,  Amniotic  fold. 


Vena  omphalo-mesentenca. 


Heisler). 


342 


Veterhiary  Obstetrics 


md 


Fig.  6o.    Human  Embryo  of  aholt  2S  days,  showing  limb  buds.  (His). 

I  to  V,  Brain  vesicles,  f ,  F,  P,  f^  Cephalic,  cervical,  dorsal  and 
lumbar  flexures,  op,  Eye.  ot.  Otic  vesicle,  ol,  Olfactory  pit. 
mx,  md,  Maxillary  and  mandibular  processes  of  first  visceral 
arch,  sp,  Sinus  precervicalis.  h',h'-',  Heart.  1,  1',  Limbs,  als, 
Allantoic  stalk,     ch,  Villous  chorion.  (Heisler. ) 


The  Limbs 


343 


Fk;.  6 1 


Peromklus  Apu; 


Gurlt). 


^^    jem 

pp^^     "— - 

X           i^ 

^r^^"" 

.%^. 

^f   ^k 

fc 

^ 

j7      i4 

w^              ^^r 

Fic.  62.     PERo:\iKLrs  Achircs,  Foal. 


later  arise  the  vertebral  column,    the   skeletal   muscles,    tendons 
and  ligaments  and  the  corium,  or  deeper  layer  of  the  skin. 

The  formation  of  the  limbs  begins  as  small  buds,  or  outgrowths, 
arising  from  the  me-soblastic  .somites  soon  after  the  third  week  in 
the  human  embryo,  earlier  in  the  rabbit  and  probably  in  most  of 
our  domestic  mammals.  The  limb-buds  each  represent  several 
mesoblastic  somites,  as  indicated  by  the  fact  that  the  nerves  pass- 
ing to  each  limb  are  formed  by  the  union  of  branches   from   ,sev- 


344  Veteritiary  Obstetrics 

eral  intervertebral  nerves,  each  vertebra  representing  a  somite. 
The  buds  lengthen  to  constitute  the  limbs,  the  bones  arising  from 
the  connective  tissue,  while  the  muscles  develop  from  the  muscle 
plates  of  the  mesoblast.  The  segments  of  the  limbs  are  brought 
about  by  transverse  grooves  where  the  joints  are  later  to  form 
and  the  digitations  begin  as  longitudinal  grooves,  which  deepen 
into  clefts. 

Various  aberrations  in  the  development  of  the  limits  occur  in 
our  domestic  animals.  Merely  the  buds  may  appearand,  within 
them,  rudimentary  bones  representing  the  scapula  and  pelvis 
or,  more  or  less  also,  the  humerus  and  femur,  but  the  other 
parts  may  fail  of  development.  Any  one,  or  all,  of  the 
limbs  may  be  wanting.  Fig.  61  represents  the  skeleton  of  a 
bovine  fetus  without  limbs  (Peromelus  Apus),  while  Fig.  62 
represents  a  foal,  in  which  the  two  anterior  limbs  are  wanting 
(Peromelus  Achirus. )  In  such  cases  the  defect  is  apparently 
due  to  an  arrest  in  the  development  of  the  limb-buds  during  the 
first  month  of  pregnanc3\  Between  this  absence  of  limbs  and 
their  normal  development  occurs  every  gradation  of  arrest  in 
the  development  of  limbs,  as  peromelus  micromelus  or  dwarf 
limbs.  Rarely  a  limb  may  undergo  amputation  during  its  early 
stages  of  development  by  becoming  involved  in  a  loop  of  the 
umbilical  cord. 

A  more  common  aberration  in  the  limbs  and  feet  is  abnormal 
fission,  by  which  the  entire  limb  or  its  digitations  become  multi- 
plied. Most  commonly,  only  the  digits  are  involved,  resulting 
in  one  or  more  extra  digits,  as  shown  in  Figs.  63  and  64. 

Sometimes  a  greater  part  of  the  limb  is  involved  in  the  ab- 
normal fission.  Rarely  normal  fission  fails  in  those  animals  nat- 
urally provided  with  two  or  more  digits  or,  after  their  more  or 
less  complete  fission,  fusion  occurs  between  them  and  the  animal 
is  born  with  less  toes  than  normal. 

Rarely,  in  the  development  of  the  limbs,  a  tendency  is  shown 
toward  the  addition  of  an  element  not  normally  present  in  the 
genus  but  regularly  occurring  in  some  other  genera,  as  is  illustrated 
in  well  developed  clavicles  in  the  pig,  as  shown  in  Fig.  65. 


The  Li  III  Ik 


345 


Fig.   63.       Mkgalomkh's 
Pkrissodactvlus.      Pic. 


Fk-,.  64. 

MKC\I,OMELr.S    I'KRIS.SODACTVI.r.S.       FoAL. 


Fk;.  65.     HuMKKi  OF  Pk;,  with  Claviclh-mkic   Oitckowth.^ 


346 


Veterinary  Obstetrics 


l-iG.  66  A 


Fig.  66.  A,  Foal  with 
bent  anterior  meta- 
carpal bones,  show- 
ing extreme  dorsal 
flexion  of  metacar- 
po-phalangeal  arti- 
culations. 

n,  Rent  metacarpi 
from  A. 


Fig.  66  B. 
The  limbs  are  furthermore  subject  to  a  variety  of  contractures, 
.sometimes  involving  a  mi.sdirection  of  the  limb  due  to  deformity 
of  the  articulations,  at  other  times  to  a  bend  in  the  bone  itself, 
as  shown  in  P"ig.  66  A  and  B. 


THE  FETAL  MEMBRANES  AND  THE  PLACENTA. 

The  maintenance  of  the  intra-uterine  existence  of  the  fetus, 
and  its  development  to  a  degree  which  will  enable  it  to  maintain 
a  more  or  less  independent  existence  at  the  time  of  birth,  requires 
that  effective  means  be  established  for  the  exchange  of  nutritive 
and  waste  materials  between  the  mother  and  her  young,  not 
alone  for  the  basic  purposes  of  nutrition  and  excretion,  but  also 
that  the  embryo  may  be  moored  or  fixed  at  a  given  point  in  the 
maternal  organ,  where  its  position  can  be  maintained  throughout 
the  duration  of  pregnancy  in  such  a  manner  as  to  best  protect 
and  insure  its  life  and  normal  growth.  To  this  end  there  are 
formed  three  structures  from  the  blastodermic  vesicle,  which 
undergo  changes  to  finally  constitute  the  fetal  membranes  and 
placenta. 

I.  The  Vitelline,  or  Yolk  Sac. 

When  the  embryo  commences  to  develop,  the  embr\'onic  area 
folds  inward  at  its  borders,  leading  to  a  constriction  between  this 
area  and  that  part  of  the  blastodermic  vesicle  which  lies  beyond, 
and  they  finally  become  separated  except  by  a  narrow  neck,  the 
vitelline  duct,  while,  beyond,  there  exists  the  comparatively 
large  vitelline  or  yolk  sac.  This  vitelline,  or  yolk,  sac  plays  but 
a  minor  part  in  the  development  of  the  embryo  and  tends  to 
more  or  less  completely  disappear,  according  to  species,  while  in 
some  it  persists  as  an  embryonal  vestige  to  the  time  of  birth.  In 
the  mare,  the  yolk  sac  is  very  inconspicuous  early  in  fetal  life 
and  disappears  almost  completely  at  a  very  early  stage.  In 
Fig.  74  this  general  plan  is  suggested  at  the  twenty-eight  day  of 
pregnancy,  while  in  Fig.  75  it  is  indicated  that,  at  five  months, 
it   has  well  nigh  disappeared. 

In  the  sheep,  as  shown  in  Fig.  76,  it  assumes  a  wholly  differ- 
ent form  and  undergoes  great  elongation.  In  other  of  our 
domestic  animals  there  are  variations  in  the  form  which  this  sac 
assumes,  but,  in  each  alike,  it  is  of  apparently  little  importance 
except  during  the  very  earliest  stages  of  embryonic  life. 

2.  The  Amnion. 
The  amnion  commences  to  form  as  soon   as  segmentation   has 
been  completed  and  the  ovum  has  passed   through   the   oviduct 
and  reached  the  uterus.     This  occurs  at  about  the  13th   or    14th 

347 


348 


Veterinary   Obstetrics 

rrimitiz'e  grooz'e. 


Entoderm. 

Fig.  67.     Transverse  section  of  the  embryonic  area  of  a  fourteen-and-a-half-day 
ovum  of  sheep.     (  Heisler,  after  Bonnet). 

Amnion. 


i'leu  roperica  r- 
dial  cavity. 

Fig.  68.     Transverse  section  of  a  sixteen-and-a-half-day  sheep-embryo. 
(Heisler,  after  Bonnet), 
day  of  gestation  in  the  embryo  of  the  .sheep  and  i.s  soon  complete. 
The  date  of  its  appearance  in  other  domestic  animals  is  approxi- 
mately the  same. 

The  amnion  ari.ses  from  the  extra-fetal  portion  of  the  somato- 
pleure,  which  folds  upward  around  the  margin  of  the  embryonic 
area  beneath  the  zona  pellucida,  or  prochorion.     It  forms  a  double 


The  Af 


349 


membrane  which,  by  contiuuing  to  grow  upward  and  converge, 
finally  meets  above  the  dorsal  surface  of  the  embryo  and  fuses. 
By  .the  fusion  there  is  formed  a  double  sac  which  envelops  the  fetus 
completely  except  at  its  point  of  origin  at  the  ventral  surface,  where 
it  takes  part  in  the  formation  of  the  umbilicus.  The  inner  of  these 
two  membranes  constitutes  the  true  amnion,  while  the  external  one 
forms  the  external  or  false  amnion  which,  fusing  with  or  re- 
placing the  prochorion,  forms  the  primitive  chorion  and  later, 
when] the  allantois  grows  out,  blends  with  it  to  contribute  to  the 
formation  of  the  permanent,  or  allantois- chorion.     This  outer,  or 

Medul/ary 


Notochoyd.  Sotiiite      Gut  entodertn. 

Fk;.  69.     Transverse  section  of  a  sixteen-and-a-half- da}'  sheep-embryo 
with  six  somites.      (  Heisler,  after  Bonnet). 

false,  amnion  is  merely  a  portion  of  the  external  wall  of  the 
blastodermic  vesicle,  without  its  relations  having  been  changed 
exteriorly.  The  .space  between  the  amnion  and  the  fetus  con- 
stitutes the  amniotic  cavity  and  is  filled  with  the  amniotic  fluid. 
As  the  amniotic  cavity  becomes  filled  with  fluid  and  enlarges, 
it  closely  invests  the  vitelline  stalk  and  the  allantoic  cord  in  its 
passage  through  this  cavity.  The  amount  of  liquor  amnii  varies 
greatly  in  different  animals  and  at  different  periods  of  pregnancy, 
but  it  is  generally  most  abundant  at  about  the  middle  of  gesta- 
tion. In  the  cow  and  mare  the  amount  of  amniotic  liquid  varies 
from  5-6  liters,  while,  in  the  .sheep,  according  to  St.  Q.yx  and 
Violet,  it  varies  between  100  and  500  grammes.  In  woman,  the 
amount  is  said  to  be  about  i  %  liters. 


350 


Veterinary  Obstetrics 


!         \ 

^^R-                            ^i>^^ 

J 

Exlra-  \\ 

^ 

^—^^^^—7^^' 

fetal      \ 
Coelom.  \ 

|l                    --- 

■trr:-- 

"%    ! 

i'              '■■' 

1     f' 

ViUlline  Duel 

ViUlline  Sac 

Cutaneous  Navel 

w 

Y     \: 

} 

A 

Amniotic  Navel 


Placental  Tu/ts 


Fig.  70.  Schematic  longitudinal  section  of  fetal  annexes  of 
mammalia.  At  the  points  indicated  by  +  the  skin  is  con- 
tinuous with  the  amnion.     (Bonnet). 


The  Amnion  351 

An  increase  of  this  fluid  constitutes  what  is  known  as  dropsy  of 
the  amnion,  which  accumulation,  in  the  cow,  may  sometimes  reach 
the  enormous  amount  of  20  or  more  gallons  and  prove  so  burden- 
some as  to  prevent  the  patient  from  arising  when  down,  because 
of  the  great  weight  of  the  accumulated  fluid.  (See  Dropsy  of 
the  Amnion.) 

In  some  cases,  especially  in  the  embryo  of  the  cow,  the 
amnion  apparently  becomes  contracted  during  the  early  stages  of 
its  formation  and  causes  an  eversion  of  the  somatopleuric  portion 
of  the  embryo,  resulting  in  the  condition  which  we  know  as 
fissura  ventralis  or  schistosontus  reflexiis.  In  this  deviation,  no 
body  cavity  is  formed  and  the  internal  viscera,  derived  from 
the  splanchnopleure,  lie  free  within  the  chorion.  In  other  words, 
the  constriction  and  infolding  of  the  splanchnopleure  to  constitute 
the  intestine  proceeds.  The  constriction  which  should  ex- 
ternally mark  the  division  between  the  fetal  and  vitelline  por- 
tions of  the  somatopleure,  to  constitute  the  umbilicus,  fails  to 
develop;  the  amnion  contracts;  the  spinal  axis  of  the  embryo 
bends  ventralwards,  in  a  way  pas.ses  out  through  the  non-con- 
stricted umbilic  area  and  the  embryo,  so  to  speak,  turns  inside- 
out.  The  spinal  axis  of  the  fetus  becomes  sharply  doubled 
dorsally  and  the  somatopleuric  portions  lie  as  a  partially  everted 
sac  with  its  peritoneal  surface  presenting  externally.  This  ab- 
normality constantly  causes  serious  difficulties  at  the  time  of 
parturition  and  frequently  taxes  the  resources  of  the  obstetrist 
to  overcome  them.  This  will  be  more  fully  considered  when 
dealing  with  dystocia.     vSee  Figs.  71  and  72. 

Other  interesting  defects  in  the  development  of  the  amnion 
occur,  one  of  the  most  frequent  being  adhesion  of  this  membrane 
to  the  epiblast  of  the  fetus,  largely  upon  the  head,  by  which, 
at  the  time  of  birth,  the  fusion  between  the  skin  of  the  fetus  and 
its  membranes  offers  an  important  or  serious  obstacle  to  its  ex- 
pulsion. 

The  liquor  amnii  contains  albumin,  sugar,  urea  and  other  ele- 
ments of  urine  and,  in  many  cases,  especially  in  the  foal,  also 
some  masses  of  meconium.  The  avenue  by  which  each  of  the  fluid 
substances  reaches  the  amniotic  cavity  has  not  been  fully  shown. 
Some  hold  that  the  fluid  transudes  into  the  cavity  from  the 
amnion  itself,   coming  indirecth'  of  course  from    the    blood    of 


Fl(i.  71-      SCHISTCOKMIS   REFLExrs.      (Gurlt. ) 


Fic;,  72.     vSchislocorinus  reflexus,  after  partial  eiiibryotoiny  to  oxer- 
come  (lyslokia. 

E,  Left  ear,  above  which  is  seen  the  ra(Hal  portion  of  the  left  carpus. 

F,  Rij^ht  antt  rior  foot.      R,  Ribs.     ,S,  vSternmn. 

PL,  Lacerated  area  where  posterior  limbs  have  been  torn  away. 


The  Allantois  353 

the  mother.  It  is  obvious  that  the  meconium  observed  in  the 
amniotic  fluid  of  the  foal  has  been  expelled  from  the  intestine 
through  the  anus  and  that,  the  anterior  end  of  the  alimentary  tract 
opening  also  into  this  cavity,  any  discharge  of  secretions  or 
debris  from  the  mouth  or  nostrils  falls  at  once  into  the  amniotic 
cavity.  It  is  also  clear  that  urine  may  be  readily  and  freely  ex- 
pelled into  this  cavity  and  that  the  urinary  salts  found  in  the 
amniotic  fluid  are  derived  from  the  fetal  kidneys  and  discharged 
into  the  amniotic  sac  through  the  urethra. 

The  amnion  consists,  on  the  embryonic  side,  of  a  thin  layer  of 
epiblast,  while,  on  the  outer  side,  it  is  formed  from  the  somato- 
pleuric  mesoblast.  The  external  surface  of  the  amnion  is  in 
contact  throughout  more  or  less  of  its  extent,  varying  according 
to  species,  with  the  inner  wall  of  the  allantois. 

The  Allantois. 

The  allantois  arises  as  an  evagination  from  the  hind  gut  just 
posterior  to  the  vitelline  duct  and  grows  outward  and  backward 
between  the  two  amniotic  layers,  and,  in  the  mare  and  carnivora, 
finally  envelops  the  amniotic  sac  completely,  so  that,  in  these 
animals,  there  occur  two  complete  envelopes  to  the  fetus, 
each  of  which  is  eventually  filled  with  fluid.      (See  Figs.  74,  75.) 

Tracing  the  allantois  from  its  origin  in  the  hind  gut,  there  is 
a  slight  constriction  which  is  to  constitute  the  urethra,  followed 
by  a  dilation  from  which  the  urinary  bladder  is  to  develop,  then 
an  elongated,  narrow  tube,  the  urachus,  which  extends  from  the 
fundus  of  the  urinary  bladder  out  through  the  umbilicus  and 
along  in  the  umbilical  cord  across  the  amniotic  cavity. 

In  structure,  the  inner  layer  of  the  allantois  is  of  hypoblast 
derived  from  the  inner  layer  of  the  hind  gut,  while  the  external 
layer  consists  of  mesoblast,  '\\\  which  the  allantoic  vessels  are 
formed  to  constitute  the  va.scular  layer. 

In  all  our  domestic  animals,  the  allantois  constitutes  a  great 
sac,  which  is  filled  with  a  liquid,  the  allantoic  fluid,  which  con- 
sists largely  of  the  secretions  from  the  kidneys,  augmented  per- 
haps by  transudation  from  the  blood  vessels  of  the  walls  of 
the  sac  itself.     The  allantoic  fluid  contains  albumin,  grape  sugar 

23 


354 


Veterinary  Obstetrics 


Rent  in  the  Wall 
of  the  Ovum. 

Fig.  73.     A,  Embryo  of  the  horse  in  its  membranes.     4.2  cm.  in  its 

greatest  diameter.     Twenty-eight  days  after  fecundation. 
B,  The  same  seen  from  the  other  side.  (Bonnet). 


The  Chorion  355 

and  urea  aud  is,  consequently,  similar  in  character  to  the  amniotic 
fluid,  except  that  no  meconium  can  reach  this  cavity  since  only 
the  urinary  tract  communicates  with  it. 

In  the  fetus  the  urinary  secretions  may  pass  either  backward 
through  the  urethra  into  the  amniotic  cavity  or  forward  through 
the  urachus  into  the  allantoic  cavity  and,  consequently,  through 
this  tract  the  two  cavities  communicate  throughout  intra-uterine 
existence.  In  the  human  embryo  there  is  virtually  no  allantoic 
sac  except  for  a  very  brief  time  early  in  pregnancy,  the  walls  of 
the  allantois  soon  coming  in  immediate  contact. 

Collectively,  these  membranes,  with  the  addition  of  the  vesti- 
gial remains  of  the  vitelline  sac,  constitute  the  fetal  membranes, 
or  after-birth. 

The  Chorion. 

The  external  or  vascular  layer  of  the  allantois,  with  the  ex- 
ternal or  false  amnion,  constitutes  the  permanent  or  allantoic 
chorion.  In  the  brief  interval  elapsing  between  the  formation  of 
the  amnion  and  the  allantois,  the  external  or  false  anniion  per- 
forms temporarily  the  functions  of  the  placenta  by  throwing  out 
placental  tufts  which  acquire  intimate  attachments  with  the 
muco.sa  of  the  uterus,  maintain  the  attachment  and  fixation 
of  the  embryonic  ma.ss  in  its  position  and  provide  an  avenue  for 
nutrition  and  excretion.  Later,  when  the  vascular  layer  of  the 
allantois  spreads  over  the  inner  surface  of  the  false  amnion  and 
fuses  with  it,  the  allantoic  tufts  push  out  into  the  existing 
amniotic  structures,  acquire  intimate  relations  with  the  uterine 
mucosa  and  lead  finally  to  the  displacement  or  effacement  of  the 
amniotic  chorion. 

The  form,  extent  aud  relations  of  the  allantois  in  different 
animals  present  the  greatest  variability.  In  the  mare,  as  indicated 
in  Figs.  74  and  75,  the  allantois  grows  completely  around  the 
amnion  and  constitutes  a  complete  double  envelop,  except  for  the 
area  occupied  by  the  vestigial  yolk  sac.  It  thus  completely 
separates  the  amnion  from  the  false  amnion  or  amniotic  chorion, 
its  sac  being  filled  with  the  allantoic  fluid.  Its  internal  surface 
is  lined  with  endobla.st  from  the  enteric  canal,  while  its  exterior 
layer  is  of  splanchnopleuric  mesoblast.  A  study  of  Fig.  75  shows 
that  the  somatopleuric  mesoblast,  or  outer  layer  of  the  true 
amnion,  is  in  contact  with   the  splanchnopleuric    mesoblast    of 


356 


Veterinary  Obstetrics 


the  allantois  :  these,  though  separable,  adhere  somewhat  in- 
timately, the  two  together  constituting  the  sac  usually  designated 
as  the  amnion.  Similarly,  the  external  wall  of  the  allantois 
presses  against  the  mesoblastic  layer  of  the  amniotic  chorion  or 
false  amnion,   fuses  with  it  and  constitutes  the  allantois-chorion. 


Allantois  Chorion 


Sinus  Terminal' 


Circula 
Fidge' 


Central  Portion  of 
Vitelline  A  rea 

Fig.  74.  Schematic  illustration  of  fetal  annexes  of  the  embryo  of 
the  horse,  2S  days  after  fecundation,  as  in  Fig.  73.  Perpendicu- 
lar section  through  the  embryo  and  its  envelops. 

The  embryo  in  black.     —  Fctoblast Vitelline  layer. 

Parietal  mesobla.st.     —  —  —  Visceral  mesoblast.       (Bonnet). 

In  ruminants  and  swine,  unlike  the  globular  or  spheroidal 
blastoderm  of  the  hor.se  as  shown  in  Figs.  73  and  74,  it  becomes 
very  greatly  elongated,  as  shown  in  Figs.  76  and  77,  longer  even 
than  the  uterine  cavity,  necessitating  its  folding  upon  itself. 
This  elongated  sac  does  not  persist,  but  soon  atrophies  and 
almost  wholly  vanishes  long  before  birth.  The  formation  of  the 
allantois  follows  more  or  less  the  plan  of  the  blastoderm  and  its 
yolk  sac  and  in  these  animals  becomes  much  elongated.  In 
swine  the  apices  of  the  allantoic  .sac  are  destitute  of  placental 


The  Chorion 


357 


tufts,  as  shown  in  Fig.  77.  In  ruminants,  Fig.  80,  the  allantoic 
sac  becomes  much  elongated,  while  its  apex,  along  with  the 
amniotic  chorion,  finally  undergoes  necrosis,  as  shown  on  the 
right  of  the  figure,  or  the  apex  of  the  amniotic  chorion  alone  be- 
comes necrotic  without  the  allantois  having  penetrated  it,  as 
shown  at  the  left. 

In  case  of  single  pregnancy,  the  allantoic  sac  of  the  ruminant 
occupies  both  cornua.  The  arrangement  of  the  allantois  in 
ruminants  differs  greatly  from  that  of  the  horse.  The  allantoic 
sac  does  not  completely  surround  the  fetus  but.  lying  along  its 
ventral  side,  greatly  elongated,  only  partially  encloses  the  amnion. 

Amnion 

Epithelial  Thickenings 
of  the  Amnion 

miotic  Chorion 


Inner y    Layer 


Hippotnanes, 


Jfippomanes 


Fig.  75.     Schematic  longitudinal  section  of  a  horse  embryo  in  its  annexes, 

at  about  5  mos.  gestation.     Reduced  to  about  >i.  (Bonnet). 

This  applies,  however,  only  to  the  inner  or  hypoblastic  layer  of 
the  allantois,  which  constitutes  the  immediate  wall  of  the  sac. 
The  vascular,  or  mesoblastic,  laj-er  extends  completely  around 
the  fetus  and  its  amnion  but,  over  that  portion  of  the  amnion 
where  the  allantoic  sac  does  not  extend,  the  amnion,  vascular 
layer  of   the  allantois  and  amniotic   chorion   are  unseparated  by 


358 


Veterinarv  Obstetrics 


The  Placenta  359 

any  intervening  fetal  fluids.  Mesoblast  being  everywhere  con- 
tiguous to  mesoblast,  the  amnion  becomes  adherent  to  the  chorion 
over  a  large  area,  to  such  a  degree  as  to  make  their  separation 
difficult. 

This  difference  in  the  character  and  extent  of  the  allantois  es- 
tablishes a  marked  difference  in  the  phenomena  of  parturition. 
In  the  mare,  where  the  allantois  constitutes  a  complete  envelop- 
ing sac  filled  with  fluid,  the  fetus  tends  to  be  born  enclosed  with- 
in the  amniotic  sac,  including  the  adherent  inner  or  amniotic 
layer  of  the  allantois,  while,  in  ruminants,  the  extensive  area 
of  the  amnion  not  covered  by  the  allantoic  sac  causes  the  amnion 
to  remain  adherent   to  the  chorion  and  the   fetus  to  be  born 

naked. 

The  Placenta. 

By  the  term  placenta  we  understand  those  portions  of  the  fetal 
membranes  or  annexes  which  serve  to  bring  about  an  intimate 
contact  between  the  circulatory  system  of  the  mother  and  that 
of  the  fetus.  The  development  of  the  mammalian  embryo  can 
proceed  independently  for  but  a  brief  period  since,  having 
virtually  no  nutrient  reserve  in  the  vitellus,  its  growth  must 
depend  upon  nutritive  substances  obtained  from  without,  from 
the  uterus  of  the  mother.  When  the  morula  reaches  the  uterine 
cavity  at  the  eighth  to  tenth  day,  the  zona  pellucida  throws 
out  tufts,  the  primordial  chorion,  which  enter  into  somewhat 
intimate  relations  with  the  uterine  mucosa,  but  this  zone  soon 
becomes  attenuated,  and  disappears  as  the  blastoderm  rapidly 
enlarges  within  it.  This  primitive  chorion,  or  prochorion,  must 
be  replaced  by  a  more  permanent  and  efficient  structure  for  the 
nutrition  of  the  fetus. 

vSoon  there  grow  out,  from  the  surface  of  the  epiblast,  tufts  or 
villi  which  extend  into  the  mucosa  of  the  uterus  through  which 
there  is  an  exchange  of  nutritive  material  and  waste  products 
between  the  mother  and  fetus.  When  the  amnion  develops,  the 
external  or  false  amnion  is  but  a  continuation  of  the  somato- 
pleuricwall  of  the  yolk  sac,  which  completely  invests  the  embryo. 
Over  the  entire  surface  of  this  embryonic  sac,  villi  grow  out  to 
establish  relations  between  the  embryo  and  mother  and  consti- 
tute the  amniotic  chorion  or  placenta.  These  structures,  like  the 
preceding,  are  primitive  and  temporary  in  character  and  soon 
become  lost  as  unimportant  parts  of  the  more  permanent  structure 
to  follow,  or  they  atrophy  and  disappear. 


36o 


Vetcrin  a  ry  Obstetrics 


When  the  vascular  laNer  of  the  allantois  develops,  it  grows  out 
and  fuses  with  the  amniotic  chorion,  which  largel}-  disappears 
or  becomes  lost  as  a  separate  membrane,  while  the  blood  vessels 
from  the  allantois  grow  out  through  it  to  constitute  new  tufts, 
which  soon  attain  an  intimate  relation  with  the  blood  vessels  of 
the  uterus. 


AllaniOH- 
Epi  I  helium 


Afembtaiia_ 
Chorxt 


Cotyledon 


Gland 
Duel 


Bloodvessels 

A 


■'H^ 


A- 


•vine  ^  .-(r\   <^-5  r-N    ^   -     '      •_ 

Glands     ^^ 


Afucosa 
Uteri 


I  'teriiie 

Afuscular 

Ijiyer 


Bloodvessel 
Fig.  78.     Section  through  the  chorion  and   uterine  mucosa  of  the  horse,  at 
9>^  months.     Enlarged  about  .45-1.     (Bonnet). 

The  blood  vessels  of  the  fetus  and  tho.se  of  the  mother  do  not 
become  continuous,  but  are  constantly  separated  by  three  layers 
of  tissue,  the  endothelial  layers  of  both  the  maternal  and  fetal 
capillaries  and  an  intervening  layer  of  connective  tissue.  The 
capillaries  of  the  allantois  become  greatly  branched  and  grow  out 
as  villi  which,  sinking  into  the  mucous  membrane  of  the  uterus, 
come  into  immediate  contact  with  corresponding  capillary  loops 
from  the  uterine  ves.sels  and  become  closely  adherent  with  each 
other  with  extremely  thin  walls,  through  which  there   is  a  free 


The  Placenta 


361 


exchange  of  nutritive    and    waste  products,    but  not  of   cellular 
elements. 

The  separation  of  the  fetal  from  the  maternal  circulation  is  so 
complete  that  most  micro-organisms  of  disease  do  not  ordinarilj^ 
pass  through  and,  consequently,  where  the  mother  is  affected 
with  a  contagious  disease,  the  fetus  does  not  ordinarily  contract 
it  through  the  medium  of  the  blood.  For  example,  in  tubercu- 
losis the  fetus  is  almost  never  infected  during  its  intra- uterine 
existence,  but  is  born  free  from  the  malady,  however  badly  the 
mother  has  been  affected  during  the  period  of  pregnancy. 


Fig.  79.     Cotyledons  of  a  cow,  according  to  Colin. 

u,  Uterus.     Ch,  Chorion.     C,  Maternal,  C^  fetal  portion  of  cotjdedon. 
Fetal  and  maternal  portions  are  partly  separated  from  each  other. 
( Bonnet. ) 

The  area,  or  areas,  in  the  mucosa  of  the  uterus  at  which  elabo- 
rate changes  take  place  for  the  attachment  and  nutrition  of  the 
fetus,  is  known  as  the  maternal  placenta  and  the  corresponding 
portion  or  portions  of  the  chorion  which  sends  capillary  tufts 
into  the  placental  area  of  the  uterus,  constitute  the  fetal  placenta. 

Among  our  domestic  animals,  there  are  great  variations  be- 
tween these  placentae.  In  some  specieS;  the  relations  existing 
between  the  fetal  villi  and  the  capillaries  of  the  uterus  are  so 
intimate  that,  when  the  fetal  placenta  is  removed,  a  portion  of  the 
mucous  membrane  of  the  uterus  is  carried  with  it,  while,  in 
other  animals,  the  placental  villi  of  the  fetus  .separate  from  the 
maternal  tufts  and  leave  them  intact.      From   this  difference   in 


362 


Veterinary  Obstetrics 


The  Placenta  363 

the  mode  of  the  separation  or  dehiscence  of  the  fetal  membranes, 
we  divide  mammalia  into  two  groups,  known  as  the  deciduata, 
in  which  the  maternal  mucosa  is  torn  awaj'  with  the  fetal  mem- 
branes, and  the  indeciduata,  in  which  the  separation  between  the 
fetal  membranes  and  uterus  occurs  between  the  villi  of  the 
chorion  and  the  maternal  vessels. 

By  some  authors,  the  term  placenta  is  limited  to  those  struc- 
tures in  which  the  villi  of  the  chorion  are  concentrated  at  cer- 
tain points  upon  its  surface.  These  animals  are  designated  as 
placental.  In  other  animals,  the  villi  are  scattered  over  the  en- 
tire surface  of  the  chorion  and  these  are  designated  as  diffuse 
placental  or  aplacental. 

Among  our  domesticated  animals,  in  the  indeciduate  group, 
we  have,  of  the  aplacental  or  diffuse  placental  type,  the  horse 
(Fig.  75)  swine  and  camel,  and  of  the  placental  group  we  have 
the  ruminants,  except  the  camel. 

In  the  deciduous  group  are  the  elephant,  carnivora,  rodentia 
and  monkeys. 

In  man  and  the  anthropoid  apes  there  is  a  very  complex  de- 
ciduous placenta,  of  a  discoid  type,  with  a  decidua  reflexa. 

Our  most  common  and  useful  animals  belong  to  the  indeciduate 
group,  in  which  are  found  the  ruminants  and  equidae,  while  in 
the  deciduate  group  we  have  only  the  dog,  cat  and   rabbit. 

The  form  and  extent  of  the  placenta  in  the  different  species  of 
animals  varies  greatly.  In  equidae  and  swine  the  placentae  or 
chorionic  villae  are  diffused  over  the  entire  surface  of  the  chorion, 
as  small  elongated  tufts,  which  we  know  as  diffuse  placentae. 
In  ruminants  the  villi  are  restricted  to  comparatively  small  areas 
of  about  80  to  100  or  more  in  number,  which  are  known  as 
placentules  or  cotyledons.  Between  these  cotyledons  the  chorion 
is  free  from  the  uterus.  In  the  non-gravid  uterus  of  the 
ruminant,  there  exist  numerous  elevations  upon  the  surface  of  the 
mucosa,  which  constitute  the  rudimentary  cotyledons.  When 
impregnation  takes  place  the  cotyledons  become  highly  vascular 
and  their  mucous  membrane  undergoes  marked  development, 
while,  from  the  chorion,  there  grow  out,  at  points  corresponding 
to  these  eminences,  numerous  branched  villi  which  ultimately 
sink  deeply  into  the  mucosa  of  the  cotyledons  or  placentules. 
This  condition  gives  rise  to  what  we  know  as  multiple  placenta. 
(See  Fig.  79.; 


364  Veterinary  Obstetrics 

In  carnivora,  the  placentae  are  zonular,  the  chorionic  villi 
are  restricted  to  a  zone  encircling  the  embryonic  sac  and  the  an- 
terior and  posterior  poles  of  the  chorion  are  devoid  of  villi. 

The  Umbilical  Cord. 

The  umbilical  cord  .serves  chiefly  as  a  bond  of  communication 
between  the  embryo  and  the  placenta.  It  is  formed  by  the  allan- 
toic stalk,  surrounded  by  the  amnion,  and  includes  the  vestige  or 
remnant  of  the  vitelline  duct.  In  the  mare  and  carnivora  it  may 
be  divided  into  the  amniotic  and  allantoic  portions.  The  am- 
niotic portion,  or  the  umbilical  cord  proper,  extends  from  the 
umbilicus  of  the  embryo,  through  the  amniotic  cavity,  to  open 
into  the  cavity  of  the  allantois.  The  allantoic  section  of  the 
umbilic  cord  extends  across  the  allantoic  sac,  from  the  amnion 
to  the  allantois-chorion.  Cro.ss-section  of  the  umbilical  cord  in 
the  amniotic  portion  reveals  the  following  .structures  :  the  am- 
nion, serving  as  a  thin,  dense,  investing  membrane  ;  the  two 
umbilical  arteries,  the  pair  of  umbilical  veins,  .sometimes  fused 
to  constitute  a  single  vessel  ;  the  urachus  and  the  ve.stiges  of 
the  vitelline  duct.  Around  the.se  ves.sels,  filling  out  the  amni- 
otic sheath  and  investing  the  urachus  and  vessels  within  to  con- 
stitute a  more  or  less  even  cord,  is  a  gelatinous  substance,  the 
Whartonian  gelatin,  embedded  in  a  network  of  delicate  connec- 
tive tissue. 

The  allantoic  portion  of  the  umbilic  cord  consists  essentially  of 
the  ma.ss  of  umbilic  vessels,  which  have  now  become  more  or  less 
branched.  Partially  surrounded  by,  and  adherent  to,  the.se  vessels 
may  exist  more  or  less  evident  remnants  of  the  vitelline  duct 
and  sac,  prominent  in  the  very  early  stages  of  fetal  life,  rapidly 
disappearing  more  or  less  completely  at  a  later  date.  The  urachus 
ends  in  a  funnel-shaped  dilation  just  beyond  the  amniotic  sac,  to 
become  continuous  with  the  allantoic  sac. 

During  the  earlier  stages  of  gestation  there  normally  projects 
into  the  umbilical  cord  one  or  more  loops  of  intestine  and,  in 
some  cases,  portions  of  the  liver  or  of  other  viscera.  The  pro- 
truding intestinal  loop  escapes  through  the  umbilic  ring  of  the 
.somatopleure,  beside  the  allantoic  stalk,  inside  the  skin  and 
amniotic  sheath.  The  protrusion  through  the  umbilicus  ap- 
parently occurs  becau.se  the  abdominal  cavity  has  not  developed 


The  Placenta  365 

with  sufficient  rapidity  to  accomodate  the  rapidly  growing 
visceral  mass  and,  consequently,  a  portion  of  it  is  cro\\^ded  out 
through  the  umbilical  opening  alongside  the  vessels  and  remains 
outside  of  the  abdominal  cavity  until  the  contraction  of  the 
umbilicus  gradually  forces  the  intestines  back  into  the  now  more 
capacious  abdomen  where  they  permanently  remain.  In  numer- 
ous cases  the  umbilic  ring  does  not  normally  contract,  the  ring 
remains  open,  the  intestinal  loop  fails  to  return  within  the 
abdominal  cavity  and  the  fetus  is  born  with  umbilic  hernia. 

The  vessels  of  the  umbilic  cord  are  disposed  spirally  from  left 
to  right,  a  condition  sometimes  suspected  to  be  due  to  a  re- 
volution of  the  fetus  upon  its  short  axis  but  apparently  more 
properly  referable  to  a  fundamental  plan  in  development  unin- 
fluenced by  fetal  movements.  The  spiral  arrangement  of  the 
cord  adds  to  its  compactness  and  strength  and  to  the  maintenance 
of  the  vessels  in  regular  order. 

The  length  of  the  umbilic  cord  varies  widely  with  species  and 
individuals.  In  the  mare  the  length  ranges  from  35  to  40  inches, 
the  amniotic  portion  representing  about  one  third  of  the  total 
length.  It  is  sufficiently  long  that,  when  a  foal  is  normally 
born  and  the  dam  is  in  the  recumbent  position,  the  cord  remains 
intact  and  may  even  persi.st  after  the  mare  has  risen  to  her  feet, 
but  ruptures  when  she  turns  her  head  to  the  foal,  to  lick  it,  or 
starts  to  move  away  from  it.  Sometimes  the  foal,  by  its  strug- 
gles, ruptures  the  cord  by  its  own  efforts.  In  other  cases,  the 
cord  remains  intact  and  the  chorion  is  completely  expelled,  still 
attached  to  the  living  foal,  and  its  rupture  takes  place  after  the 
foal  rises  to  its  feet. 

The  point  of  normal  rupture  of  the  navel  cord  of  the  foal  is 
about  I  ^  to  2  inches  from  the  umbilicus,  at  a  well  marked  con- 
striction. This  delimits  the  cord  proper  from  what  may  be  called 
the  umbilic  base,  or  cutaneous  navel,  a  hairless,  cylindrical,  firm 
segment  i  to  1J2  inches  long.  At  the  termination  of  this  por- 
tion a  softer  and  more  fragile  cord  begins  with  a  somewhat  con- 
stricted neck  and,  within  this  latter  at  a  point  Yi  inch  or  more  from 
the  base,  the  rupture  of  the  cord  generally  occurs.  (See  Fig. 
90  B.) 

The  navel  cord  of  the  cow  consists  of  an  amniotic  portion  only 
and  is  less  than  ''2  the  length  observed  in  the  mare,   ranging  be- 


366  Veterinary  Obstetrics 

tween  ii  and  i6  inches  or  ^  to  i  the  length  of  the  fetus,  a 
difference  which  regularly  leads  to  its  rupture  during  the  ex- 
pulsion of  the  fetus  and  only  rarely  permits  the  birth  of  the  calf 
with  the  cord  intact.  Hence,  in  the  cow  and  other  ruminants, 
not  only  is  the  fetus  born  naked,  as  already  related,  but  during  its 
expulsion  the  rupture  of  the  cord  usually  frees  it  completely  from 
all   fetal  annexes. 

In  the  pig,  the  umbilic  cord  is  wholly  amniotic  and  very  long, 
ecjual  to  the  entire  length  of  the  fetus,  while,  in  carnivora,  the 
cord  is  short  and  very  resistant,  so  that  eventually  it  is  usually 
bitten  in  two  by  the  mother. 

In  relation  to  diseases  of  the  new-born,  it  should  be  noted  in 
reference  to  the  various  structures  of  the  umbilical  cord  that, 
when  it  is  permitted  to  rupture  naturally,  the  umbilical  arteries 
quickl}^  retract  within  the  abdominal  cavit)''  and  draw  along  with 
them,  in  an  inverted  manner,  the  loose  connective  tissue  surround- 
ing them.  It  has  been  claimed  by  some,  apparently  on  insuffi- 
cient grounds,  that,  in  the  cow,  etc.,  the  arteries  rupture  within 
the  abdomen.  This  retraction  of  the  arteries  accomplishes  two 
important  purposes  :  it  draws  their  wounded  ends  away  from  the 
exterior,  preventing  the  entrance  of  infection  into  them,  and  the 
inverted  connective  tissue  which  is  drawn  back  with  them,  offers 
an  impa.ssable  barrier  to  hemorrhage.  The  retraction  of  these 
arteries  also  causes  a  thickening  of  their  walls,  as  their  length 
decreases,  and  thus  .serves  to  narrow  and  virtually  obliterate  their 
cavity.      (See  Fig.  56.) 

The  umbilical  vein  remains  open  for  a  time  and  serves  as  an 
avenue  for  infection.  This  fact  is  highly  important  in  relation 
to  the  well-being  of  the  young,  since,  through  this  portal,  serious 
infection  frequently  occurs  to  constitute  the  disease  known  as 
navel  infection  or  omphalo-phlebitis.  The  urachus,  too,  may  re- 
main open  (pervious  urachus )  or  become  re-opened  a  few  days 
after  birth  through  the  agency  of  infection,  much  as  arteries  re- 
open to  constitute  secondary  hemorrhage  from  infected  wounds. 

The  Whartonian  gelatine,  if  retained  in  the  cord  by  means  of 
a  ligature,  serves  the  dangerous  purpose  of  a  culture  medium  for 
bacteria.  When  the  cord  is  normally  ruptured,  the  Whartonian 
gelatine  quickly  oozes  from  the  broken  surface,  the  stump  of  the 
cord  soon  dessicates,  the  wound  occasioned  by  the  rupture 
becomes  hermetically  sealed  and,  from  that  moment  on,  infection 
is  excluded. 


TERATOLOGY. 

Teratolog}-  is  the  science  of  monstrosities,  or  aberrations  in 
the  development  of  the  embryo.  The  subject  is  too  extensive 
for  any  definite  consideration  in  a  treatise  upon  obstetrics.  The 
extent  of  deviation  from  the  normal  may  be  of  every  gradation. 
There  may  be  merely  a  perceptible  deviation  from  the  normal, 
which  we  usually  designate  a  defect,  or  arrest,  in  development. 
Or  the  deviation  from  the  normal  may  be  so  extreme  as  to  result 
in  an  almost  shapeless  mass,  such  as  the  acardia,  or  "  mole", 
illustrated  on  page  289,  or  a  double  monster  such  as  is  illustrated 
in  Figs.  126  and  127.  Such  deviations  are  known  as  monsters 
and,  as  a  general  rule,  the  departure  from  the  normal  is  such 
that  it  prevents  the  animal  from  living  after  birth  or  compromises 
the  existence  of  the  mother  in  the  act  of  birth,  so  that  such  ab- 
normal individuals  are  rarely  born  alive  or,  should  this  occur,  their 
defects  in  structure  are  such  as  to  nearly  always  cause  their  early 
death.  In  the  lesser  deviations  from  the  normal,  we  sometimes 
fail  to  observe  the  defect  at  the  time  of  birth  and  it  is  onlj^  when 
if  has  caused  disease  that  we  are  led  to  note  the  fundamental  de- 
fect in  development.  Such  is  well  illustrated  by  the  defects  of  the 
teeth,  which  are  mentioned  on  page  314. 

In  the  preceding  chapter,  under  the  head  of  Embryology,  we 
have  mentioned  numerous  forms  of  monstrosities  and  defects  in 
development  in  order  to  draw  a  contrast  between  the  normal 
embryological  development  and  the  abnormal,  or  teratologic,  de- 
velopment. We  have  also  aimed,  in  that  chapter,  to  point  out 
the  causes  of  these  deviations,  so  far  as  they  are  well  known, 
and  to  forge  a  connecting  link  between  teratology  and  disease. 
Neither  have  we  attempted  to  give  an  extended  account  of  embry- 
ology, but  have  aimed  to  aid  the  veterinary  student,  as  far  as 
possible,  to  get  the  logical  connection  between  embryology  and 
the  subjects  of  obstetrics  and  surgery.  The  veterinary  obstet- 
rist  needs  know,  so  far  as  possible,  the  embryologic  foundation 
of  certain  defects,  and  of  diseases  arising  from  these  in  our  do- 
mestic animals,  because  intelligent  handling  of  these  mu.st  be 
based  upon  such  an  understanding. 

We  shall  have  further  occasion  to  refer  to  .some  forms  of  aber- 
ration in  development  when  dealing  with  the  subject  of  dystokia, 
•since  some  of  them  lead  to  very  great  difficulty  in  parturition  and 
tax  to  the  utmost  the  resources  of  the  obstetrist.     We  shall  again 

367 


368  Veterinary  Obstetrics 

have  occasion  to  mention  some  of  these  aberrations  in  develop- 
ment when  deahng  with  the  defects  of  the  new  born  animal. 

While  the  subject  of  teratology  is  one  of  very  great  scientific 
interest  and  serves  largely  to  emphasize  the  facts  of  embryo- 
logy and  the  regularity  with  which  the  development  of  the 
embryo  ordinarily  proceeds,  we  must  content  ourselves,  in  this 
treatise,  with  a  bare  mention  of  the  subject.  Teratology  was  first 
placed  upon  a  scientific  basis  by  Gurlt  (Lehrbuch  der  patho- 
logischen  Anatomic,  1831 )  and  later  the  science  was  expanded 
by  Saint  Hilaire  and  others. 

Experimentally,  teratology  has  also  received  a  considerable 
amount  of  attention  and  it  has  been  found  that  the  chick  embryo 
and  others  which  are  readily  available  for  manipulation  may  be 
caused  to  undergo  a  great  variety  of  aberrations  during  the  early 
stages  in  development,  by  mechanical  disturbances.  The  con- 
clusion has  been  reached,  from  these  experiments,  that  accidents 
of  a  somewhat  similar  character,  occurring  during  the  very  early 
stages  of  emljryouic  development  in  our  higher  animals  lead  also 
to  aberrations  in  development. 

It  is  worthy  of  remark  that  those  arrests  in  the  development 
which  have  occurred  early  in  the  life  history  of  a  given  embryo 
show  a  marked  tendency  to  recur  in  the  offspring  of  the  defective 
organism,  when  it  lives  to  the  breeding  age.  This  may  readily 
occur  in  the  milder  forms  of  aberration  in  development,  but  it  is 
only  rarely  that  the  more  serious  ca.ses,  which  we  generally  speak 
of  as  monstrosities,  are  capable  of  breeding,  or  even  of  surviving 
to  the  adult  period.  In  the  les.ser  aberrations  in  development, 
such  as  arrests  in  the  closure  of  the  umbilic  or  inguinal  rings, 
resulting  in  hernia,  the  defect  is  extremely  liable  to  become 
fixed  and  to  be  reproduced  with  disastrous  frequency  in  the  off- 
spring of  such  an  animal. 

Among  the  laity,  the  occurrence  of  iyonstro.sities  arouses  more 
or  less  mysticism  and  they  are  frequently  attributed  to  some 
psychic  influence  upon  the  pregnant  mother,  usually  at  some 
late  period  in  gestation,  when  the  defect  has  already  long  been 
fixed  in  the  fetus,  having  occurred  at  a  very  much  earlier  date. 
On  the  other  hand,  it  is  highly  probable  that  teratology  itself 
has  had  an  important  influence  upon  mythology  and  may  have 
played  an  important  part  in  such  myths  as  the  Cyclops,  the 
Janus  and  others,  which  myths  find  accurate  representatives 
among  the  monstrosities  in  man  and  in  animals. 


PREGNANCY,  OR  GESTATION. 

By  the  term  gestation  we  comprehend  that  period  of  time  dur- 
ing which  the  young  is  undergoing  development  in  the  uterus  of 
the  mother,  a  period  extending  from  the  time  of  the  fertilization  of 
the  ovum  until  the  birth  of  the  fetus. 

The  modifications  which  necessarih'  take  place  during  this 
period  are  of  a  very  profound  character,  and  exert  an  im- 
portant influence  upon  the  life  and  nutritive  powers  of  the 
mother. 

The  volume  of  the  uterus  becomes  very  greatly  increased.  The 
walls  of  the  non-gravid  organ  are  contracted  and  firm  and  its 
cavity  is  insignificant,  the  mucous  membrane  of  the  walls  being 
in  contact.  As  soon  as  impregnation  occurs,  the  uterus  must 
become  very  greatly  increased  in  volume  in  order  to  accommodate 
the  fetus  and  its  membranes.  Even  prior  to  impregnation,  during 
estrum,  the  uterus  has  undergone  some  degree  of  enlargement 
and  inten.sified  function  preparatory  to  the  fertilization  and 
nutrition  of  the  ovum.  Con.sequently,  impregnation  in  a  way 
continues  and  accelerates  this  increase  in  volume  until  it 
reaches  its  maximum  at  the  time  of  parturition. 

The  first  notable  change  in  the  uterus,  which  has  already  been 
anticipated  during  estrum,  is  the  greatly  increased  vascularity 
of  the  organ,  both  of  the  walls  and  the  mucosa.  The  mucous 
membrane  becomes  especially  vascular,  as  is  shown  by  its  deeper 
color  and  its  great  increase  in  thickness,  as  well  as  by  a  softening 
of  the  membrane. 

The  increased  function  in  the  mucosa  is  not  equally  apparent  in 
all  parts,  but  is  most  pronounced  in  those  regions  where  the 
attachment  of  the  fetal  placenta  is  to  occur.  Thus,  in  the 
ruminant,  the  principal  increase  in  activity-  and  growth  of  the 
mucosa  is  at  those  points  which  are  to  constitute  the  cotyledons 
of  the  gravid  horn,  while,  in  the  mare,  it  is  more  evenly  distri- 
l)Uted  over  the  entire  organ.  In  the  bitch  and  cat,  it  is  largely 
concentrated  in  that  part  which  is  to  enter  into  relations  with 
the  placental  zone  of  the   fetus. 

In  multiparous  animals,  like  the  bitch,  cat  and  sow,  the 
uterine  cornua  become  enlarged  and  bulged  at  the  points  where 
the  impregnated  ova  have  lodged  and  become  attached  to  de- 
24  369 


370  Veterinary  Obstetrics 

velop  into  embryos.  This  arrangement  results  in  a  nodular 
form  suggesting  the  general  appearance  of  a  rosemary,  the  nodes 
in  the  elongated  organ  being  usually  (juite  equally  distributed 
throughout  the  entire  length  of  the  tube.  In  the  uniparous 
animal,  in  which  the  fetus,  as  a  rule,  is  lodged  partly  in  the 
cornu  and  partly  in  the  body  of  the  uterus,  the  gravid  cornu  and 
body  increase  far  more  rapidly  in  size  and  undergo  greater 
changes  in  structure  than  the  non-gravid  or  vacant  cornu. 

The  blood  vessels  of  the  uterus  undergo  very  rapid  growth 
during  pregnancy.  The  non-gravid  uterus  is  firmly  contracted 
and  shows  no  great  vascularity,  so  that  operations  upon  it  may 
not  be  accompanied  by  great  hemorrhage.  When  pregnancy 
occurs,  the  arteries  and  veins  very  rapidly  enlarge  and  increase 
to  many  times  their  former  volume,  so  that  any  injury  or 
wound  of  these  ves.sels  tends  to  cause  more  or  less  serious 
hemorrhage. 

The  density  of  the  non-gravid  organ,  serves  to  differentiate 
it  from  the  intestines  and  other  abdominal  viscera,  because 
of  its  firmness  upon  palpation.  During  pregnancy  this 
density  decreases  very  greatly  and  the  organ  soon  comes  to  re. 
semble,  to  the  sense  of  touch,  the  intestines.  This  is  very 
markedly  the  case  in  the  pregnant  bitch,  in  which  this  change 
in  the  density  of  the  organ  causes  it,  so  far  as  the  sense  of  touch 
reveals,  to  so  closely  resemble  the  intestine  as  to  occasionally 
embarrass  an  operator  when  spaying  a  bitch  which  is  unex- 
pectedly pregnant.  This  decrease  in  the  density  of  the  organ 
is  attributed  partly  to  the  thickening  and  softening  of  the 
highly  active  mucous  membrane,  partly  to  the  enormous  in- 
crease in  the  number  and  volume  of  the  arteries  and  veins 
and  partly  to  a  relative  decrease  in  the  thickness  of  the  walls 
of  the  organ,  owing  to  its  very  rapid  distension,  in  which  process 
the  growth  in  comparative  thickness  fails  to  keep  pace  with  the  in- 
creased area.  In  the  non-gravid  uterus,  there  is  present  in  the  con- 
tracted organ  a  reserve  of  tissue,  which  must  later  undergo  very 
rapid  development.  The  non-gravid  cornu  is  usually  50  to 
100%  thicker  than  the  gravid  cornu. 

The  glands  in  the  uterine  mucosa  become  rapidl)-  elaborated  ; 
the  utricular  glands  become  enlarged,  they  increase  in  length  and 
width  and  their  secretions  become  augmented.     In  the  ruminant 


Preg7ianc}\  or  Gestation.  3yi 

the  uterine  cot3'ledons  develop  rapidly  and  it  has  been  shown 
that  new  ones  appear.  Rainard  could  distinguish  but  30  to  40 
cotyledons  in  the  uteri  of  heifers  or  lambs,  while,  after  parturi- 
tion, he  found  100  or  more.  It  has  further  been  shown  by  the 
experiments  of  Colin  and  others  that,  if  the  cotyledons  have  been 
artificially  removed  from  a  cow,  new  ones  form  during  the  period 
of  pregnancy.  In  the  mucous  membrane  of  the  uterus,  there  also 
form  crypts,  at  an  early  period  in  pregnancy,  into  which  the  villi 
of  the  fetal  chorion  grow  and  become  attached.  These  crypts 
are  the  counterpart  of  the  villi  of  the  chorion  and  vary  in  their 
form  and  complexity  according  to  the  species  of  the  animal. 
They  are  lined  with  a  thin  layer  of  epithelium,  immediately  be- 
neath which  are  the  uterine  capillaries,  in  a  rich  net-work.  In 
the  mare  these  crypts  are  distributed  over  the  entire  uterine  sur- 
face, in  harmony  with  the  distribution  of  the  viUi  of  the  chorion, 
while  in  the  cow  they  are  limited  to  the  cotyledons  and  consti- 
tute essentially  the  mass  of  these  organs  during  pregnancy.  In 
those  animals  having  zonular  placentae,  they  are  confined  to 
the  placental  zone. 

Between  the  mouths  of  these  crypts,  utricular  glands  open 
upon  the  surface  of  the  mucous  membrane  and  pour  out  their 
secretions,  the  uterine  milk.     (See  Fig.  78. ) 

Investigations  have  shown  that  during  pregnancy  the  muscle 
fibers  of  the  uterus  become  increased  in  size  and  multiplied  in 
numbers,  so  that  the  increased  volume  of  the  organ  is  not  wholly 
dependent  upon  increa.sed  function  in  some  of  the  muscle  cells, 
but  partly  upon  a  multiplication  of  the  muscle  fibers.  The 
lymphatics  and  nerves  also  increase  in  extent  and  volume  during 
pregnancy. 

The  broad  ligaments  of  the  uterus  become  increased  in 
their  length  and  thickness  and  their  muscle  fibers  in  volume. 
Fleming  asserts  that  the  muscle  fibers  are  increased  in  order 
to  give  them  sufficient  strength  to  sustain  the  weight  of  the 
greatly  enlarged  uterus  and  its  contents.  This  cannot  be  cor- 
rect, because  the  gravid  uterus  lies  upon  the  floor  of  the  abdomen 
and  does  not  swing  in  the  ligaments.  The  increase  in  the  extent 
and  strength  of  the  broad  ligaments  should  be  attributed  rather  to 
the  necessity  for  their  maintaining  their  relations  with  the  uterus 
in  its  changed  position  and  for  preventing  their  rupture  during 


372  Veterinary  Obstetrics 

movements  of  the  organ.  In  themselves,  the  ligaments  would  not 
suflEice  to  sustain  the  weight  of  the  gravid  uterus,  but  they  per- 
form an  important  office  in  tending  to  keep  the  uterus  in  its  nor- 
mal direction  along  the  abdominal  floor.  It  should  be  constantly 
borne  in  mind,  however,  that  the  parietal  attachments  of  the 
broad  ligaments  do  not  change  during  pregnancy  and  neither 
advance  nor  retreat.  It  is  also  to  be  noted  that  the  gravid  uterus 
grows  forward  constantly  and  advances  beyond  the  anterior  attach- 
ment of  the  broad  ligaments  to  the  abdominal  walls,  and  that  it 
is  because  of  this  that  torsion  of  the  uterus  can  occur. 

The  sensibility  of  the  uterus  is  increased,  presumably  because 
of  a  heightened  development  of  the  nerves  of  the  organ.  Upon 
opening  the  bodies  of  pregnant  animals  under  anaesthesia,  or  im- 
mediately after  death,  the  uterine  walls  undergo  very  marked 
contractions,  which  closely  resemble  the  peristalsis  of  the  intes- 
tines. These  uterine  contractions,  or  peristalsis,  are  especially 
marked  in  the  pregnant  bitch  or  cat,  where  there  are  alternate 
constrictions  and  dilations  due  to  alternating  contraction  and 
relaxation  of  the  circular  fibers,  while  the  part  taken  by  the  lon- 
gitudinal muscle  fibers  is  shown  by  an  alternating  increase  and 
decrease  in  the  length  of  the  uterus. 

The  sympathy  between  these  uterine  contractions  and  the 
other  parts  of  the  genital  apparatus  is  shown  in  a  variety  of  ways. 
It  has  been  generall)'  believed  that  copulation,  in  case  of  the 
pregnant  female,  tends  to  produce  sympathetic  contraction 
of  the  uterus,  with  an  expulsion  of  its  contents,  or  abortion.  In 
manipulations  of  the  pregnant  uterus,  we  constantly  consider 
that  we  should  be  very  gentle  and  careful  lest  we  induce  con- 
tractions which  will  end  in  the  death  and  expulsion  of  the  fetus. 
Hess  has  asserted,  moreover,  that  artificial  abortion  is  readily 
and  uniformly  induced  by  the  dislodgement  of  the  yellow  bodies 
from  the  ovaries  by  manual  compression  per  rectum.  It  is  a 
common  experience  that  the  removal  of  the  ovaries,  or  castration, 
of  the  pregnant  female  tends  constantly  to  induce  abortion. 
This  contractility  of  the  uterus  during  pregnancy  probabl}^  has 
an  important  relation  to  its  functional  activity  and  the  nutrition 
of  the  fetus,  and  tends  to  maintain  the  fetuses  in  their  proper 
position  and  direction  by  correcting  any  chance  displacement 
caused  by  any  sudden  movements  of  the  body. 


Pregnancy ,  or  Gestation.  373 

These  contractions  are  important  for  the  development  of  the 
power  in  the  uterine  walls  which  finally  assumes  a  verj-  necessary 
function  at  the  time  of  parturition,  because  it  is  largely 
through  these  that  the  os  uteri  is  dilated  and  the  fetus  is  ex- 
pelled. It  is  notable  that  it  is  in  the  multipara,  where  the  uterus 
is  long  and  tubular,  that  the  uterine  contractions  play  the  great- 
est part  in  the  expulsion  of  the  fetuses,  while,  in  the  unipara, 
like  the  mare  and  cow,  the  principal  expulsive  powers  at  the 
time  of  parturition  reside  in  the  abdominal  walls  and  the  uterus 
performs  a  less  conspicuous  part  in  the  act  of  birth. 

After  the  expulsion  of  the  young  from  the  uterus,  it  is  again 
highly  important  that  there  should  be  a  vigorous  contractile 
power  in  the  organ,  in  order  that  it  may  expel,  at  an  early  period, 
the  fetal  membranes  and  such  portions  of  the  uterine  epithelium 
as  are  cast  off.  It  is  needful  that  the  walls  should  contract 
vigorously  in  order  to  check  the  amount  of  blood  passing  to  the 
organ  and  to  close  all  capillaries  in  the  uterine  mucosa  w^hich 
have  been  opened  during  the  process  of  separation  between  the 
fetal  membranes  and  the  uterus.  It  is  also  important  that  the 
uterine  cavity  shall  be  promptly  closed  and  the  epithelium  of 
its  w^alls  brought  in  contact.  This  contraction,  too,  indirectly 
exerts  a  disinfecting,  or  bactericidial,  power  and  serves  to  prevent 
the  entrance  of  infection  or  overcome  any  infection  which  may 
have  gained  entrance  into  the  cavity  during  or  immediately  after 
the  expulsion  of  the  fetus. 


THE  FORM  OF  THE  PREGNANT  UTERUS. 

The  gravid  uterus  undergoes  important  changes  in  its  form, 
since  it  must  adapt  itself  to  the  form,  volume  and  position  of  the 
fetus  or  fetuses  and  especially-  to  the  membranes  which  surround 
them.  In  the  multiparous  animals,  we  have  already  stated  that 
the  fetuses  are  distributed  somewhat  equidistant  from  each  other 
throughout  the  length  of  the  cornua  and  that,  at  the  points 
where  they  develop,  the  organ  becomes  enlarged,  while  between 
them  it  is  constricted  so  that  it  gives  the  organ  a  nodular 
appearance.  In  animals,  like  the  mare  and  cow,  which  usually 
produce  but  one  young  at  a  time  the  uterus  assumes  a  somewhat 
oblong  or  globular  form.  In  uniparous  animals  the  fetus  is  usu- 
ally contained  in  the  uterine  body  and  one  horn,  so  that  the  princi- 
pal changes  take  place  in  those  parts  and  leave  the  non-gravid  cornu 
but  slightly  increased  in  size  or  changed  in  form,  so  that  it  appears 
as  a  mere  appendage  upon  the  side  of  the  enlarged  cavity  which 
contains  the  fetus.  In  the  multiparous  animal,  whether  there 
be  several  fetu.ses  or  only  one,  the  development  of  the  young  oc- 
curs in  the  cornu  or  cornua  and  the  so-called  uterine  body  regularly 
remains  empty  and  serves  merely  as  a  passage  for  the  fetus  from 
the  point  of  its  development,  when  the  time  for  parturition 
arrives.  In  rare  cases  in  multiparous  animals,  not  infrequently 
in  the  mare,  a  fetus  may  develop  more  or  less  equally  in  the  two 
cornua,  bicornual  pregnane}-,  and,  at  the  time  of  parturition,  offer 
serious  or  fatal  obstacles  to  birth.  (See  Transverse  or  Bicornual 
Pregnancy.)  Usually,  in  multiparous  animals,  the  number  of 
fetuses  is  approximately  equal  in  the  two  horns. 

The  cervix  of  the  uterus  undergoes  well-marked  changes  dur- 
ing the  latter  part  of  pregnancy.  During  pregnancy  the  os 
uteri  is  firmly  closed  by  the  constriction  of  the  circular  muscle  fibers 
of  the  cervix  and  the  occlusion  is  further  .secured  by  means  of  an 
albuminous  clot,  which  is  quite  thick  and  firm.  The  cervix  is  at 
first  quite  firmly  contracted,  so  that  it  is  exceedingly  difficult  to 
force  a  passage  through  it  into  the  uterus  of  the  cow,  while,  in 
the  mare,  as  in  the  non-pregnant  state,  it  is  very  easily  dilated 
and   one  or  more  fingers  or  the  entire  hand  may  be  inserted. 

As  parturition  approaches,  the  os  uteri  normally  becomes 
somewhat  dilated.     The  walls  of  the   cervix   become  softer  and 

374 


The  Form  of  the  Pregnant  Uterus  375 

more  distensible  and  the  longitudinal  folds  of  mucous  membrane 
begin  to  disappear.  Finally,  when  labor  begins,  the  os,  under 
normal  conditions,  dilates  until  it  becomes  completely  effaced 
and  is  of  the  same  dimensions  as  the  vagina  and  uterus,  so  that 
the  two, cavities  now  become  continuous,  with  no  distinct  line  of 
demarcation  between  the  two  portions.  After  parturition  has 
occurred,  the  os  and  cervix  normally  resume  their  previous 
condition  very  promptly,  so  that  within  a  few  days  these  parts 
are  approximately  the  same  as  before  impregnation. 

The  situation  of  the  uterus  is  modified  \>\  the  changes  taking 
place  in  its  volume.  At  the  same  time,  its  growth  must  alter 
in  some  degree  the  situation  of  other  floating  viscera.  The 
gravid  uterus  possesses  the  highest  specific  gravity  among  the 
floating  organs  of  the  abdominal  cavity  and,  as  a  consequence, 
in  our  quadrupedal  animals  it  soon  descends  to  and  rests  upon  the 
abdominal  floor.  Its  position  upon  the  abdominal  floor  is  slightly 
modified  in  some  cases  hy  neighboring  organs,  when  they  are 
sufficiently  voluminous  and  possess  a  high  specific  gravity,  like 
the  rumen  of  ruminants  and  the  great  colon  of  solipeds.  As  a 
result,  in  the  mare  the  pelvic  flexure  of  the  colon  is  displaced 
somewhat  to  the  right  and  the  uterus  passes  along  beneath  it 
to  the  left  of  the  median  line.  In  ruminants,  on  the  other  hand, 
the  uterus  becomes  slightly  displaced  to  the  right  by  the  enormous 
rumen.  In  the  multiparous  animals,  none  of  which  have  any 
very  voluminous  floating  viscera,  the  gravid  uterus  becomes  the 
most  important  abdominal  organ  and  takes  first  place  along  the 
median  line,  displacing  the  other  viscera  to  either  side  or  upward. 

These  changes  come  about  somewhat  slowly.  At  first  the 
gravid  uterus  rests  partly  in  the  pelvis  and  well  suspended  by 
the  broad  ligaments  in  the  sublumbar  region,  but,  as  soon  as  the 
fetus  has  acquired  any  great  volume,  it  at  once  bears  the  uterus 
downward  and  forward  onto  the  abdominal  floor  and  finally 
pushes  its  way  along  this,  as  on  an  inclined  plane,  until  it  reaches 
the  diaphragm,  where  the  most  anterior  extremity  of  the  gravid 
uterus  lies  in  close  relation  with  the  .stomach,  liver  and  dia- 
phragm. 

During  this  change  in  the  po.sition  of  the  uterus,  the  os  uteri 
is  for  a  time  dragged  forward  so  that  it  is  farther  from  the  vulva 
than  in  the  non-pregnant  animal,  but  later,  in  unipara,  when  the 


376  Veterinary  Obstetrics 

fetus  has  come  to  rest  against  the  diaphragm  and  has  acquired  a 
longitudinal  diameter  which  equals  or  exceeds  that  of  the 
abdominal  cavity  of  the  mother,  the  more  posteriorly  situated 
end  of  the  fetus,  with  its  membranes,  pushes  up  into  the  pelvis 
to  the  OS  uteri.  The  os  uteri  may  itself  be  pushed  back  toward 
the  vulva,  and  in  some  cases,  when  parturition  is  near,  especially 
in  the  cow  and  ewe,  the  os  uteri  becomes  displaced  backward  to 
such  a  degree  that  it  may  even  appear  between  the  lips  of  the 
vulva  when  the  animal  is  lying  down.  This  prolapse  of  the 
vagina  and  cervix  in  pregnant  ruminants  sometimes  requires  the 
attendance  of  the  obstetrist.  See  Ante-partum  Prolapse  of  the 
Vagina. 

On  the  other  hand,  in  some  animals  with  exceedingly  pen- 
dulous abdomens,  or  in  that  pathologic  condition  where  rup- 
ture of  the  abdominal  floor  has  occurred  so  that  the  fetus  passes 
through  the  muscular  floor  of  the  abdomen  to  rest  against  the 
skin,  the  uterus  is  dragged  abnormally  downward  and  forward 
so  that  the  vulva  and  anus  are  drawn  inward  and  present  a  con- 
cavity. 

In  multiparous  animals  the  uterus  lies  folded  upon  itself  very 
much  the  same  as  the  intestine.  Fleming  states  that,  in  the  pig, 
each  cornu  of  the  uterus  lies  above  the  corresponding  line  of 
mammae.  This,  however,  is  impossible,  since,  when  there  are 
6  or  7  fetuses  in  one  cornu,  their  combined  length  is  at  least 
double  that  from  the  pubis  to  the  diaphragm.  Consequentl)^ 
the}'  cannot  be  arranged  in  a  straight  line,  but  the  cornu  must 
be  thrown  into  folds  to  accommodate  the  disposition  of  the 
fetuses  contained  within  it. 

The  direction  of  the  uterus  in  our  domestic  animals  is  very 
simple.  Its  weight  and  the  horizontal  position  of  the  body  tend 
constantly  to  keep  it  in  an  antero-posterior  direction,  in  a  general 
line  with  the  long  axis  of  the  body,  modified  only  in  those  cases 
of  multiparous  animals,  in  which  the  cornua  are  too  long  to  lie  in 
a  direct  line,  and  in  the  larger  herbivora,  in  which  the  uterus 
may  be  slightly  displaced  to  the  right  or  left  by  great  viscera. 

In  those  animals  like  the  cow  and  mare,  in  which  the  ab- 
domen may  be  very  pendulous,  there  may  be  a  somewhat  marked 
deviation  of  the  uterus  downward,  which  would  cause  the  os 
uteri  to  present  .somewhat  upward,   but  this  is  not  of  such   a 


The  Form  of  the  Pregnant  Uterus  377 

character  as  to  be  termed  abnormal  and  forms  no  particular  im- 
pediment to  labor.  In  other  cases,  the  uterus  becomes  displaced 
on  account  of  the  ruptured  prepubian  tendon  (which  see)  or  it 
may  become  rotated  upon  its  long  axis,  inducing  torsion  of  the 
uterus,  which  we  shall  consider  later. 

The  influence  of  the  gravid  uterus  upon  neighboring  organs 
is  comparativeh^  unimportant  except  in  a  purelj'  mechanical  way. 
It  does  not  interfere  materially  with  an)'  of  the  abdominal 
viscera.  When  the  fetus  attains  considerable  size  and  rests 
against  the  diaphragm,  it  may  mechanically  impede  respiration 
to  a  slight  degree. 

The  influence  of  the  gravid  uterus  upon  the  circulation  of  the 
region  has  been  claimed  by  some  writers  to  be  quite  important. 
Fleming  states  that,  in  the  cow  and  mare,  the  gravid  uterus  ex- 
erts an  unfavorable  compres.sion  upon  the  blood  vessels  of  the 
hind  limbs,  vulva  and  rectum  and  causes  engorgement  of  the 
veins  and  lymphatics  in  these  parts.  In  this  way  he  accounts 
for  the  edema  of  these  parts  so  often  observed  in  the  later  stages 
of  gestation  in  the  mare.  He  thinks,  also,  that  this  edema  is  re- 
ferable to  some  extent,  in  the  mare  and  cow,  to  pressure  upon  the 
saphena  and  mammary  veins.  It  would  be  exceedingly  difficult 
to  demonstrate  this  hypothesis  upon  anatomical  grounds.  In 
woman,  in  her  upright  position,  with  the  head  of  the  fetus 
normally  resting  against  the  pelvic  inlet  and  the  entire  weight 
of  the  fetus  bearing  upon  these  parts,  it  would  seem  reasonable 
to  expect  .some  interference  with  the  return  of  blood  from  the 
inferior  extremity  of  the  mother,  and  this  is  clinically  true. 
However,  in  our  domestic  animals  in  their  quadrupedal  position 
this  cannot  well  follow.  In  dropsy  of  the  amnion  in  the  cow 
(which  see),  there  is  such  a  great  collection  of  amniotic  or 
allantoic  fluid  that  the  patient  is  borne  down  by  the  immense 
weight  and  cannot  rise  to  her  feet.  Still,  in  the.se  cases,  dropsy 
of  the  limbs  is  never  seen,  but  they  are  on  the  contrary  very  clean 
and  free  from  any  edema  whatever.  Both  from  an  anatomical 
and  a  clinical  standpoint,  the  allegation  that  compression  by  the 
gravid  uterus  causes  edema  of  the  posterior  limbs  and  abdom- 
inal floor  is  questionable  ;  the  edema  should  probably  be  referred 
to  other  than  mechanical  influences. 

The  changes  in  volume,  weight  and  position  of  the  gravid 
uterus,  while  they  bring  about  some   alterations  in   the  position 


378  Veterinary  Obstetrics 

of  other  viscera,  do  not  interfere  materially  with  their  functions. 
The  modifications  in  position  necessitated  by  the  growth  of  the 
uterus  come  about  gradually,  so  that  the  other  organs  readily 
adapt  themselves  to  the  change,  without  inconvenience. 

The  increased  weight  of  the  body  contents,  which  has  become 
greater  in  pregnancy,  necessarily  hampers  somewhat  the  move- 
ments of  the  mother,  so  that  she  is  slower  and  less  agile.  It 
may  be  also  that  there  are  psychic  reasons  which  cause  her  to 
move  more  slowly  and  carefully,  lest  there  should  be  danger  of 
injury  to  herself  or  her  fetus. 

Ver3^  early  in  pregnancy,  important  psychic  changes  occur. 
In  the  mare,  especially,  it  is  noted  that  there  is  greater  docility 
and  that  the  animal  seems  somewhat  more  sluggish.  Both  the 
mare  and  the  cow,  toward  the  latter  part  of  pregnane}-,  show  .some 
arousing  of  the  maternal  instinct  and  are  more  ready  to  defend 
themselves  in  event  of  danger.  This  is  especially  noted  in  the 
cow  upon  the  approach  of  carnivorous  animals,  which,  in  the 
natural  state,  constitute  her  enemies. 

In  domestic  animals  we  do  not  observe  those  disturbances  in 
the  digestive  and  nervous  systems  which  are  seen  at  the  com- 
mencement of  pregnancy  in  woman.  As  a  general  rule,  the 
pregnant  female  is  more  quiet  and  contented  than  the  non- 
pregnant and,  during  the  first  half  of  pregnancy,  takes  on  flesh 
rapidly  upon  a  comparatively  light  diet,  but  later  in  gestation 
shows  a. tendency  to  lose  flesh,  becau.se  of  the  great  drain  upon 
the  maternal  system  due  to  the  rapid  growth  of  the  fetus.  This 
tendency  to  fatten  during  the  early  stages  of  pregnancy  is  used 
by  stock-feeders  to  hasten  the  fattening  process  of  animals  in- 
tended for  slaughter.  The  animals  are  habitually  bred  at  a 
favorable  time  and  then  sold  upon  the  market  before  they  have 
reached  the  middle  stage  of  gestation. 

Fleming  states  that  the  pressure  exerted  by  the  uterus  upon 
the  vagina  and  the  neck  of  the  bladder  causes  the  animal  to 
urinate  more  frequentl3%  but  this  is  not  noticeable  clinically. 
Probably  this  thought  is  suggested  by  the  clinical  fact  observed 
in  pregnant  woman,  in  whom,  owing  to  her  position  and  that 
of  the  fetus,  there  is  direct  mechanical  compression  of  the  urinary 
bladder.  The  volume  of  blood  in  the  body  of  the  pregnant 
female  is  said  to  be  positively  increased,  but  its  corpuscles  and 
solid   constituents  relatively  decreased. 


THE  POSITION  OF  THE  FETUS  IN  THE  UTERUS. 

The  position  of  the  fetus  or  fetuses  in  the  uterine  cavit}-  is 
largely  determined  b}'  the  form  and  direction  of  the  cavity  itself 
and  the  form  and  specific  gravity  of  the  fetus.  Since  these 
factor?:  are  reasonably  constant  in  each  species,  it  follows  that 
the  position  of  the  3'oung  in  the  uterine  cavity  is  also  quite 
uniform. 

It  is  not  always  easy  to  determine  precisely  the  po.sition  of  the 
fetus  in  the  uterus,  by  post-mortem  examination,  because  of  the 
fact  that  the  fetus  and  uterus  probably  change  their  position 
somewhat  according  to  that  of  the  maternal  body.  We  have  al- 
ready stated  above  that  the  gravid  uterus  possesses  the  highest 
specific  gravity  of  any  of  the  abdominal  viscera.  The  fetus  al.so 
offers  the  highest  specific  gravity  among  the  uterine  contents 
and,  this  being  true,  it  follows  that  the  position  of  the  fetus 
should  always  be  stable,  independent  of  its  umbilic  attachments. 

In  the  development  of  the  embryo,  the  head-end  grows  much 
more  rapidh^  during  the  first  stages  of  embryonic  life  than  the 
posterior  portions.  The  circulation  of  the  fetus  is  so  distributed 
that  more  arterial  blood  reaches  the  anterior  than  the  posterior 
end  of  the  embryo,  especially  during  the  early  stages  of  fetal  life. 
The  brain  grows  very  rapidly  and  the  dorsal  surface  of  the  body 
outgrows  the  ventral,  so  that  the  embryo  is  soon  arciform.  The 
great  development  of  the  head-end  of  the  embryo,  as  compared  to 
the  posterior,  causes  the  anterior  portion  to  possess  greater  weight, 
which  would  constantly  tend  to  cause  the  embryo,  if  suspended, 
to  rest  with  its  head-end  lower  than  the  posterior  part  of  the 
body.  The  arciform  character  of  the  fetus  continues  throughout 
intra-uterine  life  and,  from  the  beginning,  aflfects  the  stability  of 
the  position  of  the  fetus. 

The  fact  that  the  uterine  cavity  of  each  of  our  domestic  animals 
is  more  or  less  tubular  in  form  renders  it  essential  that  the  long  axis 
of  the  fetus  should  correspond  to  the  long  axis  of  the  uterine 
cavity,  so  that  regularly  the  fetus  is  found  resting  in  this  position. 
Exceptions  to  this  rule  occur  in  the  uterus  of  the  mare  and,  more 

379 


380  Veterhiary  Obstetrics 

rarely,  in  other  animals  in  which  a  single  fetus  develops  more  or 
less  equally  in  each  of  the  two  coruua,  but  even  in  this  instance 
the  rule  is  followed  in  a  measure  by  the  fetus  being  placed 
longitudinally  in  the  combined  cavities  of  the  two  cornua.  This 
compels  the  fetus  to  assume  a  transverse  position  in  relation  to 
the  long  axis  of  the  body  of  the  mother  and  of  the  body  of  the 
uterus.  The  question  of  the  development  of  the  fetus  in  the 
two  horns  is  discussed    under  "  Bi-cornual  Pregnancy." 

The  question  of  the  presentation  of  the  anterior  or  posterior 
end  of  the  fetus  toward  the  os  uteri  is  largely  determined,  so 
far  as  we  know,  by  the  inclination  of  the  uterus  and  comparative 
specific  gravity  of  the  head  and  tail  ends  of  the  fetus.  Early  in 
embryonic  life,  as  we  have  already  related,  the  fetus  floats  free 
in  the  amniotic  sac  and  may  turn  upon  its  short  axis,  so  that 
either  the  head  or  tail  may  present  toward  the  os  uteri.  In  the 
mare  and  carnivora  there  is  further  facility  afforded  for  the  fetus 
to  turn  upon  its  short  axis,  by  the  complete  allantoic  .sac.  This 
entirely  surrounds  the  amniotic  sac,  so  that  the  fetus  with  its 
amnion  may  turn  within  the  allantois.  Turning  upon  the 
short  axis  must  necessarily  cease  as  soon  as  the  long  axis  of  the 
fetus  exceeds  the  transverse  axis  of  the  uterine  cavity.  The 
fetus  then  becomes  fixed,  so  far  as  its  antero-posterior  diameter 
is  concerned,  for  the  remainder  of  its  intra-uterine  life. 

In  the  uniparous  and  biparous  animals,  the  bases  of  the 
uterine  cornua  slope  more  or  less  backward  and  downward  from 
their  anterior  attachments  toward  the  os  uteri  and  maintain 
this  position  until  the  weight  of  the  fetus  and  its  membranes, 
with  that  of  the  contained  fluids,  bears  the  organ  down  to  the 
abdominal  floor.  During  this  period,  prior  to  the  descent  of  the 
uterus  upon  the  abdominal  floor,  the  head-end  of  the  fetus  is 
much  the  heavier  and  consequently  tends  to  become  directed 
toward  the  os  uteri.  A  further  influence  in  reference  to  the 
position  of  the  fetus  is  the  question  of  the  form  of  the  uterine 
tube  itself.  This  tube  is  not  uniform  in  its  transverse  diameter, 
but  is  tapering  and  becomes  smaller  as  the  oviducts  are  approached, 
so  that  again  the  tendency  would  be  for  the  larger  end  of 
fetus  to  occup3^  the  larger  end  of  the  cornu,  which  would  cause 
the  head-end  to  present  toward  the  os  uteri. 

In  multiparous  animals,   in   which   the    uterus    lies    upon   the 


The  Position  of  the  Fetus  in  the  Uterus.  38 1 

abdominal  floor  at  a  verj^  earl}-  period  in  pregnancy,  the  question 
of  the  inclination  of  the  uterus  can  have  less  influence  upon  the 
direction  in  which  the  head-end  shall  present  than  in  the  uni- 
para,  and  so  we  find  that  they  present  somewhat  indifferently 
though  the  tendency  for  the  head-end  of  the  fetus  to  present 
toward  the  vulva  is  still  well  marked. 

Late  in  gestation,  the  hinder  parts  of  the  fetus  become  more 
developed,  so  that  in  the  larger  herbivora  these  parts  equal  or 
exceed  in  bulk  and  weight  the  anterior  portions  of  the  bod}-. 
By  this  time  the  uterus  is  lying  upon  the  abdominal  floor  and 
the  posterior  part  of  the  fetus  occupies  the  lowest  point  of  the 
abdomen  in  the  neighborhood  of  the  diaphragm.  In  addition  to 
this,  the  fetus  has  acquired  a  longitudinal  diameter  which  is 
in  excess  of  the  transverse  diameter  of  the  uterine  cavity,  and 
the  relationship  between  the  long  axis  of  the  fetus  and  that  of 
the  uterine  cavity  becomes  fixed  and  permanent. 

We  thus  find  that,  in  the  vast  majority  of  cases  in  our  larger 
domestic  animals,  the  fetuses  regularly  present  anteriorly  at  the 
time  of  birth.  In  multiparous animals,  the  fetuses  present  some- 
what indifferently,  usually  anteriorly,  frequently  posteriorly. 

The  relationship  between  the  transverse  axis  of  the  fetus  and 
that  of  the  maternal  body  is  largely  determined  by  the  form  of  the 
fetus  itself  and  of  the  surface  upon  which  it  rests.  We  have  alread}- 
learned  that  the  fetus  early  assumes  the  form  of  an  arc  and  that  this 
form  is  maintained  throughout  its  intra-uterine  life.  The  fetus 
bends  ventral  wards  and  its  form  inhibits  any  marked  dorsal  flexion. 
During  the  early  stages  of  gestation,  the  uterus  is  suspended  by 
its  ligaments  in  the  abdominal  cavity  and  its  cornua  in  the  mare 
are  more  or  less  curved  downward  at  their  middle  portion.  In 
ruminants  the  gravid  cornu  or  cornua  retain  for  a  time  their  non- 
gravid  .spiral  form,  curving  downwards,  backwards  and  then 
upwards.  An  arciform  fetus  would  normally  assume  the  most 
stable  position,  which  would  be  with  its  convex  or  dorsal  surface 
applied  to  the  convex  side  of  the  uterus  and  its  concave  or  ven- 
tral surface   toward   the  concave   uterine  surface. 

At  this  stage  the  natural  position  of  the  fetus  in  the  mare  is  with 
its  dorsum  downward  and  its  ventral  surface  upward.  In  the 
ruminant,  so  long  as  the  uterus  remains  in  its  non-gravid  position, 
the  ventral  surface  of  the  fetus  would  normally  present    down- 


382  Veterinary  Obstetrics 

wards,  if  in  the  base  of  the  cornu,  to  correspond  with  the  concave 
side  of  the  uterus. 

As  the  weight  of  the  fetus  increases  and  bears  the  uterus 
downward  to  the  abdominal  floor,  the  position  of  the  arciform 
fetus  becomes  unstable  because  it  tends  to  come  to  rest,  lying  up- 
on its  convex  dorsal  surface,  upon  the  essentially  plane  abdominal 
floor.  Its  position  would  be  equally  unstable  should  it  settle 
against  the  abdominal  floor  upon  its  ventral  or  concave  border, 
as  might  occur  in  the  ruminant.  Either  of  the.se  positions  is  so 
unstable  that  the  fetus  tends  to  revolve  upon  its  long  axis 
and  finally  come  to  rest  in  a  more  or  less  lateral  recumbent  posi- 
tion. Hence,  during  the  later  stages  of  pregnancy,  the  fetus  is 
generally  found  lying  .somewhat  upon  its  side  along  the  abdomi- 
nal floor,  where  it  may  be  readily  felt,  through  the  flank,  in  our 
larger  animals. 

In  ruminants,  the  downward,  forward,  and  finally  backward, 
curvature  of  the  uterine  cornua  leads  to  instability  of  the  fetal 
position  and,  as  the  fetus  acquires  weight  and  descends  to  the 
abdominal  floor,  it  must  assume  a  stable  attitude  and,  instead  of 
resting  upon  its  ventral  surface  with  its  concave  border  down- 
wards, must  turn  upon  its  side  and  come  to  rest  upon  the  abdomi- 
nal floor.  In  .so  doing,  the  gravid  cornu  tends  to  revolve  .slightly 
upon  its  long  axis. 

The  attitude  of  the  fetus  is  largely  determined  by  its  form  and 
the  available  space  for  its  accomodation.  In  the  cow  and  mare, 
the  abdominal  cavity  is  not  sufficiently  long  to  accommodate  the 
fetus  in  an  extended  position  and  it  must  con.sequently  be  doubled 
up  in  a  way  to  occupy  a  minimum  amount  of  space  autero- 
po.steriorly.  This  condition  is  most  completely  fulfilled  by  the 
head  and  neck  bending  ventralwards  .so  that  the  chin  comes 
in  contact  with  the  sternum  ;  the  anterior  limbs  flexed  at  the 
elbow  and  carpus  so  that  the  anterior  feet  rest  with  their  ventral 
surfaces  against  the  chest,  the  carpus  being  in  contact  with  the 
sides  of  the  head,  and  the  posterior  limbs,  flexed  at  the  stifle  and 
tarsus,  folded  beneath  the  body  in  approximately  the  same  posi- 
tion as  is  observed  in  sternal  recumbency  of  the  adult  animal. 

In  the  multiparous  animals,  the  fetuses  rest  in  a  more  direct 
line,  there  being  much  less  curvature  in  the  long  axis,  especially 
toward  the  termination  of  pregnancy.     The  limbs,  being  shorter 


The  Position  of  the  Fetus  i7i  the  Uterus.  383 

and  less  conspicuous  than  in  the  larger  animals,  are  more  fre- 
quenth'  extended  and  the  neck,  being  very  short,  is  not  curved. 

When  parturition  approaches  and  the  fetus  of  the  uniparous 
animal  has  well-nigh  outgrown  the  available  room  in  the  abdomi- 
nal cavity,  the  presenting  end  of  the  fetus  pushes  up  to,  or  into, 
the  pelvic  cavity  and  is  readily  felt  by  manual  exploration  per 
vaginam  or  per  rectum.  In  the  cow,  the  fetus  having  a  com- 
paratively short  neck,  the  head  is  frequently  extended  a  few 
days  before  parturition,  pushes  up  into  the  pelvic  cavity  and, 
extending  over  the  top  of  the  vagina  by  pushing  the  superior 
wall  of  the  uterus  backward,  it  appears  to  the  inexperienced 
veterinarian  to  be  outside  the  uterus,  although  in  reality  the 
position  is  not  rare  and  not  abnormal.  Along  with  the  head, 
there  may  present  also,  in  these  cases,  two  anterior  feet,  extended. 
We  have  not  observed  this  attitude  of  the  fetus  in  the  mare, 
although  it  may  occur. 

At  the  termination  of  pregnancy,  the  fetus  changes  its  position 
and,  when  it  begins  to  move  toward  the  pelvic  inlet,  as  a  result  of 
labor  pains,  it  normally  revolves  slightly  upon  its  long  axis  and, 
changing  from  lateral  recumbenc3%  presents  with  its  dorsum 
toward  the  lumbar  vertebrae  of  the  mother  and  its  ventral  surface 
toward  her  pelvic  floor.  This  is  essential  in  relation  to  the 
resistance  offered  to  the  passage  of  the  fetus  through  the  pelvic 
canal.  Whenever  it  presents  otherwise  than  with  the  dorsal  sur- 
face corresponding  to  the  spinal  column  of  the  mother,  it  causes 
great  or  insuperable  diflBculty  in  expulsion  and  calls  for  a  version 
of  the  fetus  upon  its  long  axis  before  delivery  can  readily  occur. 
This  difficulty  arises  from  the  fact  to  which  we  have  already  al- 
luded, that  the  fetus  maintains  the  form  of  an  arc,  the  ventral 
surface  being  concave.  The  direction  of  the  roof  of  the  passage 
through  the  pelvis  is  also  somewhat  arciform,  with  its  concavity 
downwards,  so  that  the  arciform  fetus  can  readily  pass  only  in  the 
one  position  and  a  very  great  obstacle  is  offered  to  its  passage  when 
its  dorsum  is  directed  downward  or  to  the  right  or  left,  its  arci- 
form body  becoming  impacted  against  some  portion  of  the 
maternal  passage. 


SIGNS  OF  PREGNANCY. 

It  is  of  great  importance  in  man}-  cases  to  determine  the  ex- 
istence or  non-existence  of  pregnancy.  In  the  examination  of 
mares  in  case  of  sale,  it  becomes  highly  important  that  the 
veterinarian  should  be  able  to  determine  definitely  if  the  animal 
be  pregnant  or  not.  If  desired  for  breeding  purposes,  the 
greatest  proof  that  can  be  established  of  the  breeding  power  of 
a  female  'animal  is  the  fact  that  .she  is  pregnant.  When 
a  mare  is  being  purchased  wholly  for  work  it  is  important 
to  determine  in  advance  if  she  is  pregnant  or  not,  since  the 
condition  of  pregnancy  may  interfere  seriously  with  her  useful- 
ness. In  the  cow  also  it  frequently  becomes  desirable  to  determine 
for  the  owner  or  prospective  buyer  whether  pregnancy  exists  or 
not.  In  cows  which  are  used  for  dairy  or  breeding  purposes,  it  is 
essential  that  thej^  be  capable  of  breeding  and  it  is  frequently  a 
very  important  question  to  the  owner  to  decide  whether  a  cow 
shall  be  retained  for  breeding  or  dairy  purposes  or  whether  she 
shall  be  sold  to  the  butcher  as  .sterile,  and  this  can  only  be  de- 
termined either  by  an  intelligent  investigation  by  the  veterinarian 
or  by  awaiting  the  time  for  parturition  to  occur,  which  latter 
method  may  occasion  a  very  considerable  loss  to  the  owner  because 
of  the  delay. 

In  all  animals,  it  is  important  that  we  should  be  able  to 
differentiate  between  pregnancy  and  certain  diseases,  which  may 
more  or  less  closely  simulate  that  condition. 

There  are  many  signs  of  pregnancy  which  have  more  or  le.ss 
value,  but  the  vast  majority  of  them  are  somewhat  erratic  and 
liable  to  mi.slead.  It  not  infrequently  occurs  that  an  animal  is 
regarded  as  pregnant  for  a  long  period  of  time  and  presents  the 
general  appearance  of  that  condition,  but  finally  fails  to  bring 
forth  young,  while  in  other  cases,  which  may  be  even  more  de- 
deceptive,  there  are  but  slight  external  appearances  of  pregnancy 
and  the  owner  is  surprised  when  parturition  unexpectedly  occurs. 

The  veterinarian  should  consequently  be  able  to  speak 
positively  regarding  the  question  of  pregnancy  in  a  domestic 
animal  and,  doing  so,  he  needs  to  know  and  consider  all  symptoms 
or  signs  which  have  any  relation  to  the  question. 

384 


Sig7is  of  Pregnancy  385 

The  diagnosis  of  pregnancy  during  its  earlier  stages  is  exceed- 
ingly difficult  and,  during  the  very  earliest  period,  is  impossible. 
The  symptoms  of  pregnancy  may  be  divided  into  three  principal 
groups  :  the  subjective  or  physiologic  signs  ;  the  objective  signs  ; 
and  the  positive  or  direct  signs,  which  are  observed  by  ex- 
amination of  the  parts  in  a  way  to  definitel}'  determine  the  pres- 
ence of  the  fetus  itself. 

Physiologic  or  Subjective  Signs. 

Some  of  the  physiologic,  and  psychic,  manifestations  of  pregnancy 
are  quite  well  marked,  but  tend  in  some  cases  to  become  decep- 
tive. The  physiologic  symptom  upon  which  the  greatest  re- 
liance is  placed  is  the  cessation  of  estrum.  As  a  general  rule, 
fertilization  stops  the  appearances  of  estrum  very  promptly  and 
permanently  throughout  gestation.  Estrum  may  not  cease  im- 
mediately upon  fertilization,  but  continue  to  the  close  of  the 
normal  estrual  period  during  which  the  impregnation  has  taken 
place.  Perhaps  in  this  case  we  should  rather  say  that  the 
estrum  continues  until  ovulation  and  fertilization  have  occurred. 
In  discussing  the  relationship  between  estrum  and  ovulation, 
we  ventured  to  suggest  that  in  some  animals,  if  not  in  all, 
but  especially  in  the  cow,  ovulation  does  not  occur  until 
near  the  close  of  the  estrual  period.  Consequently  fertil- 
ization does  not  take  place  until  such  time,  and  until  then 
we  cannot  expect  a  cessation  of  estrum.  In  other  words, 
copulation,  even  though  it  be  eventually  fruitful,  does 
not  mark  the  period  of  fertilization.  However,  it  is  generally 
noted  that,  if  copulation  occurs  early  during  estrum  and 
fertilization  follows,  the  estrual  period  seems  to  be  cut  short. 

Not  only  do  the  sj-mptoms  of  estrum  usually  disappear  to  not 
recur  until  after  parturition  has  taken  place,  causing  the  female 
to  persistently  refuse  copulation,  but  it  is  said  by  some  observers 
that  males  themselves  in  many  cases  decline  to  copulate  with 
females  which  are  pregnant.  This  is  not  uniformly  true  by  any 
means.  Both  in  the  mare  and  cow  there  are  frequent  cases  in 
which  the  pregnant  animal  shows  all  the  signs  of  estrum  and  in 
which  prompt  and  repeated  copulation  occurs  in  an  apparently 
natural  way.  This  is  especially  true  in  nymphomaniac  cows, 
which  frequently  show  all  the  signs  of  estrum,  at  the  regular  in- 
25 


386  Veterinary  Obstetrics 

tervals,  after  fertilization  has  occurred,  and  will  continue  to 
copulate  regularly  for  two,  three  or  more  estrual  periods,  in  spite 
of  the  existence  of  pregnancy.  In  a  case  which  we  personally 
observ^ed,  the  cow  was  bred  for  three  successive  estrual  periods, 
to  a  bull  of  one  breed  the  first  time,  and  to  one  of  another  breed 
during  the  last  two  periods,  and  finally  gave  birth  to  a  calf  at  the 
proper  time  from  the  first  breeding,  which  showed  the  character- 
istics of  the  breed  of  the  first  bull.  vSimilar  observations  are 
made  in  all  our  domestic  animals,  though  not  so  frequently  as 
in  the  cow. 

It  is  quite  generally  believed  that  copulation  in  an  advanced 
state  of  pregnancy  is  liable  to  induce  abortion  and  numerous 
cases  have  been  cited  to  apparently  demonstrate  the  fact.  In 
one  ca.se  which  we  observed,  the  cow  showed  signs  of  estrum  at 
about  the  close  of  the  eighth  month  of  pregnancy  and  was  bred. 
On  the  following  day  abortion  took  place.  The  conclusion  was 
that  the  copulation  had  caused  the  abortion.  This  may  or  may 
not  have  been  true.  The  abortion  may  have  been  due  to  the 
same  causes  as  the  estrum,  or  we  might  say  that  possibly  the 
abortion,  or  rather  the  death  of  the  fetus  preparatory  to  its  ex- 
pulsion, had  induced  the  signs  of  estrum  and  led  to  copulation 
with  the  male. 

While  the  cessation  of  estrum  is  an  important  indication  of 
pregnancy,  it  is  evidently  not  final  nor  wholly  reliable  ;  a  non- 
pregnant animal  may  cease  to  show  signs  of  estrum,  as  we  have 
already  related  when  discussing  sterility,  while  a  pregnant  one 
may  show  signs  of  estrum  at  any  time  during  gestation  and 
copulate  freely  with  the  male. 

In  our  domestic  animals  there  is  usually  noted,  as  a  con.se- 
quence  of  impregnation,  a  more  tranquil  disposition  of  the 
female,  as  a  result  of  which  .she  tends  to  take  on  fat  during  the 
earlier  stages  of  gestation  and,  as  we  have  already  remarked, 
this  tendency  is  made  use  of  in  preparing  animals  for  slaughter. 

Toward  the  close  of  pregnancy,  animals  apparently  become 
lazy  and  are  not  capable  of  performing  certain  kinds  of  move- 
ments which  require  agility,  such  as  running  and  jumping,  with 
the  same  ease  as  those  which  are  not  pregnant.  But  these 
changes  are  not  well  marked  and  the  mare  which  is  kept  regu- 
larly at  work  suffers  but  little  inconvenience  .so  long  as  the  labor 


Sig7is  of  Pregnancy  387 

is  of  a  moderate  character,  that  is,  if  the  load  to  be   drawn    or 
carried,  or  the  pace  which  is  to  be  maintained,  is  not  extreme. 

Physical  or  Objective  Signs. 

The  most  important  physical  signs  of  pregnancy  are  those 
indicated  by  a  change  in  the  volume  and  form  of  the  abdomen 
and  mammae,  accompanied  by  the  secretion  of  milk,  to  which 
may  also  be  added,  according  to  some  investigators,  a  change  in 
the  composition  of  the  urine. 

The  development  of  the  fetus  with  its  membranes  and  the  con- 
tained fluids,  along  with  the  increase  in  the  volume  of  the  uterus 
itself,  necessarily  leads  to  a  corresponding  increase  in  the  volume 
of  the  abdomen.  This  increase  naturally  occurs  chiefly  during 
the  later  stages  of  pregnancy,  although  it  begins  very  early  in 
gestation.  During  these  earlier  months  the  apparent  increa.se 
in  the  volume  of  the  abdomen  must  be  due  to  an  increased 
volume  of  fat  or  of  intestinal  contents,  since  the  actual  increase 
in  the  size  of  the  gravid  uterus  is  not  sufficiently  conspicuous  to 
bring  about  any  visible  changes.  Later,  this  change  in  volume 
becomes  more  marked  and  there  ensues  also  some  degree  of 
change  in  form,  which  serves  to  distinguish  the  enlargement  of 
pregnancy  from  other  abdominal  enlargement. 

The  pregnant  uterus,  having  a  very  high  specific  gravity, 
drops  directly  upon  the  abdominal  floor  and  bears  it  down,  which 
causes  the  abdomen  to  enlarge  chiefly  in  the  lower  part,  while 
the  upper  portion  apparently  sinks  somewhat. 

While  this  symptom  is  important  as  an  indication  of  pregnancy, 
it  is  not  reliable.  The  enlargement  is  frequently  not  prominent, 
so  that  in  some  cases,  especially  in  mares,  there  may  be  so  little 
increase  in  the  size  of  the  abdomen  as  to  wholly-  deceive  the 
owner  until  near  the  time  of  parturition. 

On  the  other  hand,  various  diseased  conditions  may  give  rise 
to  an  enlargement  of  the  abdomen  which  may  closely  simulate 
pregnancy,  such  as  dropsy  or  tumors  of  the  ovaries,  uterine 
tumors,  hydrometra  or  pj'ometra,  ascites,  and  dropsy  of  the 
kidney  (hydronephrosis)  and  other  abdominal  organs.  Even 
in  health,  some  females,  especially  the  large  herbivora,  acquire 
a  very  voluminous  abdomen  from  feeding  heavily  on  hay  or 
grass,  and  the  condition  at  times  so  closely  simulates  pregnancy 


388  Veterifiary  Obstetrics 

as  to  lead  to  error.  The  enlargement  of  the  abdomen,  as  a  sign 
of  pregnancy,  becomes  valuable,  therefore,  only  in  connection 
with  other  signs  and  should  not  be  depended  upon  alone. 

The  enlargement  of  the  mamm?e  normally  begins  quite  early 
during  pregnancy  in  primipara,  while,  in  animals  which  have 
produced  young  several  times,  the.se  organs  do  not  ordinarily 
show  signs  of  enlargement  until  toward  the  clo.se  of  gestation. 
In  the  cow  or  goat  which  is  used  for  dairying  purposes,  the 
milk  flow  may  be  perpetual  and.  when  the  milking  of  the  animal 
has  been  continued  throughout  gestation,  there  is  no  nota])le  en- 
largement of  the  udder.  In  poor  milkers  there  is  usually  a 
tendency  for  the  flow  of  milk  to  decrease  soon  after  impregnation 
and  in  many  cases  it  is  impossible  to  keep  the  cow  milking  up 
to  the  time  of  parturition  or  even  to  mid-term.  In  other  ca.ses, 
however,  the  animal  continues  to  secrete  milk  throughout  gesta- 
tion, and  toward  the  time  of  parturition,  when  the  mammae 
would  ordinarily  enlarge  as  a  result  of  pregnancy,  there  is  in- 
creased secretion  of  milk. 

The  enlargement  of  the  mammae  is  not,  however,  a  tru.st- 
worthy  sign  of  pregnancy.  In  some  animals  the  glands  fail  to 
enlarge  to  any  appreciable  degree  and,  after  parturition,  fail  to 
furnish  milk  for  the  nutrition  of  the  young.  This  is  especially 
observed  in  old  mares,  which  have  been  bred  for  the  first  time. 
On  the  other  hand,  the  mammae  become  enlarged  in  the  absence 
of  impregnation.  Fleming  states  that  the  milk  glands  may  be 
aroused  to  activity  in  the  young  animal,  when  but  a  few  days 
old,  owing  to  suction  upon  the  teats,  as  is  habitually  observed 
in  young  calves  when  a  number  of  them  are  kept  together,  in 
which  case  they  form  the  habit  of  sucking  each  other  repeatedly. 
While  this  rarely  excites  the  glands  to  function,  it  is  claimed 
that  it  does  at  times.  In  other  cases  it  is  repeatedly  noted  that 
animals  which  are  in  estrum  show  functional  activity  of  the  milk 
glands.  The  bitch,  while  in  estrum,  very  frequently  shows  en- 
largement and  some  functional  activity  of  the  mammae.  We 
have  ob-served  a  mare  mule  which,  though  presumably  incapable 
of  impregnation,  constantly  soiled  her  hind  legs  badly  while  in 
estrum,  owing  to  a  profuse  flow  of  milk  from  the  greatly  en- 
larged udder. 

It  has  been  claimed  that  toward  the  close  of  gestation  there 


Si'g-ns  of  Pregnayicy  389 

are  alterations  in  the  composition  of  the  urine  of  the  pregnant 
animal,  consisting  chiefl}^  in  a  decrease  in  the  salts  of  lime,  but 
the  data  upon  this  point  are  not  sufficient  to  warrant  anj- definite 
conclusion. 

Some  have  proposed  to  weigh  animals  suspected  of  being 
pregnant,  but  the  weight  of  animals  varies  so  greatly,  as  a  result 
of  the  character  of  food,  work  or  health,  that  no  deductions  can 
safely  be  drawn  in  this  way. 

Finally,  when  parturition  is  near,  there  is  an  increased  vascu- 
larity of  the  mucous  membrane  of  the  vulvar  opening. 

In  the  cow,  a  further  sign  of  pregnancy,  applying  only  near  the 
close  of  gestation,  is  that  of  sinking  of  the  hips  owing  to  relax- 
ation of  the  broad  sacro-sciatic  ligaments  of  the  pelvis.  As  al- 
ready noted  similar  signs  are  regularly  observed  in  sterility  es- 
pecially when  due  to  diseased  ovaries. 

None  of  the  foregoing  signs  of  pregnancy  are  wholly  reliable. 
While  they  generally  answer  the  purposes  of  the  breeder,  there 
are  frequent  exceptions  which  may  lead  to  more  or  less  serious 
error.  Any  one  of  the  foregoing  symptoms  of  pregnancy  maj^ 
be  induced  by  other  causes  and  any  one  of  them  may  be  absent 
nearly  or  quite  to  the  time  of  parturition. 

Positive  or  Direct  Signs. 

We  can  only  determine  the  existence  of  pregnancy  positively 
by  observing  the  presence  of  the  fetus  in  the  uterus  by  some  un- 
equivocal means.  To  this  end  we  have  definite  means:  i,  by 
vaginal,  rectal  or  abdominal  manipulations  or  by  ballottement  ; 
2,  by  auscultation  of  the  fetal  heart-beat  ;  3,  by  observing  the 
movements  of  the  living  fetus. 

The  determination  of  the  pre.sence  of  the  fetus  in  the  uterus 
by  manual  exploration  is  more  or  less  available  in  all  our  domestic 
animals  when  gestation  is  well  advanced.  In  our  larger  her- 
bivora  it  is  not  eas}-  to  feel  the  fetus  through  the  abdominal 
walls,  because  of  their  tension  and  firmness,  but  in  the  small 
animals,  like  the  bitch  and  cat,  the  fetuses  may  be  .somewhat 
easily  felt  through  the  thin  abdominal  walls. 

In  the  larger  animals,  if  the  fetus  is  well  back  and  a  portion 
of  it  projects  into  the  pelvis,  it  may  readily  be  touched  and  re- 
cognized through  the  vagina.     This  method,  however,   is  not  so 


3 go  Veterinary  Obstetrics 

available  as  that  per  rectum  and  is  quite  inapplicable,  as  a  rule, 
until  very  near  the  close  of  pregnancy. 

In  the  mare  and  cow,  rectal  exploration  affords  conclusive 
evidence  of  the  presence  of  a  fetus.  If  the  rectum  is  properly 
emptied  and  the  oiled  hand  is  introduced  to  the  full  length  of 
the  arm,  it  is  generally  possible  to  reach  the  fetus  as  it  lies  within 
the  uterus  and,  by  careful  palpation,  to  distinguish  its  parts. 
Usually  in  the  course  of  this  palpation,  after  the  mid-term  of 
pregnancy,  the  fetus  reacts  to  the  touch  and  moves  somewhat, 
revealing  not  only  its  presence,  but  also  the  fact  that  it  is  living. 

In  some  cases,  however,  when  the  fetus  has  acquired  con- 
siderable volume  and  the  abdomen  of  the  mother  is  quite 
capacious  and  pendulous,  the  fetus  drops  .so  far  away  forward 
that  it  may  be  almost  out  of  the  examiner's  reach.  In  such 
cases  the  examiner  will  find  the  enlarged  tightly  stretched 
vagina  passing  over  the  brim  of  the  pelvis  and  disappearing 
forward  into  the  abdominal  cavity.  This  is  in  marked  contrast 
to  the  normal  non-gravid  uterus,  which  can  be  readily  dis- 
tinguished and  picked  up  by  the  hand  per  rectum.  When  the 
uterus  has  thus  disappeared  out  of  reach  forward,  the  ovaries 
have  also  been  dragged  with  it  and  cannot  be  touched.  This 
absence  of  the  uterus  from  its  normal  non-gravid  position  and 
the  presence  of  the  enlarged  and  stretched  vagina  extending 
forward,  is  at  least  conclusive  evidence  that  the  uterus  has  been 
borne  forward  by  a  load  of  some  character,  which  we  would  at 
once  assume  to  be  a  fetus.  Further  manipulation  will  reveal  the 
presence  of  the  fetus,  some  part  of  it  lying   within   reach. 

In  making  the  examination  per  vagina  or  per  rectum,  great 
care  should  be  taken  to  provoke  as  little  excitement  of  the 
animal  or  irritation  of  the  uterus  as  is  possible.  It  is  needless  to 
suggest  that  the  examination  per  vaginam  should  be  made  under 
antiseptic  precautions  and  in  a  manner  which  would  not  cause 
straining.  The  examination  should  be  made  through  the  walls 
of  the  vagina  at  the  sides  of  the  cervix  uteri  and  not  through 
the  OS  uteri,  as  this  would  inevitably  jeopardize  the  life  of  the 
fetus. 

Ballottement  may  be  carried  out  in  two  ways.  Some  claim 
that  ballottement  can  be  practiced  in  small  animals,  the  same  as  in 
human  obstetrics,  per  vaginam  :  but  it  would  .seem  that  the  re- 


Sigfis  of  Pregnancy  391 

suits  are  not  satisfactory  because,  in  our  multiparous  animals, 
the  fetuses  lie  in  the  cornua  and,  even  though  we  place  the 
animal  in  a  vertical  position,  the  young  cannot  readily  drop  into 
the  pelvic  cavity  in  a  manner  to  permit  of  ballottement. 

In  the  larger  domestic  animals,  ballottement  through  the  ab- 
dominal walls  is  usually  quite  satisfactory,  after  some  experience 
has  been  acquired.  The  animal  is  examined  in  the  standing  posi- 
tion. The  veterinarian  stands  upon  the  right  side  of  the  cow, 
or  upon  either  side  of  the  mare,  though  preferably  upon  the  left, 
and  places  the  palm  of  his  hand  against  the  abdominal  wall  in 
the  lower  flank  region  just  above  and  anterior  to  the  udder.  By 
a  sudden  push  upward  there  should  be  recognized  a  hard  body 
which  recedes  from  the  hand  as  though  floating  in  a  liquid  and, 
a  moment  later,  falls  back  again  and  strikes  the  examiner's  hand. 
The  exact  point  for  this  manipulation  must  be  determined  for 
each  individual  case  and  it  may  be  necessary  to  search  the  sur- 
rounding area  for  some  distance  before  coming  in  contact  with 
the  fetus  and  thus  recognizing  its  presence.  This  constitutes 
one  of  the  most  reliable  and  available  methods  for  the  diag- 
nosis of  pregnancy.  There  are  no  other  normal  abdominal  con- 
tents which  can  thus  be  pushed  away  from  the  abdominal  wall 
with  a  bound  and  then  fall  back  again  with  an  evident  impact 
upon  the  point  from  which  they  departed.  Naturally,  this  meth- 
od is  only  applicable  after  the  fetus  has  acquired  considerable 
volume  ;  hence,  it  is  not  available  for  purposes  of  diagnosis  until 
the  beginning  of  the  last  half,  or  third,  of  pregnancy. 

The  determination  of  pregnancy  by  auscultation  of  the  fetal 
heart-beat  is  recognized  as  positive  in  its  results.  It  is  only 
available  when  the  fetal  heart  has  acquired  such  dimensions  and 
force  as  to  render  its  sounds  audible.  It  not  only  demonstrates 
fully  the  presence  of  a  fetus,  but  also  gives  the  important  infor- 
mation that  the  fetus  is  alive. 

The  heart-beat  of  the  young  consists  of  regular  sounds  which 
are  not  rythmic  with  the  beat  of  the  maternal  heart  ;  they  are 
much  more  rapid  and  have  a  different  character,  the  sound  hav- 
ing less  volume  and  being  somewhat  clearer — perhaps  we  should 
say  having  a  higher  pitch.  Lafosse  claims  to  be  able  to  diag- 
nose pregnane}^  in  the  cow  at  six  months  by  the  heart  sounds, 
but  admits  that  the  results  are  not  uniform  in  all  cases,  or  rather. 


392  Veterinary   Obstetrics 

that  in  some  the  heart-beat  cannot  be  perceived,  but  that,  when 
present,  it  is  thoroughly  reliable.  As  a  general  rule,  the  rate  of 
the  heart-beat  is  about  twice  that  of  the  mother.  The  heart- 
beat is  detected  best  in  the  standing  animal  along  the  floor  of  the 
abdomen  or  low  down  in  the  flank,  though  the  exact  point  for 
best  hearing  it  must  be  determined  separately  for  each  ca.se.  In 
our  experience  we  have  found  it  very  easy  in  most  cases  to  de- 
tect the  heart-beat  in  the  mare,  cow  and  ewe,  either  directh'  or 
with  the  aid  of  the  stethoscope. 

Under  some  conditions,  when  the  intestines  are  very  active, 
their  sounds  may  mask  or  obliterate  those  of  the  heart,  render- 
ing the  examination  vQ.xy  difficult  and  possibly  destroying  its 
efficiency. 

The  movements  of  the  fetus  con.stitute  clear  evidence  of  preg- 
nancy and  of  the  fact  that  it  is  alive.  We  have  no  reliable  and 
safe  methods  for  inducing  movements  of  the  young  and,  con- 
.sequently,  this  evidence  of  motion  is  procurable  only  by  chance 
or  at  considerable  risk.  Fleming  remarks  that  some  ignorant 
persons  pour  water  into  the  ears  of  the  pregnant  animal,  in  order 
to  cause  it  to  make  violent  efforts  to  get  rid  of  the  fluid'  and 
claim  that,  if  the  animal  is  pregnant,  it  will  only  shake  the  head 
and  ears.  Others  give  a  drink  of  cold  water  to  an  animal  which 
is  warm  and  very  thirsty  and  thus  induce  movements  of  the  fetus, 
owing  to  the  shock  from  the  close  proximity  of  the  cold  water 
when  it  enters  the  stomach  or  rumen,  to  the  fetus.  This  is  a 
dangerous  procedure,  liable  at  all  times  to  cause  abortion. 

The  only  safe  method  of  determining  pregnancj*  by  the 
presence  of  fetal  movements  is  bN^ongand  repeated  observations, 
until  the  fetus  makes  more  or  less  distinct  movements,  in  a  volun- 
tary way,  which  can  be  seen  through  the  abdominal  walls. 
These  occur  in  most,  if  not  all,  pregnant  animals,  but  are  most 
readily  observable  in  the  mare  and  cow,  where  the  size  and 
strength  of  the  fetus  suffice  to  bring  about  very  vigorous  move- 
ments. They  are  noted  chiefly  at  the  same  point  in  the  abdomen 
as  that  designated  for  ballottement,  that  is,  in  the  lower  flank 
region. 

In  all  the.se  methods  for  diagnosing  pregnancy,  it  will  be  ob- 
served that  none  of  them  are  applicable  or  reliable  in  the  earlier 
stages,  so  that  at  this  period  reliance  must    be   placed    upon  the 


Sig?is  of  Pregnayicy  393 

two  preceding  classes  of  sj-mptoms  rather  than  upon  direct  in- 
vestigation. Among  these  direct  methods,  that  most  early 
available  is  the  manipulation  per  rectum,  which  can  be  made  to 
succeed  as  early  as  a  fetus  has  acquired  sufficient  size  to  be  felt 
floating  within  the  uterus.  In  this  case,  upon  examination  per 
rectum,  the  uterus  is  found  markedly  enlarged  and  softened  and 
more  or  less  fluctuating  or  sugillating.  Floating  somewhere 
within  the  liquid,  usually  lying  at  the  bottom  on  account  of  its 
high  specific  gravity,  is  the  fetus,  which  is  perfectly  movable 
and  some  of  the  parts  of  which  may  be  recognized. 

The  differentiation  of  pregnancy  from  various  diseases  of 
the  uterus  or  abdominal  organs  sometimes  causes  difficulty. 

The  uterus  itself  is  subject  to  a  variety  of  diseases  which  cause 
its  enlargement  and  thereby  simulate  the  pregnant  condition. 
In  very  rare  cases  there  has  been  observed,  especially  in  the 
cow,  a  dropsical  condition  of  the  uterine  walls,  which  causes  the 
organ  to  become  enormously  enlarged  and  leads  sometimes  to 
the  supposition  that  the  animal  is  pregnant.  In  such  cases,  our 
only  positive  means  for  differentiation  is  the  determination  of  the 
presence  or  absence  of  the  fetus  itself  within  the  uterine  cavity, 
by  one  or  several  of  the  methods  which  we  have  already  described. 
Such  a  uterus  will  not  respond  to  ballotteraent,  there  can  be  no 
fetal  heart-beat  and  no  fetus  can  be  touched  bj^  rectal  explora- 
tion. 

Extensive  abscess  of  the  uterus,  or  pyometra,  might  be  mis- 
taken for  pregnancy.  In  the  case  of  pyometra,  there  is  usually 
some  abnormality  of  the  cervix  uteri  and  a  more  or  less  constant 
discharge  from  the  vulva,  while  the  uterus  itself  is  very  flaccid 
and  the  two  horns  are  usually  distended  alike,  no  fetus  being 
recognizable  in  either.  In  abscess  of  the  uterus,  the  organ  is 
large  and  more  or  less  spherical  and  its  walls  are  hard  and  tensely 
stretched,  while  an  examination  through  the  vagina  shows  that 
the  OS  uteri  is  obstructed  or  effaced. 

Uterine  tumors  may  be  mistaken  for  a  fetus,  but  should  be 
distinguishable  by  the  fact  that  they  do  not  move  in  the  uterus, 
but  only  with  the  uterus  or  its  walls  ;  that  is,  the  tumor  may  be 
pushed  back  and  forth  only  to  the  same  degree  as  the  uterus  it- 
.self  moves  with  it,  while  the  fetus  may  move  freely  within  the 
cavity  of  the  organ,  except  in  cases  of  mummification. 


394  Veterinary  Obstetrics 

Tumors  of  the  ovaries,  whether  cystic  or  solid,  rarely  attain 
sufficient  size  to  be  mistaken  for  pregnancy,  though  in  one 
case  we  observed  in  a  sow  an  ovarian  tumor  weighing  28 
pounds.  These  tumors  are  to  be  differentiated  from  pregnancy, 
or  at  least  from  normal  uterine  pregnancy,  by  the  fact  that  the 
uterus  itself  is  normal,  empty  and  in  its  proper  location,  except 
as  it  may  be  displaced   by  the  weight  of  the   tumor. 

Hydronephrosis,  or  cystic  kidney,  is  occasionally  observed  in 
our  domestic  animals,  usually  in  the  sow,  and  may  simulate 
pregnancy  to  the  extent  of  causing  a  very  great  increase  in  the 
size  of  the  abdomen.  In  one  case  which  we  observed  in  a  sow 
which  would  normally  weigh  about  300  pounds,  there  was  a 
cyst  of  the  kidney  which  occupied  almost  the  entire  abdominal 
cavity  and  caused  a  very  great  enlargement  of  it.  The  weight 
of  the  cyst  finally  became  so  great  that  the  animal  could  not 
rise  when  down.  The  cyst  contained  about  80  pounds  of  fluid. 
In  an  animal  of  this  size,  it  is  not  easy,  for  a  time,  to  differentiate 
between  this  condition  and  pregnancy.  In  the  cystic  kidney, 
however,  the  cyst  augments  continually  and  more  or  less  rapidly, 
giving  the  body  a  general  fullness,  which  is  not  at  all  confined 
to  the  lower  flank  region,  as  in  pregnancy.  The  abdomen  be- 
comes very  tense  and,  moreover,  there  is  likely  to  be  increased 
thirst,  along  with  some  depression  and  greater  difficulty  in  mov- 
ing than  if  the  animal  were  pregnant.  Moreover,  there  is 
usually  some  history  of  the  date  of  breeding  and  the  enlargement 
of  the  abdomen  soon  shows  a  want  of  harmony  between  it  and 
the  period  of  possible  impregnation.  If  the  normal  duration  of 
pregnancy  has  been  exceeded  and  the  distension  is  very  great, 
these  facts  become  highly  diagnostic  ;  or,  if  great  distension  of 
the  abdomen  occurs  prior  to  the  time  at  which  pregnancy 
should  normally  cause  enlargement,  it  becomes  obvious  that 
this  is  due  to  some  other  cause. 

Ascites,  or  dropsy  of  the  abdomen,  may  also  become  confused 
with  pregnancy,  especially  in  the  bitch,  where  it  is  comparatively 
common.  Here  again  our  differentiation  would  depend  largely 
upon  the  same  considerations  as  in  cystic  kidney,  between  which 
two  conditions  there  is  little  difference  in  the  symptoms  in  the 
living  animal. 


Duration  of  Pregnancy  395 

In  either  hydronephrosis  or  ascites,  along  with  general 
symptoms  of  those  maladies,  the  trocar  may  be  used  as  an  aid  in 
diagnosis. 

The  Duration  of  Pregnancy. 

The  duration  of  pregnancy  varies  greatly  according  to  the 
species  of  animal,  in  the  individuals  of  the  same  species  and  even 
in  the  same  individual  during  different  pregnancies.  In  our 
domestic  animals  we  find  the  extremes  of  variations  in  normal 
duration  in  the  rabbit,  where  the  3'oung  are  carried  for  28  to  30 
days,  and  in  the  elephant,  where  the  duration  is  i^  years,  or 
about  21  months.  The  duration  of  pregnancy  is  not  definite  in 
the  individuals  of  any  species  and  the  limits  in  variation  increase 
somewhat  according  to  the  increase  in  the  average  duration. 
In  those  animals  having  a  short  period  of  gestation,  like  the 
rabbit,  the  variation  is  very  slight,  scarcely  exceeding  two  days, 
while  in  the  mare,  with  an  average  duration  of  a  trifle  more 
than  1 1  months,  the  variability  is  increased  to  two  or  three 
months.  The  variations  in  the  duration  of  normal  pregnancy  in 
the  mare  are  more  than  twice  the  normal  duration  of  pregnancy 
in  the  rabbit. 

The  duration  of  pregnancy  bears  a  somewhat  inconstant  ratio 
to  the  size  of  the  animal  and,  as  a  general  rule,  the  larger  the 
animal,  the  greater  the  duration  of  pregnancy.  This  law,  how- 
ever, is  not  wholly  applicable  and  in  some  cases  would  .seem  to  be 
well-nigh  overthrown.  In  a  given  species  where  there  are  great 
variations  in  size,  as  in  the  dog,  there  is  no  variation  in  the 
duration  of  pregnancy  because  of  .size,  so  that  the  great  Mastiff, 
weighing  more  than  100  pounds,  has  no  greater  gestation  period 
than  the  Toy  Terrier  weighing  2  or  3  pounds.  In  some  cases, 
also,  species  which  are  somewhat  closely  allied  have  very  uniform 
periods  of  pregnancy,  which  do  not  accord  with  the  differences  in 
size.  Thus,  the  duration  of  gestation  in  the  dog  is  only  a  trifle 
greater  (about  12%)  than  in  the  cat.  In  those  species  which 
cross  to  produce  hybrids,  such  as  the  horse  and  ass,  the  duration 
of  pregnancy    is    naturally  nearly  the  same. 

The  duration  of  pregnancy  is  also  somewhat  dependent  upon 
the  state  of  development  in  which  the  young  are,  born.  Thus, 
in  the  carnivora  we  find  a  duration  of  8  or  9  weeks,   while  in 


396  Veterinary  Obstetrics 

sheep  and  swine,  which  are  but  little  larger  in  man^-  instances, 
the  duration  is  more  than  double.  However,  in  these  latter 
instances,  when  the  young  are  born  they  are  far  more  developed 
than  the  former. 

It  has  been  claimed  that  breed  exerts  some  influence  upon  the 
duration  of  pregnancy  and  Wilhelms  has  asserted  that  the 
Hungarian  cow  goes  some  lo  days  longer  than  the  Dutch  cow. 
Fleming  is  of  the  opinion  that  thoroughbred  mares  have  a  longer 
duration  of  pregnancy  than  those  of  the  common  breeds. 

Statistics  apparently  show,  also,  that  a  male  fetus  is  carried  a 
trifle  longer  than  a  female  in  those  animals  where  generally  but 
a  single  young  is  born  at  a  time,  but  if  any  difference  exists  it 
is  quite  unimportant  obstetrically. 

It  may  be  that  some  of  the  variation  in  the  duration  of  preg- 
nancy can  be  accounted  for  by  the  time  during  estrum  at  which 
copulation  takes  place  or  the  time  elapsing  between  copulation 
and  fertilization.  This  can  scarcely  appl)'  to  any  great  extent 
in  such  an  animal  as  the  cow,  in  w^hich  the  estrual  period  is 
ordinarih'  less  than  24.  hours,  while  the  variation  in  the  duration 
of  pregnancy  is  very  great,  and  in  which  fertilization  does  not 
follow  forced  coition  at  or  subsequent  to  the  close  of  estrum.  It 
has  not  been  determirted  how  long  a  time  is  required  for  fertiliza- 
tion to  take  place  after  impregnation,  but  it  may  generally  be 
assumed  that  the  ovulation  occurs  soon  after  copulation  and  that 
fertilization  follow^s  promptly. 

According  to  Bonnet,  the  ova  of  the  ewe,  sow  and  bitch  have 
undergone  segmentation  and  passed  through  the  oviducts  to  the 
uterus  eight  to  ten  days  after  coition,  which  would  intimate  that 
the  fertilization  had  occurred  within  a  few  hours  after  ovulation 
and  impregnation,  and  segmentation  had  prompth^  begun.  Thus, 
the  time  elapsing  between  coition  and  fertilization  must  be  in- 
consequential, as  related  to  the  .span  of  gestation. 

The  chief  cause  of  variation  in  the  span  of  gestation  does  not 
rest  upon  these  considerations.  To  some  extent  it  may  be  ex- 
plained by  the  fact  that  the  fetus  may  be  expelled  in  a  state  of 
relative  immaturity,  almost  a  premature  birth  ;  it  may  reach 
that  average  stage  of  development  which  we  would  designate 
as  normal,  or  it  may  remain  more  or  less  quiescent  in  the  uterus 
for  a  period  after  the  attainment  of  this  normal  degree  of  intra- 


Duration  of  Pregnaiicy  397 

uterine  development.  It  is  reasonable  also  to  conclude  that  the 
rate  of  development  of  the  young  will  varj'  according  to  the  in- 
dividual character  of  the  mother  and  xwa.y  be  dependent,  in  a 
degree,  upon  her  state  of  nutrition. 

Duration  of  Pregnancy  in  the  Mare.  As  a  general  rule, 
the  duration  of  pregnancy  in  the  mare  is  about  12  lunar,  or  a 
trifle  over  11  calendar  months,  or  about  330  to  340  days.  Bon- 
net gives  11^  to  12  lunar  months  (322-336  days)  as  the 
normal.  Dietrichs,  among  500  observations,  found  that  80  ^^^  of 
mares  foaled  between  331  and  350  days.  Count  LehndorfF, 
in  his  text-book  on  horse  breeding,  gives  a  table  of  more  than 
8,300  records,  in  which  the  average  duration  of  pregnancy  was 
II  months  and  3  days.  Statistics  show  that,  in  various  studs, 
the  male  foals  were  carried  from  Yz  to  6  or  8  days  longer  than 
the  female.  There  are  great  variations  of  opinion  by  different 
writers  in  reference  to  the  normal  duration  of  pregnancy.  Some 
consider  normal  a  birth  which  occurs  anywhere  from  300  days, 
or  10  calendar  months,  to  365  or  more  days  and  some  even  ex- 
tend the  limit  to  394  or  even  to  420  days,  as  in  a  case  given  by 
Baumeister  and  Rueff . 

Saint-Cyr  concludes  that  the  normal  duration  of  gestation  in 
the  mare  is  340  to  350  days,  between  which  time  most  foals  are 
born.  Some  may  be  born  alive  and  continue  to  live,  from  the 
300th  day  onward,  while  it  is  not  rare  for  foals  to  be  born  up  to 
nearly  365  days.  Rarely  normal  gestation  may  be  prolonged  to 
400  days  or  over  13  months.  It  would  seem,  therefore,  that 
there  may  be  a  variation,  in  the  period  of  gestation  in  the  mare, 
of  about  100  days,  or  more  than  three  months,  and  that  we  ap- 
parently have  no  means  for  determining  in  advance  at  what  time 
a  mare  will  foal,  except  that,  in  a  general  way,  we  may  expect 
the  vast  majority  of  births  to  take  place  between  11  and  ii)^ 
calendar  months.  It  has  been  alleged  that  breed  has  a  certain 
degree  of  influence  upon  the  span  of  pregnancy  and  statistics  of 
Count  LehndorfF  .seem  to  indicate  that,  in  different  studs,  there 
are  more  or  less  marked  differences  in  the  duration. 

A  former  client,  engaged  in  breeding  pedigreed  French  draft 
horses,  found  that,  in  55  mares,  the  average  duration  of  preg- 
nancy was  336  days.  Among  the  13  pregnancies  in  one  year, 
the    average    was    333    days,    the    longest    being    364  days,    a 


398  Veterinary  Obstetrics 

mare  foal,  and  the  shortest  318  days,  a  horse  foal.     The  shortest 
duration  recorded  by  him   was   298  days,  the  foal  being  a  mare. 

Duration  of  Pregnancy  in  the  Ass. 

Carsten-Harms  gives  the  duration  of  pregnancy  in  the  she-ass 
as  348  to  377  days,  which  is  in  excess  of  the  average  duration  in 
the  mare,  but  the  observations  which  have  been  made  are  not 
sufficient  in  number  to  render  them  very  reliable.  Various 
writers  claim  that  the  period  of  gestation  of  mule  foals  is 
greater  than  with  horse  foals. 

The  Q.O-W.  The  duration  of  gestation  in  the  cow  is  usually 
270  to  280  days,  with  a  very  wide  variation.  In  1062  cases 
quoted  by  Fleming,  15  were  pregnant  less  than  241  days,  52  from 
241  to  270  days,  119  from  271  to  280  days,  544  from  271  to  300 
days,  230  from  282  to  290  days,  70  from  290  to  300  days,  and  32 
beyond  301  days.  Fleming  gives  the  average  duration  at  about 
283  days,  while  Colin  makes  the  average  280  to  285  days. 

The  Sheep  and  Goat.  The  duration  of  pregnancy  in  the 
sheep  and  goat  is  about  5  months,  with  variations  of  some  12 
days.  Some  observers  have  found  that  the  duration  of  gestation 
was  longer  in  female  than  in  male  lambs  and  there  is  an  impres- 
sion, which  is  apparently  supported  by  statistics,  that  twins  are 
born  somewhat  earlier  than  single  fetuses,  but  the  difference,  if 
any  exi.sts,  is  very  slight. 

The  Sow.  The  duration  of  pregnancy  in  the  sow  is  a  trifle 
short  of  four  calendar  months,  or  about  115  to  120  days,  the 
variation  not  being  very  great,  although  some  authors  give,  as 
extremes,  about  104  to  127  days,  with  most  births  occurring  be- 
tween 115  and  125  days. 

Carnivora.  The  bitch  is  pregnant  from  58  to  65  days,  but 
usually  about  9  weeks  or  63  days,  while  the  duration  of  preg- 
nancy in  the  cat  is  3  or  4  days  less,  or  about  8  weeks,  with  a 
variation  of  3  or  4  days. 

Wild  Animals. 

In  wild  ruminants,  the  duration  of  pregnancy  varies  from  34 
or  35  to  40  weeks.  Harms  notes  the  peculiar  fact  that  in  the 
deer  there  is  a  period  of  40  weeks  between  impregnation  and  the 
birth  of  the  young,  but  that  this  time  does  not  represent  the 
period  of  development  of  the  fetus  as  we  understand  it   in   most 


Twi7i    Pregnancy  399 

animals.  The  ovum  of  the  deer  undergoes  segmentation  and 
then  lies  in  the  uterus  for  four  months  in  an  essentially  dormant 
state.  About  December  the  distinctive  embryonic  development 
begins  and  birth  follows  in  May  or  June,  or  about  five  months 
later.  If  this  time  of  five  months,  during  which  the  active  de- 
velopment of  the  fetus  has  taken  place,  is  compared  with  the 
duration  of  gestation  in  the  sheep,  the  two  periods  of  gestation 
become  virtually  identical.  It  is  suggested  that  this  delay  in 
the  development  of  the  young  is  a  provision  by  which  it 
may  be   born  at   a   favorable  season  of  the  year. 

The  Number  of  Fetuses. 
In  the  domestic  animals  we  find  great  variation  in  the  number 
of  fetuses  ordinarily  brought  forth  at  a  given  birth,  and  we 
recognize,  as  a  rule,  two  or  three  classes  of  animals  in  reference 
to  these  numbers  :  the  uniparous  animals,  chiefly  the  mare  and 
cow,  which  ordinarily  give  birth  to  but  a  single  j^oung  at  a  time  ; 
the  biparous,  or  twin-bearing,  animals,  among  which  we  find 
chiefly  the  goat  and  the  larger  breeds  of  sheep  ;  and  the  multi- 
parous  animals,  among  which  we  include  the  carnivora  and 
the  sow. 

Twin  Pregnancy. 

In  all  animals,  however,  there  are  occasional  departures  from 
the  rule.  Thus,  in  unipara,  we  occasionally  find  twins  and 
sometimes,  in  our  multipara,  only  one  or  two  young  are  born  at  a 
time. 

Among  our  uniparous  domestic  animals,  twins  are  most  rare 
in  the  mare,  although  every  veterinarian  of  experience  in  a 
horse-breeding  district  has  observed  such  cases.  Among  cows, 
twins  are  not  at  all  rare. 

The  causes  of  twin  pregnancy  may  vary.  Fundamentally,  the 
number  of  fetuses  must  depend  upon  the  number  of  ova  which 
have  been  discharged  into  the  uterus  during  a  given  estrual 
period.  In  some  cases,  two  or  more  eggs  are  formed  in  one 
Graafian  follicle  and,  when  discharged  and  fertilized,  may  each 
■develop  into  a  fetus,  but  one  yellow  body  remaining  in  the  ovary 
to  indicate  their  origin. 

Usually  twins  proceed  from  the  simultaneous  rupture  of  two 
ripe  ovisacs,  with  the  discharge  and  subsequent  fertilization  of 
one  ovum  from  each. 


400  Veterhiary  Obstetrics 

In  other  cases,  twin  pregnancy  may  be  caused  by  complete 
division  of  the  ovum  or  blastoderm  to  form  two  separate  embryos, 
in  which  instance  they  become  identical  twins,  being  of  like  sex 
and  enclosed  in  a  common  chorion  each  having  a  separate 
amnion. 

Twin  pregnancy  in  the  mare  nearly  always  results  in  abortion 
at  about  the  eighth  to  tenth  month  and  in  a  large  proportion  of 
cases  it  is  found,  when  the  two  fetuses  are  expelled,  that  one  is 
much  more  developed  than  the  other,  indicating  that  the  least 
developed  one  has  been  dead  in  the  uterus  for  a  considerable 
period  of  time,  without  having  undergone  decomposition.  In 
the  mare,  this  twin  abortion  occurs  in  probably  90%  of  the  cases 
and,  among  those  which  are  born  alive,  it  not  infrequently 
occurs  that  one  of  the  pair  is  liliputian  in  size. 

Rueff  records  one  case  of  twin  gestation  in  the  mare  in  each 
250  cases  and  this  seems  to  be  somewhat  near  to  the  average. 
While  we  have  personally  obser^-ed  several  instances  where  both 
twins  have  been  born  alive,  they  are  usually  more  or  less  im- 
perfect and  tend  to  perish  soon  after  birth.  In  other  cases, 
however,  we  have  seen  them  quite  normal  and  vigorous,  very 
much  alike  in  size  and  form  and  partaking  of  that  striking 
likeness  common  in  the  twins  of  other  animals  and  of  man. 
Triplets  and  quadruplets  have  also  been  recorded  very  rarely 
in  the  mare.  As  in  twins,  abortion  usually  brings  the  preg- 
nancy to  a  premature  close  or,  if  born  alive,  the  foals  are 
generally  weak  and  tend  to  perish.  Saint-Cyr  cites  one  case  in 
which  a  mare,  from  a  single  stallion  service,  aborted  two  fetuses 
in  one  chorion  and,  some  months  later,  gave  birth  to  a  living 
and  vigorous  foal. 

The  most  interesting  cases  of  twin  pregnancy  recorded  are 
those  of  a  series  quoted  by  Saint-Cyr,  in  which  the  twins  were 
due  to  successive  copulations.  The  mare,  having  been  put 
first  to  a  stallion  and  then  to  a  male  ass,  brought  forth  a 
foal  and  a  mule  at  the  same  time.  In  these  cases  the  two  copula- 
tions were  not  very  widely  separated,  usually  during  the  same 
day  or,  in  one  case,  after  an  interval  of  15  days,  probably  one 
prolonged  estrum. 

In  the  cow,  twin  and  triplet  pregnancies  are  not  so  unconmion 
and  the  tendency  to  twin  abortion,  which  is  seen   in   the   mare, 


Tzvin    Pregnancy  401 

is  absent.  They  tend  to  carry  the  twin  fetuses  to  the  regular 
period  as  though  but  one  were  present,  though,  as  already  noted, 
it  is  claimed  that  the  duration  of  twin  pregnancy  is  normall}'  a 
trifle  less  than  that'of  single  pregnancy. 

In  some  cases  there  is  an  hereditary  tendency  to  the  production 
of  twins  in  a  given  strain  or  family  and  certain  individual  cows 
produce  twins  year  after  year.  Fleming  quotes  one  case  in 
which  a  cow,  during  an  interval  of  seven  years,  produced  25 
calves,  or  an  average  of  more  than  three  per  annum,  having 
given  birth  to  a  single  calf  the  first  time  and  thereafter  pro- 
ducing anywhere  from  two  to  six  calves  at  a  birth.  In  the  one 
instance  of  six  young,  all  died  prematurely.  One  of  the  most 
notable  cases  of  excessive  numbers  is  that  given  in  the  Magazine 
of  Gurlt  and  Hertwig,  Vol.  23,  page  125.  A  cow  which  had 
given  birth  to  one  vigorous  calf  was  butchered,  and  fifteen 
fetuses  were  found  in  the  uterus.  Other  instances  of  from  three 
to  six  or  more  calves  at  a  birth  are  recorded,  scattered  through- 
out veterinary  literature,  and  are  of  little  interest,  except  from 
the  standpoint  of  curiosity,  unless  we  should  remark  that,  when 
a  cow  is  attended  during  parturition,  a  search  of  the  uterus 
should  always  be  made,  after  the  removal  of  one  fetus,  to  de 
termine  the  presence  or  absence  of  additional  young. 

In  the  ewe,  twins  are  very  common  and,  in  some  of  the  large 
mutton  breeds,  twin  pregnancy  becomes  the  rule  and  single 
births  the  exception,  aside  from  yearling  ewes.  In  some  well- 
fed  bands  of  ewes,  we  have  seen  an  average  of  two  lambs  per  ewe 
for  the  entire  number.  In  one  case  of  26  Cotswold  ewes  we  ob- 
served 52  lambs,  there  having  been  a  sufficient  number  of  trip- 
lets to  bring  the  average  up  to  two  lambs  per  ewe. 

In  the  smaller  breeds  of  sheep,  like  the  Merino,  twins  are  less 
frequent. 

In  the  goat,  the  general  rule  is  twins  or  triplets. 

We  have  already  noted,  page  156,  the  frequent  occurrence  in 
the  cow  of  what  is  known  as  freemartins,  or  of  twin  pregnancy, 
in  which  one  of  the  pair  of  twins  has  become  arrested  in  its  sexual 
development  and  remains  to  some  extent  hermaphroditic,  or 
neutral,  in  character. 

The   Diagnosis  of  Multiple   Pregnancy  in  uniparous  ani- 
mals is  seldom  called  for  except  in  cases  of  difficult  labor.     Even 
26 


402  Veterinary  Obstetrics 

then,  as  a  rule,  it  is  not  suspected  except  in  those  cases  where 
the  difficult  labor  is  produced  by  simultaneous  presentation  of 
parts  of  the  two  fetuses.  Sometimes  a  twin  pregnane)^  may  be 
suspected  on  account  of  the  very  great  size  of  the  abdomeh,  and 
it  might  be  diagnosed  by  an  exploration  per  rectum,  though  not 
with  great  certainty.  When  two  young  present  simultaneously 
at  the  pelvic  inlet  and  cause  dystolcia,  the  condition  can  usually 
be  readily  diagnosed  by  tracing  the  presenting  parts,  limbs  or 
head,  to  the  separate  bodies  of  the  fetuses.  The  only  difficulty 
occurring,  as  a  rule,  is  when  a  single  fetus  undergoes  that  de- 
formity which  we  know  as  campylorrhachis  or  schistocormus  re- 
flexus,  Figs.  71  and  72,  in  which  case  the  spine  of  the  fetus 
is  abruptly  bent  upon  itself,  so  that  the  head  and  all  four  feet 
present  simultaneously  at  the  pelvic  inlet,  thus  closely  simulat- 
ing twins.  This  abnormality  is  to  be  differentiated  from  twins 
by  the  fact  that,  when  one  portion  is  repelled  or  advanced,  the 
other  part  moves  in  harmony  with  it,  which  is  not  true  of  cases 
of  twin  pregnancy,  where  the  one  fetus  can  be  repelled  while  the 
other  advances. 

Position  of  Fetuses  in  Multiple  Pregnancy.  In  animals 
which  are  normally  uniparous,  as  the  mare  and  cow,  it  is  inter- 
esting to  study  the  position  of  fetuses  in  case  of  twins  or  triplets. 
In  general  it  may  be  stated  that,  where  twins  occur  as  a  result  of 
the  simultaneous  rupture  of  two  ovisacs  and  the  fertilization  of 
the  eggs,  they  develop  two  complete  sets  of  membranes,  each 
fetus  having  its  own  amnion  and  chorion.  In  those  cases  where 
twin  pregnancy  is  due  to  the  fission  of  a  single  ovum,  the  two 
embryos  are  developed  in  the  same  chorion,  but  each  has  its  own 
amnion. 

When  the  two  fetuses  each  have  separate  membranes,  it  is  pos- 
sible for  one  of  them  to  be  expelled  at  one  time  and  the  other  to 
remain  in  the  uterus  for  a  considerable  period  afterward  and 
finally  be  born  alive.  In  this  way  we  find  recorded,  in  our  liter- 
ature, occasional  instances  where  an  animal  has  aborted  one  fetus 
at  a  comparatively  early  period  in  gestation  and  later,  after  the 
normal  duration  of  pregnancy,  has  given  birth  to  a  living  twin. 
We  find  quite  commonly,  in  the  mare,  that  one  of  a  pair  of  twins 
perishes  and  remains  in  the  uterus  for  a  considerable  time,  while 
the  other  continues  to  live  and  develop.     Finally  they  are  aborted. 


Twin     Preg7iancy  403 

or  the  one  is  born  alive,  and  there  is  observed  a  great  variation 
in  the  degree  of  development  of  the  two,  which  sometimes  leads 
to  the  belief  that  they  represent  impregnations  at  widely  sep- 
separated  times. 

When  death  of  one  fetus  occurs  early,  it  may  undergo  mummi- 
fication and  remain  in  the  uterus  as  an  inert  bodj-.  In  our 
museum,  there  are,  in  the  uterus  of  a  cow,  twin  mummified 
fetuses  which  had  perished  at  about  the  7th  month  of  gestation. 

In  the  cow  and  ewe,  each  of  the  twin  fetuses  very  largely 
occupies  one  uterine  cornu  and  usually  presents  with  the 
head  toward  the  os  uteri,  but  it  is  not  rare  to  find  them 
presenting  alternately,  that  is,  one  anteriorly  and  the  other 
posteriorly. 

It  is  interesting  to  note  also  that  occasionally,  in  twin  preg- 
nancies, one  twin  is  more  or  less  enclosed  within  the  body  of  the 
other.  This  presumably  results  from  fission  of  an  ovum,  by 
which  two  embrN'os  result  from  a  single  egg  and,  being  unequal 
in  size  and  remaining  intimately  connected,  the  one  grows 
around  and  includes  the  other,  until  finally  its  inclusion  is  more 
or  less  complete. 


THE  HYGIENE  OF  PREGNANT  ANIMALS. 

Little  can  be  said,  in  reference  to  the  hygiene  of  a  pregnant 
female,  which  would  not  equally  apply  to  the  same  species  of 
animal  in  an  unimpregnated  state.  It  has  been  held  by  many 
that  the  pregnant  female  requires  different  care  from  others,  but 
there  is  no  scientific  reason  why  this  should  be  so,  nor  have  we 
any  clinical  experience  supporting  such  a  contention. 

There  is  but  one  view-point  from  which  we  may  claim  that 
special  care  is  essential  for  the  well-being  of  the  pregnant  female 
and  the  young  within  her  uterus.  The  weight  of  the  fetus 
tends  to  render  the  animal  somewhat  less  capable  of  performing 
certain  kinds  of  labor  or  movements  and  the  attachments  of  the 
fetus  with  the  uterus  are  such  that  any  very  violent  movements 
may  cause  some  disturbance  of  these.  It  consequently  follows 
that,  in  animals  in  an  advanced  state  of  pregnancy,  more  care 
should  be  used  in  reference  to  violent  exertions.  This  is  seen 
to  some  extent  in  all  animals,  but  more  especially  in  our  larger 
herbivora,  where  the  single,  very  large  fetus  may  cause  some 
disturbance  of  the  placental  attachments  should  any  sudden 
movement  of  the  mother  occur.  In  a  general  way,  however,  we 
would  not  care  to  submit  a  non-pregnant  animal  to  such  abuse 
as  might  lead  to  injury  of  the  pregnant  female. 

The  well-being  of  the  pregnant  female  is  best  con.served  by 
the  same  diet  which  would  maintain  the  non-pregnant  animal  in 
the  best  state  of  health  and,  in  relation  to  exercise,  the  same 
conditions  hold  true.  Tho.se  pregnant  females  which  are 
allowed  their  freedom  and,  consequently,  get  normal  exercise 
without  any  serious  disturbance  are  those  which  most  regularly 
pass  through  the  pregnant  state  without  serious  inconvenience 
and  danger.  Next  to  these  we  find  the  safest  pregnancy  in 
the  mare  to  be  that  accompanied  by  regular  daily  labor  of  a 
gentle  character. 

Any  violent  movements  in  any  pregnant  female  are,  of  course, 
to  be  obviated  as  far  as  practicable.  It  is  important  that  the 
pregnant  mare  which  is  worked  should  not  be  roughly  jostled 
by  the  pole  of  a  vehicle,  because  such  blows  may  serve  to  directly 
injure  the  fetus  or  disturb  its  placental  attachments  and  thus 
imperil  its  life.  Abortion  following,  the  life  of  the  mother  may 
404 


Hygiene  of  Pregnant  Ayiimals  405 

also  be  in  danger.  Any  form  of  violence  which  might  bring 
about  a  sudden  and  severe  impact  upon  the  abdominal  walls 
should  be  avoided. 

Mares  used  for  draft  work  should  be  carefully  guarded  against 
violent  pulling,  because  this  tends  constantly  to  increase  the 
intra-abdominal  pressure  and  thereby  to  greatly  interfere  with 
the  circulation  in  the  uterus  and  to  disturb  the  placental  attach- 
ments of  the  fetus.  Abortion,  following  very  severe  pulling,  is 
not  rare.  We  observe  precisely  the  same  danger  at  times  when 
the  animal  is  free  in  the  pasture  and  becomes  accidently  mired 
in  deep  mud. 

Pregnant  animals  which  are  used  for  labor  may  continue  at 
quiet  work  to  the  end  of  pregnancy,  but,  if  the  labor  is  of  a 
somewhat  strenuous  character,  it  is  best  to  omit  it  at  an  earlier 
period.  A  brood  mare  put  to  gentle  farm  work  or  other  labor 
of  a  similar  character  may  be  continued  at  it  without  disadvant- 
age and,  in  many  cases,  rather  with  advantage,  up  to  the  time  of 
parturition.  It  is  not  at  all  rare  in  agricultural  communities  to 
have  mares  stop  in  the  plow  and  give  birth  to  a  foal  without  any 
accident  and  in  a  very  prompt  and  successful  way.  We  have 
personally  observed  cases  where  the  mare  has  dropped  in  the 
harness  and  has  scarcely  permitted  time  for  being  unharnessed 
before  the  foal  was  expelled.  Yet,  no  harm  has  come  from  it. 
We  have  seen  the  same  occurrence  in  mares  which  have  been 
used  for  driving  purposes  and  where  parturition  came  on  so 
suddenly  that  it  was  impossible  to  return  the  mare  to  the  stable 
and  she  has  foaled  upon  the  roadside.  We  have  never  observed 
any  untoward  eflfect  to  either  the  mother  or  fetus  from  such  an 
occurrence. 

Anything  which  is  liable  to  cause  the  gravid  uterus  to  be 
violently  thrown  about  in  the  abdominal  cavity  has  a  constant 
tendency  to  bring  about  injury  to  the  placenta  or  displacements 
of  the  uterus  which  may  prove  more  or  less  serious.  It  is  not 
safe  to  drive  a  mare,  well  advanced  in  pregnancy,  at  a  rapid 
pace,  because  of  the  unavoidable  displacements  of  the  uterus 
with  its  heavy  contents.  Consequently,  rapid  trotting,  galloping 
and  jumping  should  be  avoided  as  far  as  practicable.  When 
pregnant  animals  are  free  in  the  pasture  they  usually  guard 
against  these  excesses  and  move  with  care,   at   a   comparatively 


4o6  Veteriyiary  Obstetrics 

slow  pace,  and  thus  avoid  the  dangers  which  may  be  thrust 
upon  them  by  injudicious  handling  while  at  work. 

Much  the  same  results  are  noted  in  pregnant  animals  which 
are  shipped  in  railway  cars.  The  shipment  itself  is  not  essentially 
dangerous  under  proper  conditions,  but  the  unsteady  movements 
of  the  car  and  the  fright  of  the  animal  cause  it  to  be  thrown 
about  more  or  less  violently.  If  these  violences  can  be  avoided, 
the  dangers  from  railway  travel  are  reduced  to  a  minimum 
and  rendered  comparatively  unimportant. 

The  dangers  which  we  have  enumerated  are  of  such  a  charac- 
ter that  we  would  generally  wish  to  avoid  them  in  the  non-preg- 
nant, as  well  as  in  the  pregnant,  animal.  The  chief  difference  is 
that  the  ri.sk  is  somewhat  greater  for  the  pregnant  animal  than 
for  the  non-pregnant,  largely  because  it  involves  the  lives  of 
both  the  mother  and  the  young,  each  dependent  upon  the  other. 

Some  writers  suggest  that  the  pregnant  female  should  not  be 
allowed  near  the  male,  but  there  is  no  clinical  evidence  in  support 
of  such  a  contention.  It  is  quite  true  that  in  exceptional  cases 
a  pregnant  female  will  show  signs  of  estrum  and  copulate  with 
the  male,  but  it  has  not  been  shown  that  this  is  extremely  seri- 
ous. Instances  have  been  observed  where  abortion  has  quickly 
followed  copulation,  though  it  has  not  yet  been  determined 
whether  the  coition  caused  the  abortion  or  the  death  of  the  fetus 
caused  the  appearance  of  estrum  and  hence  the  coition.  At  best, 
it  may  be  said  that  injury  from  this  coition  during  pregnancy  is 
very  rare.  It  is  to  be  remembered,  however,  that  pregnant 
females  will  only  rarely  copulate,  and  it  is  a  notable  fact  that 
those  which  do  so  are  almost  wholly  stabled  animals  and  very 
rarely  those  which  are  running  at  large.  In  this  class  of  stabled 
animals,  if  they  show  estrum  it  is  usually  accepted  as  conclusive 
evidence  of  non-pregnancy,  and  the  animal  is  bred,  incurring 
all  the  ri.sks  pos.sible  were  the  male  habitually  free  with  the  female. 

Abortion  is  probably  more  rare  among  those  animals  where  the 
male  and  female  are  allowed  to  consort  throughout  the  year  than 
in  any  other  class.  Upon  the  ranges,  where  the  bulls  consort 
with  cows  throughout  the  year,  accidental  abortion  is  not  known 
to  be  any  more  common,  nor  even  so  likely  to  occur  as  in  stabled 
cows,  and  the  same  is  true  in  ca.ses  where  .stallions  are  allowed  to 
con.sortwith  mares  throughout  the  year.     In  our  smaller  domes- 


Hygiene  of  Pregnant  Animals  407 

tic  animals,  males  habitually  consort  with  pregnant  females 
throughout  their  pregnancy,  and  yet  abortion  is  far  more  rare  in 
these  than  in  the  larger  animals.  The  clinical  evidence,  there- 
fore, would  indicate  that  it  is  not  harmful  to  pregnant  animals 
to  permit  the  male  to  consort  with  them  regularl}'. 

Admittedh^  however,  it  is  dangerous  to  allow  a  male  to  be 
abruptly  turned  loose  among  pregnant  females,  where  he  may 
greatly  annoy  them  and  possibly  cause  serious  injury.  On  the 
contrary,  when  a  male  is  permitted  to  regularly  consort  with  the 
pregnant  females  he  does  not  annoy  them  nor  in  any  way  endan- 
ger the  well-being  of  the  fetus  in  the  uterus. 

The  quality  of  food  to  be  recommended  for  a  pregnant  animal 
does  not  differ  essentially  from  that  for  any  other.  There  are 
foods  which  are  not  safe  for  the  non-pregnant  animal  and  are 
equally  unsafe  for  the  pregnant  female.  Pregnant  herbivorous 
animals  are  most  healthful  if  allowed  to  graze  in  pastures,  under 
the  most  normal  conditions  possible.  It  is  not  highly  essential 
that  they  should  be  protected  from  inclement  weather  anj'  more 
than  if  they  were  not  pregnant.  Rain,  snow,  cold  or  heat  is  no 
more  prejudicial  to  the  well-being  of  a  pregnant  animal  than  to 
that  of  the  non-pregnant. 

Some  writers  have  insisted  that  certain  forms  of  food,  notably 
those  which  have  been  attacked  by  rust,  fungi  or  molds,  are 
especially  dangerous  for  pregnant  animals.  This,  however,  has 
not  been  demonstrated  clinically.  It  is  quite  true  that  abortion 
is  more  common  at  times  among  animals  which  are  fed  upon  a 
very  poor  quality  of  food,  but,  if  we  observe  other  non-pregnant 
animals  which  are  compelled  to  sub.sist  upon  the  same  diet,  we 
find  that  they  suffer  in  a  similar  way  in  all  respects  save  the  one 
question  of  the  well-being  of  the  fetus.  Both  pregnant  and  non- 
pregnant animals  become  emaciated  and  weak  or  show  other 
constitutional  disturbances  as  a  result  of  being  compelled  to  live 
upon  such  "food  and  occasionally  abortion  is  merely  an  additional 
symptom  of  the  injudicious  feeding.  Special  emphasis  has  been 
placed  at  times  upon  foods  which  are  affected  with  smut  or  ergot 
and  they  are  blamed  for  producing  wide-spread  abortion.  As  a 
general  rule,  however,  the  presence  of  smut  or  ergot  upon  fodder 
is  seized  upon  merely  as  an  excuse  for  the  presence  of  abortion, 
which  may  generally  be  properly  attributed  to  other  causes. 


4o8  Veten'fiary  Obstetrics 

If  contagious  abortion  breaks  out  in  a  harem  of  mares  which 
are  running  upon  corn  stalks  during  the  autumn  or  earl}- winter, 
after  the  corn  has  been  gathered,  it  is  not  difficult  for  the  owner 
or  veterinarian  to  find  stalks  of  corn  affected  by  smut  and, 
believing  that  this  causes  abortion,  to  make  it  serve  as  a  scape- 
goat for  the  infectious  disease  which  is  destroying  the  foal  crop. 
At  another  season  of  the  year,  if  the  mares  are  grazing  upon  blue^ 
grass  and  abortion  breaks  out,  the  searcher  after  ergot  may  find 
a  few  traces  upon  the  grass  and  thereby  explain  the  presence  of 
the  contagious  disease.  If  the  mares  are  grazing  upon  red 
clover,  which  admittedly  has  a  tendency  to  induce  tympany  and 
other  serious  diseases  in  case  of  overfeeding,  the  character  of  the 
food  is  again  drawn  upon  to  explain  the  presence  of  the  disease. 

In  general  it  should  then  be  stated  that  the  food  should  be  of 
a  good  quality,  just  as  it  should  be  for  a  non-pregnant  animal, 
and  that  in  amount  it  should  correspond  very  closely  with  the 
volume  allowed  to  ordinary  animals. 

In  reference  to  water  for  pregnant  females,  there  is  again  no 
essential  danger  which  does  not  equally  apply  to  the  non-preg- 
nant animal.  Fleming  holds  that  pregnant  animals  should  not 
be  allowed  to  drink  very  cold  water,  which  is  not  clinically  true. 
We  have  habitually  observed  animals  drinking  cold  water  at  will 
and  have  never  observed  any  ill  effects  from  it.  Throughout  the 
western  parts  of  the  United  States,  and  even  in  the  Mississippi 
Valley,  pregnant  animals  habitually  have  cold  water  during  the 
winter  season.  Upon  the  Great  Plains  of  the  United  States, 
pregnant  animals  very  largely  use  snow  instead  of  water  and  it 
does  them  no  harm  ;  when  they  do  drink  water  from  a  stream  it 
is  generally  barely  above  the  freezing  point.  Throughout  the 
Mississippi  Valley  it  is  not  at  all  rare  in  the  winter  season  to  be 
obliged  dail}^  to  break  or  cut  the  ice  which  covers  the  water 
which  pregnant  animals  are  to  drink. 

Nevertheless,  there  is  some  force  to  the  remark  in  reference  to 
the  allowance  of  very  cold  water  ;  if  an  animal  is  allowed  to  be- 
come extremely  thirsty  and  has  been  made  very  warm  by  fatigu- 
ing labor  and  is  then  allowed  to  drink  an  inordinate  amount  of 
ice-cold  water,  it  may  have  a  very  deleterious  influence  upon  the 
fetus,  since,  when  the  water  reaches  the  stomach  or  rumen,  it 
comes  in  close  contact  with  the  young  animal  and  causes  a  very 
severe  shock.     But  even   this  injudicious    allowance    of   water- 


Hygiene  of  Pregnant  A7iimals  409 

would  be  improper  in  case  of  a  non-pregnant  animal,  and  in  real- 
ity we  have  no  clear  clinical  evidence  that  a  draft  of  such  cold 
water  causes  abortion.  In  those  pregnant  animals  which  are 
much  out  of  doors  during  cold  weather  and  which  go  to  water  at 
will,  there  seems  to  be  no  danger  whatever  from  drinking  the 
cold  water,  because  it  is  taken  very  slowly,  as  a  rule,  so  that  the 
shock  is  not  so  great.  It  is  common  to  note  that  these  animals, 
after  drinking  of  ice-cold  water,  shiver  somewhat  in  the  cold, 
but  this  does  not  seem  to  have  any  special  danger  for  the  life  of 
the  fetus. 

Some  writers  also  speak  very  unfavorably  of  allowing  pregnant 
animals  to  eat  frozen  food,  or  herbage  which  is  covered  with 
frost.  This  notion  also  seems  to  be  quite  erroneous.  Upon  the 
western  plains  the  animals  which  are  left  out  during  the  entire 
winter,  whether  pregnant  or  not,  must  habitually  paw  or  dig 
the  snow  from  the  scanty  herbage  in  order  to  procure  food  and 
consequently  eat  with  the  grass  a  considerable  amount  of  snow, 
which  may  be  at  a  temperature  of  as  much  as — 40°  or — 50°  F. 
Yet,  pregnant  animals  do  not  suffer  from  this  cause.  In  the 
Mississippi  Valley,  during  the  earlier  periods  in  the  settlement  of 
the  country,  almost  all  pregnant  animals  were  fed  out  of  doors  in 
the  winter  time  and  the  food  had  to  be  taken  from  the  ground, 
which  was  largely  covered  with  snow  and  frequently  at  quite  a 
low  temperature.  Yet.  these  pregnant  animals  almost  never 
aborted  under  any  conditions  whatever.  We  must  admit,  how- 
ever, as  we  have  done  in  reference  to  the  drinking  of  cold  water, 
that  some  foods  may  be  so  damaged  by  cold  as  to  make  them  un. 
digestable  and  injurious,  alike  for  pregnant  and  non-pregnant 
animals.  Succulent  foods,  like  roots,  clover  or  green  vege- 
tables, which  are  normally  killed  by  a  moderately  low  tempera- 
ture, may  be  so  frozen  as  to  be  quite  injurious.  Naturally,  they 
should  not  be  allowed  to  pregnant  animals,  nor  to  those  which 
are  non-pregnant. 

The  housing  of  pregnant  animals  should  not  differ  in  any  ma- 
terial respect  from  that  of  the  non-pregnant.  The  same  rules  as 
to  light,  air,  ventilation  and  the  amount  of  cubic  space  per  ani- 
mal applies  alike  to  all,  whether  pregnant  or  not.  A  stall  that 
is  good  for  a  non-pregnant  animal  is  sufficient  for  a  pregnant  one. 
It  is  of  course  desirable  that  the  stalls  for  pregnant  animals  should 


4IO  Veterinary  Obstetrics 

not  slope  very  greatly,  either  backward  or  forward.  The  same 
rule  applies  also  to  the  non-pregnant  animal,  although  pregnancy 
intensifies  the  backward  pressure  of  the  abdominal  viscera,  in 
case  the  stall  slopes  very  greatly,  and  may  thus  thus  tend  to  cause 
prolapse  of  the  vagina. 

When  the  time  for  parturition  draws  near,  it  is  generally  ad- 
visable that  cows  and  mares  which  have  been  kept  in  single  stalls- 
or  stanchions  should  be  removed  from  these  and  given  .some  de- 
gree of  liberty  of  movement  at  the  time  of  labor.  Mo.st  writers 
advise  that  the  mare  should  be  given  a  roomy  box-stall,  under 
the  belief  that  she  can  better  foal  in  such  a  place.  This  may  be 
generally  true,  although  accidents  have  occurred  because  of  the 
very  fact  that  the  animal  was  loose  in  a  box- .stall.  In  such  a 
stall  the  mare  sometimes  lies  down  with  her  buttocks  immedi- 
ately against  the  side  wall  and  there  is  not  room  for  the  expul- 
sion of  the  foal.  Instead,  the  foal  is  jammed  against  the  side  of 
the  stall,  its  expulsion  delayed  and  its  life  endangered.  In  other 
ca.ses  the  mare  turns  somewhat  violently  and  the  head  of  the  pro- 
truding fetus  is  seriously  injured  by  being  pressed  against  the 
wall.  The  box-stall  in  which  a  mare  is  to  foal  should,  therefore, 
be  ample  in  size  and  give  every  possible  opportunity  for  labor  to 
progress  without  danger  of  accident  from  contact  with  the  side 
walls.  Some  breeders  arrange  a  .special  stall  for  foaling  mares. 
A  false  wall  is  added,  beginning  at  the  base,  three  or  four  feet 
inwards  from  the  main  wall,  and  sloping  upward  and  outward  at 
an  angle  of  45°,  joining  the  main  wall  at  the  height  of  three  or 
four  feet.  This  slanting  wall  prevents  the  foaling  mare  from  be- 
coming cast  and  the  protruding  foal  from  being  jammed  against 
the  walls. 

Later,  when  considering  the  question  of  abortion,  we  shall  deal 
with  the  handling  of  animals  which  have  aborted  or  threaten  to 
abort  in  a  stable  or  herd  of  other  pregnant  females. 

The  pregnant  animal,  like  any  other,  should  be  allowed  to  lead 
a  tranquil  existence,  free  from  cruel  handling  and  from  great 
fear.  If  pregnant  animals,  especially  in  the  advanced  stages,  are 
chased  by  other  animals,  such  as  ewes  being  annoyed  by  dogs,  it 
is  naturally  prejudicial  to  the  life  of  the  fetus.  It  has  been  sug- 
gested by  some  that  pregnant  animals  of  different  species  should 
not  be  allowed  in  the  same  field  or  pasture,  but  this  is  only  par- 
tially correct  and  depends  rather  upon  the  character  of  the  indi- 


Hygiene  of  Pregnayit  Animals  411 

vidual  animals  than  the  question  of  difference  in  species.  We 
have  habitually  seen  pregnant  mares,  cows,  sheep  and  pigs  in  the 
same  enclosure,  without  any  special  danger  to  either  from  the 
presence  of  the  other. 

It  needs  to  be  noted  that  at  the  time  of  parturition  it  is  unsafe 
to  permit  hogs  in  the  enclosure  where  parturition  is  occurring, 
since,  being  omnivorous,  they  may  devour  the  new-born  young, 
and,  should  the  parturient  animal  be  exhausted  or  otherwise  un- 
able to  defend  herself,  she  too  may  succumb  to  the  rapacity  of 
the  hogs.  This  is  especially  true  in  cases  of  dystocia  and  still 
more  when  prolapse  of  the  uterus  occurs.  Fleming  relates  a 
case  of  prolapse  of  the  uterus  in  a  cow  in  which  hogs  devoured 
the  prolapsed  organ  but  amputated  it  so  well  that  the  animal 
recovered. 

On  the  other  hand,  it  is  a  well  known  fact  that  some  animals 
take  it  upon  themselves  to  annoy  others,  and  even  compromise 
their  lives,  whenever  opportunity  offers.  This  is  especially  true 
of  mules,  which  sometimes  have  so  meddlesome  a  disposition 
that  they  constantly  harry  any  animal  which  cannot  resist  them, 
simply  as  a  pastime  ;  to  a  less  degree,  the  same  applies  to  colts. 
Again,  we  sometimes  observe  that  a  pregnant  mare  or  cow  is 
exceedingly  irritable  toward  her  companions  and  consequently 
it  is  sometimes  unwise  to  permit  a  particularly  ill-natured  preg- 
nant mare  to  consort  with  other  pregnant  mares,  becau.se  of  the 
injuries  which  she  may  inflict  upon  them  by  kicking  or  other 
violence. 

Surgical  operations  and  medication  sometimes  offer  dangers  to 
the  pregnant  animal  and  should  consequently  be  undertaken  in- 
telligently. Serious  surgical  operations  which  are  not  urgent 
should  be  delayed  until  after  parturition,  especially  if  they  involve 
the  confinement  of  the  pregnant  animal.  But  this  caution  should 
not  carry  us  too  far.  Serious  operations,  with  rigid  confinement, 
pain,  fear,  chloroform  anaesthesia,  loss  of  blood,  subsequent  in- 
infection  and  fever,  are  repeatedly  performed  upon  pregnant  ani- 
mals without  untoward  results.  While  suggesting  caution,  preg- 
nancy should  not  be  regarded  as  a  bar  to  major  operations  upon 
pregnant  animals.  Much  will  depend,  in  these  cases,  upon  the 
temperament  of  the  individual  animal.  In  one  instance  we  dis- 
horned a  timid  Jersey  heifer,  which  was  in  an  advanced  stage  of 
pregnancy,  and  abortion  promptly  followed  in  a  manner  which 


412  Veterinary  Obstetrics 

suggested  that  it  was  due  to  the  fright  and  pain  of  the  surgical 
operation  or  possibly  to  a  considerable  hemorrhage  which  fol- 
lowed the  removal  of  the  horns. 

An\'  drug  which  causes  more  or  less  serious  poisoning  of  the 
mother  may  naturally  imperil  the  life  of  the  fetus.  Chief  among 
the  drugs  which  have  a  bad  repute  in  this  respect  are  aloes 
and  other  drastic  purgatives.  Whether  these  act  by  pa.ssing 
through  the  placenta  and  gaining  access  to  the  fetus  itself  and 
injuring  it,  or  by  causing  contractions  of  the  uterus  in  harmony 
with  the  peristalsis  of  the  intestines,  we  do  not  know.  Usually, 
however,  other  purgatives,  such  as  bland  oils  and  moderate  doses 
of  eserine  and  arecoline,  may  be  given  without  inducing  abortion 
and  with  the  same  safety  as  if  the  animal  were  not  pregnant. 

Consequently,  in  dealing  with  pregnant  animals,  we  should 
constantly  bear  in  mind  the  possibilities  of  abortion  or  other  in- 
jury to  the  fetus,  and  not  cause  unnecessary  interference  which 
may  imperil  the  life  of  the  fetus.  From  a  politic  standpoint,  the 
owner  of  the  animal  should  always  be  advised  of  the  possible  dan- 
ger to  the  fetus  from  medication  or  surgical  operation  and  in  all 
cases  the  casting  and  other  manipulations  connected  with  disease 
or  operation  should  be  as  gently  and  judiciously  carried  out  as  is 
possible. 


ANOMALIES  IN  FECUNDATION  AND  GESTATION. 

SUPERFECUNDATION. 

Superfecundation  is  the  fertilization  of  two  or  more  ova,  one 
after  another,  during  one  estrual  period.  When  two  or  more  ova 
are  discharged  during  a  given  estrual  period,  one  or  more  of  them 
is  fertilized  as  the  result  of  one  copulation,  another  ovum  as  the 
result  of  a  subsequent  copulation.  If  the  two  or  more  copula- 
tions are  made  by  the  same  male,  the  evidence  of  superfecunda- 
tion is  wanting.  When  two  or  more  males  of  different  types, 
breeds  or  species  copulate  with  the  female  and  each  fertilizes  cer- 
tain ova,  the  evidence  of  superfecundation  becomes  marked.  The 
phenomenon  may  occur  in  any  female  in  which  two  or  more  ova 
are  discharged  during  a  given  estrum.  If  all  the  ova  are  simul- 
taneously discharged,  superfecundation  is  less  probable,  except 
the  copulations  follow  each  other  shortly. 

Superfecundation  is  most  common  in  the  bitch,  in  which  there 
is  a  prolonged  estrum,  probably  successive  ovulations,  and  very 
commonly  repeated  copulations  with  dogs  of  various  breeds.  As 
a  result,  it  is  not  rare  to  find  the  young  of  a  given  litter  showing 
unmistakable  evidences  of  varying  male  parentage,  some  of  the 
young  being  evidently  of  one  breed,  others  of  another. 

In  such  biparous  animals  as  the  sheep  and  goat,  such  results 
are  always  possible,  but  the  opportunity  for  copulation  by  males 
of  different  breeds  is  not  usually  offered. 

In  the  mare,  in  which  twins  are  rare,  there  are  records  of  a  few 
cases  in  which  a  mule  and  horse  foal  have  been  born  as  twins, 
the  result  of  closely  succeeding  copulations  of  a  stallion  and  an 
ass.  The  two  services  may  be  separated  by  several  days,  not 
exceeding  the  duration  of  the  estrual  period.  Lanzillotti-Buo- 
santi  records  a  case  where  an  interval  of  eight  days  elapsed  be- 
tween the  service  by  the  stallion  and  the  ass. 

SUPERFETATION. 

Superfetation  differs  from  superfecundation  in  that  fecunda- 
tion occurs  in  an  animal  already  pregnant,  due  to  copulations 
during  two  separate  estrual  periods.     The  phenomenon  depends 

413 


414  Veterinary  Obstetrics 

upon  two  conditions.  First,  the  female  must  depart  from  the 
physiologic  rule  that  pregnancy  inhibits  ovulation  and  estrum. 

How  frequently  this  rule  is  violated,  we  do  not  precisely  know. 
In  the  cow,  especially  the  closely  confined  dairy  cow,  estrum 
during  pregnancy  is  by  no  means  rare.  Regular  estrum  may  ap- 
pear for  two,  three  or  more  periods  after  fecundation,  copulation 
occur  and,  finally,  a  calf  may  be  normally  born  from  the  first 
copulation.  We  do  not  know,  however,  that  ovulation  occurs  in 
these  cases.  Perhaps  it  does.  But  superfetation  rarely,  if  ever, 
follows. 

A  second  essential  condition  is  an  open  passage  from  the  os 
uteri  externum,  through  one  of  the  oviducts,  to  the  pavillion  of 
the  tube,  so  that  the  spermatozoa  and  ovum  may  meet.  In  uni- 
para,  this  passage  tends  to  become  occluded  early  by  the  pres- 
ence of  a  fetus  in  the  uterine  body  and  the  adhesion  of  the  fetal 
membranes  to  the  entire  circumference  of  the  tube.  In  bicornual 
uteri,  in  which  the  fetuses  are  usually  limited,  in  their  location,  to 
the  cornua,  and  the  uterine  body  is  vacant,  the  fetuses  of  the  pri- 
mary fertilization  may  be  confined  to  one  of  the  cornua,  an  open 
avenue  through  the  entire  length  of  the  other  cornu  exist  and 
a  second  fecundation  at  a  more  or  less  remote  period  occur. 
De  Bruin  (Geburt.shilfe  b.  d.  Kleineren  Haustieren)  quoting 
Kroon,  relates  that  a  goat  was  bred  September  14,  1897,  estrum 
and  copulation  reccurring  on  November  5th,  or  52  days  later. 
On  February  13,  1898,  152  days  after  the  first  breeding,  and  at 
the  completion  of  the  normal  duration  of  pregnancy,  she  ex- 
pelled two  living  and  one  dead,  fully  developed  young.  On 
the  following  day,  when  the  membranes  were  expelled,  there 
were  discovered  three  more  fetuses,  perfectly  formed,  but 
not  fully  developed.  These  Kroon  regarded  as  certainly  the  re- 
sult of  the  second  copulation. 

Tapken,  also  quoted  by  De  Bruin,  observed  superfetation  in 
sows.  In  one  instance  the  sow  was  bred  on  February  22,  1890, 
and  again  17  days  later.  On  June  21,  120  days  from  first  breed- 
ing, she  gave  birth  to  7  live  pigs  and,  14  days  later,  to  9  live  and 
3  dead  pigs. 

The  Wandering  of  Genital  Cells. 

Schmaltz  (Carsten- Harms)  claims  that  the  spermatozoa  may 
pass   through  one  of  the  oviducts,   into  the  peritoneal  cavity, 


Extra- Uterine  Pregnayicy  415 

and  cross  ov^er  to  the  opposite  ovary.  It  has  also  been  experi- 
mentally shown  that,  in  rare  cases,  an  ovum  which  has  escaped 
from  one  ovary,  but  failed  to  enter  the  corresponding  oviduct, 
may  pass  across  to  the  other  ovary  and  enter  its  Fallopian  tube. 
An  egg  which  has  emanated  from  one  ovary  may  become  fertil- 
ized, pass  through  the  corresponding  oviduct  and  cornu  to  the 
uterine  body  and  thence  upward  into  the  opposite  cornu,  to  be- 
come attached  and  develop  into  an  embryo.  The  evidence  of 
such  occurrence  is  found  in  the  fact  that  a  fetus  sometimes  de- 
velops in  one  uterine  cornu,  while  the  yellow  body  from  which 
the  ovum  evidently  emanated  is  located  in  the  opposite  ovary. 

Polyspermia. 
It  is  believed  by  some  authors  that  an  ovum  may  be  over- 
fertilized,  that  is,  instead  of  one  spermatozoon  penetrating  an 
ovum,  two  or  more  gain  admission  to  it,  in  which  case  the  devel- 
opment may  be  abnormal  and  lead  to  the  formation  of  some  of 
the  double  or  triple  monstrosities. 

Extra-Uterine  Pregnancy. 

Extra-uterine  pregnancy  is  the  existence,  for  a  greater  or  less 
period  of  time,  of  a  living  ovum  outside  the  uterine  cavity, 
within  the  abdomen.  The  precise  nature  of  most  cases  of  alleged 
extra-uterine  pregnancy  in  animals  has  not  been  definitely 
ascertained  and,  before  arriving  at  any  final  conclusion  as  to  their 
nature,  the  subject  needs  much  investigation.  Not  infrequently 
fetuses  are  found  outside  the  uterus  in  the  abdominal  cavities 
of  animals,  but  it  has  not  been  clearly  shown  how  they  attained 
this  position.  Many  records  are  given  of  the  finding  of  such 
fetu-ses  in  the  peritoneal  cavity,  but  their  anatomical  relations 
are  not  recorded. 

Several  forms  of  extra-uterine  pregnancy  occur  : 
I.  Ovarian  pregnancy  has  been  recorded  and  verified.  In 
these  cases  it  appears  that  the  ovisac  ruptures,  but  the  ovum  does 
not  escape  from  it  and  spermatozoa,  pa.ssing  up  through 
the  oviduct  and  pavilion  of  the  tube,  reach  the  ovum  and  bring 
about  its  fertilization.  The  ovum  may  then  undergo  a  develop- 
ment analogous  to  that  observed  in  the  uterus,  either  enclosed 
within  the  ovary  or  attached  to  it  by  the  fetal  membranes.  The 
records  of  ovarian  pregnancy  are  exceedingly  rare,  and  as  a  rule 


4i6 


Veterinary  Obstetrics 


there  are  no  symptoms  which  would  lead  to  a  diagnosis  of  the 
condition  during  the  life  of  the  mother.  Ovarian  pregnancy  is 
liable  at  any  time  to  cause  the  sudden  death  of  the  mother,  owing 
to  a  rupture  of  the  ovary  when  the  fetus  has  developed  within  it 
or  a  violent  detachment  of  the  placenta,  by  either  of  which  acci- 
dents fatal  hemorrhage  is  highly  probable. 

2.  Tubal  pregnane}^  is  apparently  the  most  common  cause  of 
extra-uterine  gestation  and,  in  all  probability,  accounts  for  the 
majority  of  cases  of  this  character.  Tubal  gestation  is  more 
readily  understood  than  other  forms.  Any  defect  in  the  tube, 
which  might  cause  the  arrest  of  the  ovum  during  its  passage 
through  it,  would  naturally  result  in  the  attachment  and  devel- 
opment of  the  embryo  at  that  point.  In  multiparous  animals,  if 
one  of  the  earliest  ova  should  become  arrested  during  its  descent. 


Fig.  8i.     Extra-uterine  pregnancy.     Swine.     Showing  2  fetuses  closely 
adherent  to  each  other  and  intimately  invested  b}'  membranes. 

all  those  on  the  ovarian  side  of  it  would  alike  become  halted  in 
their  migration.  Consequently,  a  series  of  tubal  embryos  might 
be    formed,    which    apparently    occurs    sometimes    in  domestic 


Extra- Uterine  Pregnancy  417 

animals,  especiallj'  in  the  sow,  and  leads  eventually  to  the  exist- 
ence of  a  group  of  two  or  more  extra- uterine  fetuses,  as  shown 
in  Fig.  81. 

The  cause  of  the  arrest  in  the  migration  of  the  ovum  may  be  a 
folding  in  the  tube  or  disease  or  injury  of  the  mucous  membrane. 
The  tendency  of  tubal  pregnanc3'  in  animals  is  for  the  develop- 
ment to  go  forward,  in  a  quasi-normal  manner,  up  to  that  period 
when  the  volume  of  the  fetus  and  its  membranes  becomes  so 
great  that  the  tube  is  no  longer  capable  of  accommodating  them. 
Then  the  thin  walls  of  the  tube  rupture  and  the  fetus  or 
fetuses,  with  part  or  all  the  membranes,  pass  out  into  the  perito- 
neal cavity.  This  rupture  and  the  detachment  of  the  fetal  mem- 
branes may  cause  fatal  hemorrhage.  If  fatal  hemorrhage  does 
not  follow,  and  the  fetal  membranes  have  not  been  wholly  de- 
tached from  the  maternal  placenta  in  the  oviduct,  the  fetus  may 
become  attached  to  or  imbedded  in  the  peritoneal  surface,  and 
continue  to  develop.  If  its  placental  attachments  in  the  oviduct 
have  become  wholly  separated,  the  fetus  necessarily  perishes 
at  once  and  may  undergo  partial  dessication  and  remain  in  the 
peritoneal  cavity  without  injury  or  inconvenience  to  the 
mother  throughout  her  normal  span  of  life. 

In  other  instances  of  tubal  pregnancy,  the  developing  fetus 
escapes  through  the  pavilion  of  the  tube  and  thus  gains  the 
peritoneal  cavity.  It  may  retain  its  attachment,  through  its 
membranes,  with  the  tube,  become  adherent  to  the  peritoneal 
walls  and  continue  until  the  normal  duration  of  pregnancy  has 
been  completed  and  the  usual  size  of  the  fetus  is  reached,  when 
it  perishes  and  probably  partially  dessicates. 

We  do  not  ordinarily  discover  tubal  pregnane^'  during  the  life 
of  the  mother,  but  only  upon  post-mortem  examination,  usually 
when  the  animal  is  slaughtered  for  food. 

3.  Rupture  of  the  gravid  uterus  may  occur  at  almost  any  stage 
of  pregnancy,  and  the  possibility  of  such  an  accident  increases  as 
the  clo.se  of  the  normal  period  of  pregnancy  approaches.  Rupture 
of  the  uniparous  uterus  most  readily  occurs  in  its  body  or  the 
gravid  cornu,  and  the  adjacent  fetus  tends  to  at  once  drop 
through  the  rent  into  the  peritoneal  cavity.  In  the  biparous 
uterus,  the  rupture  may  occur  at  such  a  point  as  to  interfere 
with  but   one  twin,  unless   the  twins  have  a  common   chorion, 


4i8  Veterinary  Obstetrics 

when  each  must  be  aflFected  similarly.  In  a  multiparons  uterus, 
the  rupture  may  occur  at  any  part  of  the  gravid  organ  and  one, 
two  or  more  adjacent  fetuses  escape  through  the  opening. 

The  accident  usually  causes  fatal  shock  or  hemorrhage  of  the 
mother.  Otherwise,  the  fetus  may  at  once  perish,  infection 
of  its  body  and  membranes,  through  the  os  uteri,  follow,  leading 
quickly  to  fatal  sepsis  of  the  mother,  or  abscessation  may  follow, 
the  adherent  surrounding  tissues  constituting  the  abscess  wall 
and  the  decomposing  fetus  and  membranes,  the  abscess  contents. 
The  abscess  may  rupture  externally  through  the  abdominal 
walls  or  internally  into  the  intestinal  tract. 

Escaping  these  immediate  dangers,  should  the  chorion  remain 
partially  attached  to  the  placenta,  the  fetus  may  continue  to  live 
up  to  the  normal  period  of  birth  or  it  may  perish  immediately, 
but,  the  OS  uteri  remaining  sealed  or  infection  otherwise  avoided, 
the  fetus  remains  as  an  inert  body  for  an  indefinite  period,  to 
constitute  a  variety  of  extra-uterine  pregnancy. 

4.  It  is  claimed  by  some  writers  that  a  primary'  abdominal  im- 
pregnation may  take  place — that  is,  an  ovum  may  drop  into  the 
peritoneal  cavity  and  there  become  impregnated  by  a  spermato- 
zoon, which  has  traversed  the  uterus,  cornu  and  oviduct  and 
escaped,  through  the  pavilion,  into  the  peritoneal  cavity.  The 
embryo  becomes  attached  to  the  peritoneal  surface  and  develops 
in  a  more  or  less  normal  way.  No  unquestioned  case  of  primary 
abdominal  pregnancy  has  yet  been  seen.  The  possibility  of  such 
an  occurrence  has  not  been  di.sproven.  The  ca.ses  thus  far  cited 
to  prove  the  actual  occurrence  have  all  been  faulty  in  some  par- 
ticular, which  serves  to  throw  a  doubt  upon  the  correctness  of 
the  alleged  occurrence. 

The  course  of  abdominal  pregnancy  in  animals,  so  far  as  has 
been  observed  and  recorded,  is  that  the  fetus  or  fetuses  acquire 
a  more  or  less  rigid  attachment  to  the  abdominal  walls  or  some 
of  the  viscera,  and  the  fetal  membranes  closely  invest  the  fetal 
body  in  such  a  way  as  to  compress  it  into  the  smallest  possible 
space.  In  the  cases  ordinarily  observed,  the  fetus  or  fetuses  are 
closely  enveloped  in  firm  membranes  without  any  intervening 
liquids,  so  that  the  covering,  which  may  be  regarded  as  the  am- 
nion, is  in  direct  contact  with  the  hair  of  the  fetus  and  cannot 
readily  be  stripped  away  from  it.     This  is  well  shown  in  Fig.  81. 

The  fetus  usually  seems  to  have  been  normal  originally,  but 


Extra- Uterine  Pregnancy  419 

to  have  later  undergone  a  process  of  dessication  and  in  this  state 
remains  as  an  inert  body  for  an  indefinite  period  of  time.  We 
have  few  records  of  how  long  a  fetus  may  thus  remain  as  an  inert 
body  in  our  domestic  animals,  because,  as  a  rule,  it  is  only  dis- 
covered upon  slaughter  and  the  time  at  which  it  developed  has 
not  been  determined.  In  woman,  where  the  observations  have 
been  more  accurate,  there  are  cases  recorded  where  an  abdominal 
fetus  has  remained  inert  and  without  inconvenience  to  the  mother 
during  a  period  of  more  than  50  years. 

The  degree  of  dessication  in  extra-uterine  pregnancy  is  not 
equal  to  that  observed  in  intra-uterine  mummification,  as  a  com- 
parison of  Figs.  81  and  86  well  show.  Extra-uterine  fetuses  are 
comparatively  plump,  usually  normal  in  size  and  development 
and  are  closely  invested  by  tough,  adherent  membranes.  Intra- 
uterine mummified  fetuses  are  free  from  membranous  attach- 
ments, greatly  shrivelled,  discolored  and  gnarled. 

There  are  few  cases,  indeed,  in  which  extra-uterine  pregnancy 
has  caused  any  known  disease  or  discomfort  in  animals.  Flem- 
ing cites  a  number  of  cases  in  which  the  fetus  has  undergone 
putrid  decomposition,  with  the  formation  of  an  abscess,  which 
has  ruptured  into  the  intestines  or  other  viscera  or,  more  fre- 
quently, externally  through  the  abdominal  wall.  He  classes 
these  cases  as  extra-uterine  pregnancy,  but  submits  no  evidence 
to  show  that  the  fetus  was  not  in  the  uterus  until  it  decomposed 
and  finally  escaped  therefrom  as  a  part  of  the  contents  of  an  ab- 
scess within  the  uterine  cavity.  We  shall  refer  further  to  this 
subject  under  the  heads  of  "Torsion  of  the  Uterus,"  "Atresia 
of  the  Os  Uteri,"  and  "  Putrid  Decomposition  of  the  Fetus." 

The  diagnosis  of  extra-uterine  pregnancy  is  difficult  in  the 
living  animal.  In  carnivora,  the  fetus  may  possibly  be  recog- 
nized, and  its  location  outside  the  uterus  determined,  by  extra- 
abdominal  manipulation.  However,  this  is  difficult,  as  we  can- 
not readily  trace  the  non-gravid  uterus  by  this  means.  Even 
though  we  can  feel  a  fetus  through  the  abdominal  walls,  we  can 
not  be  sure  that  it  is  not  in  the  uterus.  It  may  be  attached 
firmly  to  the  abdominal  floor,  which  would  constitute  presump- 
tive evidence  that  it  is  extra-uterine,  but  the  proof  is  not  final, 
since  one  of  the  uterine  cornua,  with  a  fetus  included,  may  be 
firmly  adherent  to  the  abdominal  wall  and  thus  nullify  the  diag- 
nosis.    In   our  larger  domestic  animals,  an  exploration  of  the 


420  Veterinary  Obstetrics 

uterus  may  show  that  it  contains  no  fetus  and  if,  through  its 
walls  or  those  of  the  rectum,  a  fetus  can  be  recognized  it  becomes 
clear  that  we  are  dealing  with  extra-uterine  pregnancy,  or  at 
least  with  an  extra-uterine  fetus. 

Fleming  (Text-Book  of  Veterinary  Obstetrics,  ist  Edition,  p. 
159)  quotes  S.  Della-Rovere  as  havnng  attended  a  case  of  extra- 
uterine pregnancy  in  a  cow,  in  which  he  removed  a  living  calf 
through  an  incision  in  the  wall  of  the  vagina.  The  citation  by 
Fleming  fails  wholly,  however,  to  show  that  the  fetus  was  not  in 
the  uterus.  No  record  is  made  as  to  the  condition  of  the  uterus 
itself  and  it  is  almost  certain  from  Fleming's  quotation  that  it 
was  not  extra-uterine  pregnancy  at  all. 

It  is  not  at  all  rare  to  meet  with  cases  of  uterine  pregnancy 
which  closely  simulate  extra-uterine  gestation.  We  have  already 
suggested,  on  page  383,  while  considering  the  position  of  the 
fetus  during  gestation,  that  in  some  cases  in  the  cow  the  fetus 
pushes  its  way  up  into  the  pelvis  alongside  the  vagina  and  can 
be  clearly  felt  there.  This  position  is  apparently  normal  and  has 
no  danger, [seemingly ,  for  the  life  of  either  mother  or  fetus.  A  still 
more  puzzling  condition  is  the  bi-cornual  or  transverse  preg- 
nancy of  the  mare,  in  which  the  fetus  lies  beneath  the  vaginal 
floor  in  a  transverse  position,  in  such  a  way  as  to  lead  the  inex- 
perienced to  believe  that  extra-uterine  pregnancy  exists. 

In  order  to  definitely  recognize  and  verify  extra-uterine  preg- 
nancy in  the  living  animal,  the  following  factors  are  essential : 
first,  we  must  recognize  the  presence  of  a  fetus  ;  second,  we  must 
establish  the  fact  that  it  is  not  in  the  uterus,  and  we  can  do  this, 
in  case  of  a  uuiparous  animal,  only  by  determining  clearly  that 
the  uterine  cavity  is  vacant.  The  emptiness  of  the  uterus  must 
be  verified  either  by  inserting  the  fingers  or  hand  into  the  uter- 
ine cavity  itself,  or  by  an  ample  and  authentic  examination  of 
the  uterus  per  rectum.  Otherwise,  we  can  clearl}-  determine 
extra-uterine  pregnancy  only  by  a  post-mortem  examination. 

The  treatment  of  extra-uterine  gestation  is  rarely  necessary. 
If  diagnosed,  and  it  seems  to  threaten  the  life  or  health  of  an 
animal,  the  removal  of  the  fetus  may  be  considered.  In  animals 
which  are  used  for  meat  purposes,  the  patient  should  be  sent  to 
the  butcher  at  the  earliest  convenience,  providing  the  meat  has 
not  been  injured  by  decomposition  of  the  fetus  or  other  disease 
induced  by  its  presence.  In  carnivora,  the  fetus  may  be  re- 
moved by  laparotomy. 


DISEASES  OF  THE  PREGNANT  ANIMAL. 

Special  diseases  of  pregnant  animals  are  comparatively  rare. 
Most  pregnant  animals  are  kept  in  a  reasonably  natural  state  and, 
consequently,  do  not  suffer  greatly  as  a  result  of  gestation. 
Quite  naturally  pregnancy  confers  no  immunity  against  the 
ordinary  di.seases  of  animals.  Nevertheless,  we  find  more  or  less 
serious  diseases  during  gestation,  which  are  referable  to  the  preg- 
nant state  and  which  require  our  attention.  The  tendency  to 
disease  of  pregnant  animals  is  in  harmony  with  the  environment, 
the  degree  of  domestication  and  the  care  given  the  animal. 
Those  animals  which  are  most  closely  confined  and  housed  are 
most  subject  to  diseases  during  the  pregnant  state  ;  but  this  is 
also  in  harmony  with  the  prevalence  of  the  diseases  of  non-preg- 
nant animals. 

The  influence  of  gestation  upon  the  course  of  the  ordinary  dis- 
eases of  animals  is  not  well  marked  and  apparently  makes  very 
little  difference,  except  that,  when  a  pregnant  animal  becomes  so 
seriously  diseased  that  its  life  is  threatened,  the  fetus  tends,  in 
many  cases,  to  perish  and  become  expelled  prior  to  the  death  of 
the  mother.  Hence,  any  serious  disease  of  the  pregnant  female 
may  acquire  additional  gravity-  because  of  the  possibility  of  abor- 
tion, which  would  complicate  the  malady.  It  must  be  admitted 
that  the  fetus  constitutes  a  heavy  burden  upon  the  maternal 
system  and,  when  serious  disease  arises,  this  demand  upon  the 
nutritive  supply  of  the  mother  for  the  maintenance  of  the  life  of 
the  fetus  may  constitute  a  factor  in  reference  to  the  prognosis  of 
the  malady.  Advanced  pregnancy  may  greatly  modify  the  prog- 
nosis of  fractures,  strains  and  other  more  or  less  disabling  inju- 
ries, the  extra  weight  of  the  gravid  uterus  adding  to  the  difficulty 
of  getting  up  and  down  and  interfering  with  locomotion  in  a 
manner  which  may  jeopardize  the  life  of  the  mother  or  the  young. 

All  those  infectious  diseases  which  are  frequently  accompanied 
by  abortion,  such  as  contagious  pleuro-pneumoniaof  cattle,  sheep- 
pox,  contagious  cellulitis  or  pink  eye,  hog  cholera,  and  foot  and 
mouth  disease,  are  constantly  more  dangerous  for  the  pregnant 
female  than  for  other  animals,  becau.se  of  the  danger  which  they 
possess  for  the  life  of  the  fetus,  and  the  extra  hazard  to  the 
mother  through  its  death  and  expulsion. 
421 


42  2  Veteri7iary  Obstetrics 

Fleming  claims  that  the  pregnant  animal  suffers  especially 
from  numerous  affections  which  are  seen  less  frequently  in  the 
non-pregnant,  and,  according  to  his  view,  should  be  in  some  cases 
referred  to  the  pregnant  condition.  Among  these  he  mentions 
the  cramps  of  the  muscles  of  the  hind  limbs,  which  simulate 
closely,  he  says,  dislocation  of  the  patella  in  non-pregnant  ani- 
mals, though  he  does  not  point  out  the  difference  between  the 
two  affections.  Since  the  actual  character  of  the  so-called  up- 
ward dislocation  of  the  patella  in' the  horse  is  in  controversy,  it  is 
not  necessary  for  us  to  discuss  the  question  of  the  differential 
diagnosis,  but  merely  to  state  that  the  occurrence  of  this  cramp 
is  not  extremely  rare  in  the  mare  and  that  it  may  readily  be  over- 
come, as  in  the  so-called  dislocation,  by  causing  the  animal  to 
move  the  affected  limb  and  then  looking  after  the  exercise  and 
general  care  of  the  patient. 

Other  veterinary  writers  also  refer  to />zVrt,  or  morbid  appetite 
in  pregnant  animals,  although  no  evidence  is  adduced  that  this 
is  any  more  common  in  the  pregnant  than  in  the  non-pregnant 
state,  or  that  gestation  has  anything  whatever  to  do  with  its 
occurrence.  It  requires  no  .special  notice  in  reference  to  han- 
dling, but  should  be  dealt  with  as  in  the  non-pregnant  animal. 

The  same  may  be  .said  of  the  question  of  constipation  in  preg- 
nant domesticated  animals.  The  annoyance  from  this  trouble 
in  pregnant  women  is  well  known,  but  it  does  not  apparently 
hold  true  in  animals  to  any  marked  degree.  It  usually  depends 
chiefly  upon  too  clo.se  housing  and  injudicious  feeding  and 
should  be  corrected  simply  by  removing  the  cau.ses  and  giving 
the  animal  proper  attention. 

Fleming  further  refers,  among  the  diseases  of  pregnancy,  to 
edema  of  the  feet  and  limbs  of  the  mare,  which  he  compares  to 
that  observed  in  woman.  It  is  a  well  known  fact  that  edema  of 
the  feet  and  limbs  is  a  common  malady  in  the  horse,  without 
any  reference  whatever  to  pregnancy,  and  it  is  only  natural  that 
in  the  pregnant  state,  while  the  animal  is  more  quiet  than  usual, 
such  an  edema  may  become  emphasized.  Beginning,  as  is 
usual,  in  the  lower  parts  of  the  limbs  or  feet,  it  reveals  itself  as 
an  infiltration  of  the  connective  tissue  beneath  the  skin,  which 
is  painless  and  tends  to  pit  under  pressure.  The  degree  of  thi.s- 
edema  may  vary  and  it  may  gradually  extend  upward  toward 
the  body. 


Osteomalacie  423 

It  has  little  real  significance,  so  far  as  the  well  being  of  the 
mare  or  foal  is  concerned,  and  tends  to  disappear  shortly  after 
parturition.  It  nia}^  be  largely  avoided,  during  the  period  of 
pregnancy,  by  careful  attention  to  the  diet  and  the  allowance  of 
regular  exercise.  It  is  usually  not  seen  in  those  mares  which 
are  kept  at  moderate  work  regularly,  run  at  pasture,  or  are  other- 
wise kept  constantly  out  of  doors  where  they  may  take  natural 
exercise.  This  condition  should  not  be  confounded  with  rupture 
of  the  prepubian  tendon  or  the  infiltration  of  the  abdominal  floor 
leading  thereto. 

OSTEOMALACIE. 

Osteomalacic  is  described  by  numerous  European  writers  as  a 
common  disease  of  pregnant  animals.  It  does  not  differ,  appar- 
ently, from  the  o.steonialacie  of  non-pregnant  animals  but  is 
believed  to  be  more  common  and  severe  in  the  pregnant  animal. 
Its  chief  interest  to  the  obstetrist  is  the  greater  susceptibility  to 
the  malady.  In  some  instances,  epizootics  of  osteomalacic  have 
been  recorded  in  pregnant  cows  and  other  pregnant  animals. 

St.  Cyr  attributes  the  malady  to  three  chief  causes:  i.  Defi- 
cient quantity  and  quality  of  food.  2.  The  parturient  state.  3. 
Prolonged  lactation. 

The  first,  in  conjunction  with  bad  housing,  is  generally  in- 
voked to  explain  the  occurrence  of  osteomalacic  in  non-pregnant, 
as  well  as  in  pregnant  animals.  The  second  reason  assigned,  the 
pregnant  state,  is  generally  recognized  as  a  cause  of  osteomalacic. 
The  third  cause  is  presumed  to  act  merely  by  lowering  the  vital- 
ity of  the  animal,  and  thereby  increasing  its  susceptibility. 

The  beginning  of  the  malady  is  obscure.  The  pregnant  cow 
moves  carefully,  maintains  the  recumbent  position  more  than 
usual,  and  exhibits  rheumatic  symptoms.  The  appetite  remains 
good  and  fever  is  absent. 

Then  follow  fractures  of  a  more  or  less  spontaneous  character  ; 
a  slight  misstep,  a  slip  or  even  an  effort  to  rise,  serves  as  a 
sufficient  cause.  The  pelvis  suffers  most  frequently  and,  in 
many  cases,  is  comminuted.  Other  bones — scapula,  sternum  and 
long  bones—are  less  commonly  broken. 

M.  Germain  reports  the  symptoms  in  the  goat  as  consisting 
primarily  of  paraplegia,  followed  by  swelling  of  the  jaws  and  loos- 
ening of  the  teeth  in  the  alveoli,  with  difficult  mastication. 


424  Veterinary  Obstetrics 

In  solipeds,  fracture  of  the  vertebral  column  is  not  rare. 

The  diagnosis  of  the  malady  is  not  easy,  as  there  occur  no  very 
definite  symptoms,  except  those  of  general  ill-health,  until  per- 
haps a  fracture  occurs  and  this  too  often  is  referred  to  accident. 
When  a  fracture  occurs  in  a  pregnant  animal,  without  sufficient 
known  accident,  the  fact  may  well  arouse  suspicion  of  osteo- 
malacic. 

The  prognosis,  once  the  disea.se  is  well  established,  is  very 
grave.  When  the  malady  becomes  enzootic  and.  as  a  conse- 
quence, its  nature  is  recognized  early,  much  may  be  accomplished 
by  improved  hygiene  conditions,  especially  by  a  liberal  supply  of 
nutritious  food  of  proper  quality.  With  these  improvements, 
further  benefit  may  be  derived  from  the  administration  of  nux 
vomica  and  iodide  of  potash.  vSome  recommend  phosphoric  acid 
or  calcium  phosphate,  internally. 

DROP.SY    OF    THE    AmNION    AND    AlLANTOIS. 

Hydrops  Amnii.     Hydrallantois. 

When  describing  the  amnion  and  allantois  we  alluded  to  the 
fact  that  there  is  regularly  present  an  amount  of  fluid  within 
each  of  these  sacs,  which  may  vary  in  different  individuals  of  the 
same  species,  the  quantity  in  the  mare  and  cow  being  usually 
about  5  to  6  1.  of  amniotic,  and  6  to  15  1.  of  allantoic  fluid.  When 
it  materially  exceeds  this  amount  we  have  the  condition  known 
as  dropsy  of  the  amnion.  This  affection  occurs  in  various  do- 
mesticated animals.  It  has  been  observed  chiefly  in  the  cow 
and  next  in  the  mare,  though  Saint-Cyr  records  one  ca.se  in  the 
goat,  and  Merrick  has  observed  it  in  the  ewe  and  bitch. 

Generally  the  exact  nature  of  the  disease  has  not  been  fully 
determined  and,  in  the  majority  of  cases  which  we  meet  clinically, 
we  do  not  determine  whether  the  fluid  is  chiefly  or  wholly  within 
the  amnion  or  the  allantois.  In  woman,  where  the  allantois  is 
devoid  of  a  cavity  from  an  early  date,  the  dropsy  naturally  occurs 
in  the  amnion.  Because  of  this  fact,  veterinarians  refer  generally 
to  the  malady  as  hydrops  anuiii,  regardless  of  the  fact  that  the 
collection  may  be  in  either  or  both  .sacs.  In  our  domestic  ani- 
mals, where  the  allantoic  cavity  is  quite  as  extensive  as,  or  larger 
than  the  amnion,  the  fluid  may  be  collected  in  either  membrane 
or  may  pass  from  the  one  sac  into  the  other  through  the  urethra, 


Dropsy  of  the  Am^iion  and  Allantois  425 

"bladder  and  urachus.  According  to  Kammermann,  the  greater 
amount  of  the  fluid  is  generally  in  the  allantois,  but  may  be 
found  in  the  amnion.  In  those  cases  which  are  attended  during 
the  life  of  the  animal  and  in  which  the  fetus  is  extracted,  we 
naturally  obliterate  the  evidence  as  to  the  location  of  the  fluid, 
because  it  is  all  evacuated  and  the  membranes  are  largely  de- 
stroyed. 

The  increase  in  the  amount  of  fluid  varies  greatly  in  different 
cases.  Harms  records  an  accumulation  of  8  1.  in  the  goat,  while 
Lindenburg  and  Georgi  record  120  and  150  1.  in  the  cow.  In 
the  mare,  the  amount  may  reach  100-160  1.,  according  to  Kam- 
mermann and  Georgi.  These  records,  of  course,  indicate  some  of 
the  more  severe  cases  and,  between  these  and  the  normal,  there 
is  every  possible  gradation.  While  we  have  observed  several 
instances  in  the  cow,  we  have  not  accurately  measured  the 
amount  of  fluid  in  any  ca.se,  but  our  estimates  are  in  accord  with 
the  foregoing. 

The  symptoms  in  the  cow  vary  greatly  according  to  the 
severity  of  the  malady  and,  in  many  instances,  they  do  not  at- 
tract much  attention  until  the  di.sease  has  acquired  an  extreme 
degree.  There  appear  some  of  the  general  symptoms  of  ill- health, 
as  indicated  by  a  rough  and  staring  coat.  The  eyes  are  sunken 
and  there  are  present  the  general  appearances  of  dullness,  weak- 
ness and  anemia.  The  pulse  is  weak  and  frequent  and  the  heart- 
beat more  or  le.ss  tumultuous.  The  respiration  is  labored.  The 
movements  of  the  animal  are  more  or  less  difficult.  The  cow,  in 
many  cases,  emits  a  grunt  during  expiration.  The  appetite 
finally  becomes  somewhat  decreased  and  the  bowels  may  be 
slightly  constipated,  though  there  is  usually  nothing  very  evi- 
dent .in  this  respect.  Rumination  may  be  decreased  or  sus- 
pended.    The  urine  is  decreased  in  quantity. 

According  to  the  acuteness  of  the  malad}',  thirst  is  increased, 
since  evidently  the  increased  amount  of  fluid  in  the  amnion  or 
allantois  must  be  derived  from  the  liquids  which  the  animal  con- 
sumes. It  con.sequently  occurs  that,  in  severe  cases,  there  is 
usually  very  great  thirst. 

The  abdomen  becomes  abnormally  enlarged,  the  abdominal 
walls  exceedingly  tense  and  percussion  gives  a  dull  sound.  If 
the  animal  is  caused  to  move  suddenly  or  the  part   is   given  a 


426  Veterinary  Obstetrics 

sudden  thrust  or  blow  with  the  hand,  there  may  sometimes  be 
recognized  a  splashing  sound. 

Examination  per  rectum  reveals  the  uterus  abnormally  dis- 
tended with  fluid,  constituting  a  vast,  tense,  immovable  sac, 
pushing  the  other  viscera  aside  and  filling,  more  or  less  com- 
pletely, the  entire  abdominal  cavity.  The  enlarged  state  of 
the  abdomen  frequently  leads  the  owner  to  suspect  twin  preg- 
nancy or  a  fetus  of  abnormally  large  size.  Since  the  fetus  is  of 
higher  specific  gravity  than  the  surrounding  liquid,  it  may  lie 
so  low  down  along  the  floor  of  the  abdomen  that  it  cannot  be 
readily  felt  per  rectum  in  the  uterus.  The  fetus,  however,  may 
be  felt  by  abdominal  ballottement.  It  may  also  be  determined, 
by  the  presence  or  absence  of  fetal  movements,  whether  the 
fetus  is  still  living. 

The  OS  uteri  is  generally  found  quite  rigidly  closed  and  in  the 
cow  it  is  only  with  difficulty  that  the  hand  can  be  passed  through 
it.  This  does  not  differ  materially  from  the  normal  condition  of 
the  cervix  uteri  in  the  cow. 

The  great  weight  of  the  accumulated  fluid  and  the  debilitated 
state  of  the  animal  cause  it  to  lie  down  a  great  deal.  When  the 
amount  of  fluid  becomes  very  great,  it  is  frequently  necessary  to 
aid  the  cow  in  regaining  her  feet,  and  finally,  as  the  disea.se 
advances,  the  patient  becomes  wholly  unable  to  get  up,  even 
with  assistance. 

The  diagnosis  of  the  disease  must  depend  largely  upon  the  dis- 
tension of  the  abdomen,  the  dullness  upon  percussion  and  the  ex- 
ploration per  rectum.  It  must  be  differentiated  from  dropsy  of 
the  abdomen,  or  ascites,  and  from  dropsy  of  the  kidney,  or 
hydronephrosis.     The  latter  is  exceedingly  rare  except  in  the 

pig- 

Ascites  is  quite  rare  in  our  domestic  animals,  except  in  the 
bitch.  When  the  fluid  is  intra-uterine,  it  may  be  differentiated 
from  that  in  the  peritoneal  cavity  by  rectal  exploration. 

The  causes  of  dropsy  of  the  fetal  membranes  are  not  well  de- 
termined. Generally  the  disease  .seems  to  depend  largely  upon 
insufficient  nourishment  or  improper  diet.  Kammermann  records 
that,  in  one  year,  following  a  wet  summer  and  consequently  dam- 
aged fodder,  the  number  of  cases  of  dropsy  of  the  amnion  or 
allantois  was  unusually  large.  Our  observations  have  been  some- 
what  parallel  to  this  and  we  have  noted,  in  certain  stables  of 


Dropsy  of  the  Amnion  a?id  Allantois  427 

cows,  a  large  percentage  of  the  animals  affected  with  this  malady 
in  a  given  year,  when  the  food  had  been  somewhat  damaged,  and 
consequently  afforded  insufficient  nourishment. 

A  very  interesting  fact  in  connection  with  hydrops  of  the 
amnion  and  allantois  was  observed  by  us  among  a  herd  of  Short- 
horn cows,  with  which  an  American  buffalo  or  bison  was  allowed 
to  consort,  and  a  number  of  which  became  impregnated  by  him. 
Almost  without  exception,  during  one  3'ear,  all  the  cows  which 
were  in  calf  by  the  buffalo  perished  from  hydrops  amnii,  while 
the  other  cows  upon  the  farm,  of  which  there  were  100  or  more, 
did  not  suffer  from  the  malady.  Similar  observations  have  been 
recorded  by  others. 

The  cadaver  of  an  animal  which  has  died  from  this  disease  is 
emaciated  and  anemic.  In  some  cases  the  abdominal  muscles 
may  have  become  ruptured,  because  of  the  great  weight  which 
they  have  been  called  upon  to  bear,  in  addition  to  the  weak- 
ened state  of  the  muscles  as  a  result  of  the  dropsy.  The  uterus 
is  greatly  distended,  pale  and  thin-walled.  Kammermann 
has  recorded  a  rupture  of  this  organ,  Garreau  found  the 
mem])ranes  destroyed,  Harms  observed  them  ruptured,  and 
Schutt  found  plastic  clots  floating  in  the  fluid.  Harms  records 
that  the  fetuses  are,  as  a  rule,  feebly  developed  and  may  also  be 
dropsical.  The  liver  and  kidneys  show  appearances  of  paren- 
chymatous infiltration.  The  post-mortem  appearances  have  not 
been  well  studied.  Though  most  of  the  animals  die,  they  have 
generally  been  handled  before  death,  the  fetal  membranes  torn 
and  the  liquid  contents  expelled  or  removed,  so  that  the  evidences 
of  the. actual  conditions  present  during  life  have  been  largely 
obliterated  prior  to  the  death  of  the  animal. 

The  course  of  the  disease  is  variable.  Most  animals  live  until 
near  the  date  for  the  normal  close  of  pregnancy,  but  they  do  not 
as  a  rule  give  birth  to  young  without  aid.  In  the  cow,  a  large 
proportion  of  the  animals  go  down  and  are  unable  to  stand  be- 
fore the  veterinarian  is  called  and  ma}-  perish  before  the  time 
for  parturition  arrives.  When  gestation  continues  for  the 
normal  time,  there  is  an  absence  of  power  on  the  part  of  the 
mother  to  bring  about  the  expulsion  of  the  uterine  contents. 
The  long  continued,  great  distension  of  the  uterus  has  destroyed 
the  contractile  powers  of  its   walls.     The   abdominal  walls  also 


428  Veteriiiary  Obstetrics 

lose  their  power  of  contraction  and  cannot  effectively  aid  in  the 
dilation  of  the  os  uteri  and  the  expulsion  of  the  fetus  and  fluids. 
Possibh'  the  debility  of  the  uterus  was  the  cause  of  the  dis- 
ease. When  the  time  for  parturition  arrives,  the  patient  shows 
some  uneasiness  and  possibly  some  very  slight  evidences  of  labor 
pains,  not  of  a  vigorous  character. 

The  prognosis  of  dropsy  of  the  amnion  is  very  grave  for  both 
the  mother  and  the  fetus.  In  mild  cases,  it  may  be  favorable 
for  the  mother  and  a  living  fetus  may  be  born.  In  the  severe 
cases,  the  fetus  is  generally  too  feeble  to  live  after  birth.  The 
mother,  also,  is  usually  so  weak  and  her  uterus  so  flaccid  and 
open  to  infection  that  she  is  very  liable  to  perish.  Almost 
uniformly,  hydrops  amnii  is  followed  by  retention  of  the  fetal 
membranes,  which  gives  rise  to  serious  complications. 

The  gravity  of  the  condition  is  often  very  deceptive  to  the 
owner  and  the  inexperienced  veterinarian.  The  patient  is  free 
from  pain  and  fever,  looks  bright  and  cheerful  and  may  retain  a 
fair  appetite. 

In  mild  cases,  spontaneous  birth  may  occur,  but  as  a  general 
rule  assistance  must  be  given  in  order  to  bring  about  the  expul- 
sion of  the  uterine  contents.  In  the  very  .severe  ca.ses  the  ani- 
mals show  complete  loss  of  appetite,  become  unable  to  rise,  and 
soon  succumb  to  the  general  weakness  and  decubitis.  These 
symptoms  are  intensified  by  the  interference  of  respiration  caused 
by  the  pressure  of  the  fluid  upon  the  diaphragm.  When  the 
abdominal  muscles  give  way  and  the  uterus  de.scends  against  the 
skin  until  it  nearly  reaches  the  ground,  or  rupture  of  the  uterus 
occurs,  as  observed  by  Kamniermann,  death  quickly  follows. 

If  the  dropsy  is  slight,  and  the  mother  does  not  seem  to  suffer 
great  inconvenience  from  it,  the  case  may  be  allowed  to  go 
without  interference  until  the  normal  period  of  parturition  has 
been  reached.  At  this  time  the  patient  should  be  closely 
w^atched  and  early  a.ssistance  given  in  order  that  birth  may  take 
place  without  too  great  difficulty  or  danger.  Such  mild  cases 
are  rarely,  if  ever,  diagnosed. 

Whenever  the  disease  is  well  defined,  so  that  the  mother  has 
difficulty  in  getting  up  when  down  and  is  evidently  suffering 
seriously  from  the  malady,  complete  evacuation  of  the  uterine 
cavity  should  at  once  be  brought  about.     The  os  uteri  should  be 


Dropsy  of  the  Amnion  and  Allantois  429 

forcibly  and  carefully  dilated  until  the  hand  can  be  passed  into 
the  uterine  cavity,  when  the  membranes  should  be  ruptured  and 
the  excessive  fluids  allowed  to  escape  or  siphoned  out.  The  pre- 
senting parts  of  the  fetus  should  be  secured  by  cords  and,  by 
gradual  traction,  the  further  dilation  of  the  os  uteri  accomplished 
and  the  fetus  extracted.  This  requires  much  patience  and  time, 
but  in  our  judgment  should  be  persisted  in  until  the  operation  is 
completed  and  the  entire  contents  of  the  uterus,  except  the 
placenta,  have  been  removed. 

In  our  experience,  when  we  have  dilated  the  os  uteri  some- 
what and  ruptured  the  membranes,  allowing  the  fluid  to  escape, 
and  then  awaited  normal  labor,  we  have  been  disappointed.  The 
labor  pains  have  not  appeared,  the  weakened  uterus  has  under- 
gone infection,  the  fetus  has  quickly  perished,  become  emphyse- 
matous, its  extraction  has  been  made  highly  difficult,  and  the 
mother  has  perished  as  a  result.  We  believe,  therefore,  that  the 
delivery  should  be  completed  as  soon  as  possible  after  it  has  been 
begun,  and  that  no  interval  should  be  allowed  to  occur  between 
the  dilation  of  the  os  uteri,  the  rupture  of  the  fetal  membranes, 
and  the  extraction  of  the  fetus.  The  effort  should  be  continuous 
from  the  beginning  to  the  end. 

It  should  be  observed  that,  in  inserting  the  hand  into  the 
uterus  of  the  cow,  in  this  disease,  before  the  fetus  has  been  ex- 
tracted, there  is  a  peculiar  condition  of  the  organ,  which  tends 
to  confuse  the  inexperienced  operator.  In  normal  pregnancy 
the  body  of  the  uterus  becomes  enlarged  and  the  median  partition 
between  the  two  cornua  recedes  from  the  cervix.  In  hydrops 
amnii  in  the  cow,  the  inter-cornual  partition  does  not  recede  from 
the  cervix,  so  that,  as  soon  as  the  hand  enters  the  uterus,  it 
comes  in  contact  with  this  perpendicular  partition  between  the 
two  cornua,  in  a  very  unexpected  place,  in  close  proximity  to 
the  cervix.  This  fact  should  be  recognized  and  injury  to  this 
structure  avoided. 

Harms  suggests  that,  in  some  cases,  the  os  uteri  has  retreated 
so  far  into  the  abdominal  cavity  that  it  cannot  well  be  reached 
to  be  dilated  and  that,  in  such,  the  animal  should  be  turned  upon 
its  back  in  order  to  bring  it  well  within  reach.  This  position 
also  favors  the  expulsion  of  the  remaining  waters.  Harms  also 
suggests  that  animals  which  have  suffered  from  hydramnii 
should  not  again   be  used   for  breeding  purposes,  although  in- 


430  Veteriyiary  Obstetrics 

stances  have  been  recorded  where  such  cows  have  successfully 
bred. 

In  order  to  overcome  the  extreme  weakness  after  the  extrac- 
tion of  the  fetus,  it  is  well  that  stimulants  and  tonics  should  be 
administered  for  a  few  days.  Full  doses  of  strychnia,  hypoderm- 
ically,  or  strong  coffee  or  other  stimulants,  as  a  drench,  are 
indicated.  It  is  highly  essential  that  the  uterus  should  be 
closely  watched  and  involution  favored  in  ever)'  way,  in  order  to 
guard  against  infection.  The  animal  should  be  given  good, 
clean  quarters,  with  abundant  bedding,  good  and  abundant  food, 
and  every  pos.sible  hygienic  care,  until  fully  convalescent. 

Dropsy  of  the  Uterus.  Hydrometra. 

Edema  of  the  gravid  uterus  is  extremely  rare  in  domestic 
animals  and  we  find  but  one  case  recorded,  which  occurred  in  the 
cow.  In  this  instance,  cited  by  Harms,  a  cow  far  advanced  in 
pregnancy  showed  symptoms  of  abdominal  pain  and  died  within 
an  hour.  Post-mortem  examination  revealed  a  great  infiltration 
of  the  walls  of  the  uterus,  so  that  they  had  attained  a  thickness 
of  8  to  JO  cm.      Upon  incision,  the  infiltrated  fluid  escaped. 

Dropsy   of  the   Uterine  Cavity.      Ascitic  Hydrometra. 

An  accumulation  of  fluid  between  the  chorion  and  uterine 
walls  is  exceedingly  rare  and  the  few  ca.ses  which  are  related 
kre  not  perfectly  clear,  but  suggest  that  in  some  of  them  the 
writer  may  have  been  dealing  with  hydramnios  or  hydrallantois. 
It  appears,  however,  that  such  a  condition  does  rarely  occur. 

Schutt^(Gurlt  und  Hertwig,  Vol.  9,  Page  199)  relates  a  case 
in  which  the  animal  was  very  feeble  and  recumbent  much  of  the 
time,  but  could  get  up  with  help.  She  groaned  and  was  rest- 
less ;  respiration  was  somewhat  labored  ;  her  coat  was  rough  and 
her  appetite  poor.  The  abdomen  was  greatly  enlarged.  The 
motions  of  the  fetus  could  be  distingished  and  it  could  also  be 
felt  by  ballottement.  Finally  the  animal  could  not  get  up,  and 
perished. 

Post-mortem  examination  revealed  a  greatly  distended  uterus 
with  normal  walls,  fetus  and  membranes,  but  between  the 
chorion  and  uterus  there  were  30  quarts  of  clear,   odorless  fluid. 

Werner  (Berliner  Tierarztliche  Wochenschrift,  1890,  No.  52) 
records  a  case  in  which,  though   the   abdomen  was  increased   in 


Pa  raplegia  431 

size,  no  motions  of  the  fetus  could  be  determined  either  bj' 
internal  or  external  exploration.  Five  days  after  the  first  ex- 
amination, there  was  found  in  the  gutter  of  the  stall  a  watery 
fluid,  estimated  at  about  5  or  6  large  pailfuls.  The  fetus,  about 
the  size  of  a  child's  head,  was  removed  in  the  fetal  membranes. 
The  uterus  was  washed  with  a  creolin  solution  and  a  tonic  was 
administered,  under  which  the  cow  recovered  when  she  was  bred 
again,  against  the  advice  of  Werner.  The  dropsy  of  the  uterus 
returned,  and  the  cow  was  sold,  so  that  the  observation  of  the 
case  was  interrupted.      (Harms,  Tierarztliche  Geburtshilfe.) 

Paraplegia. 

In  the  cow,  and  rarely  in  other  ruminants,  there  occurs  dur- 
ing pregnancy  a  form  of  paralysis  of  the  hind  limbs,  the  nature 
of  which  has  not  been  fully  determined.  Presumably  it  depends 
upon  a  variety  of  causes.  The  cause  may  at  times  be  some  in- 
jury or  accident  to  the  limbs  or  spine  or  to  the  muscles  acting 
upon  these.  There  appears,  however,  to  be  some  more  important 
cause  in  a  large  majority  of  cases.  During  one  winter,  in  the 
vicinity  of  Ithaca,  N.  Y.,  there  was  wide-spread  complaint  from 
paraplegia  in  pregnant  cows.  It  appeared  in  numerous  dairies 
scattered  over  a  large  area  and  involved,  in  some  herds,  as  man}- 
as  10%  to  15%  of  the  cows. 

In  these  cases,  the  disease  appeared  more  or  less  suddenly  and 
the  animal  would  be  found  lying  down  unable  to  rise.  Perhaps 
at  first  she  would  be  able  to  stand,  upon  being  assisted  to  her 
feet.  This  condition  might  continue  for  days  or  weeks,  until 
finally  she  would  go  down  and  be  unable  to  rise,  even  with  assist- 
ance. The  disease  generally  appeared  two  or  more  weeks  prior 
to  the  average  end  of  gestation  and  continued  until  after  parturi- 
tion, unless  the  animal  were  previously  destroyed  or  succumbed 
to  the  affection  or  to  some  intercurrent  complication.  The  ani- 
mal was  bright,  lay  upon  the  sternum  with  the  head  erect  and 
appeared  at  first  quite  normal.  The  temperature  was  normal, 
the  muzzle  moist,  the  pulse  and  respirations  unchanged.  The 
bowels  were  normal  or  possibly  suffered  some  degree  of  torpid- 
ity, as  would  be  naturally  expected  in  an  animal  in  the  recum- 
bent position.  The  appetite  was  good.  The  fetus  was  alive  and 
apparently  normal. 


432  Veterinary  Obstetrics 

The  occurrence  of  this  malady  could  not  be  traced  to  any  defi- 
nite cause.  The  cows  which  were  affected  were  in  the  stable, 
since  the  disease  occurred  during  the  latter  half  of  the  winter. 
As  the  food  upon  which  they  subsisted  varied  in  the  different 
dairies,  nothing  definite  as  to  cause  could  be  determined  in  this 
way.  The  grain  upon  which  the  animals  were  fed  was  mostly 
imported  from  the  western  states  and  consisted  largely  of  bran, 
corn  meal  and  brewer's  grains  or  sprouts.  The  hay  was  grown 
locally  by  the  farmers,  and  had  been  generally  damaged  during 
the  haying  season  because  of  wet  weather,  so  that  most  of  it 
was  of  an  inferior  quality  and  more  or  less  discolored  and 
mouldy,  but  it  was  not  pre-eminently  bad.  The  cows  were  not 
in  good  condition.  They  were  not  extremely  emaciated  and 
had  not  been  starved  so  far  as  quantit}'  of  food  was  concerned, 
but  had  been  fed  somewhat  liberally.  Yet  they  were  thin  in  flesh 
and  seemed  to  be  weak  and  wanting  in  vigor.  This  condition 
applied  alike  to  the  pregnant  and  non-pregnant  animals.  The 
damaged  hay  seemed  the  most  probable  cause  of  the  disease. 

Saint-Cyr  records  similar  occurrences.  Though  he  thinks  it 
would  be  improper  to  speak  of  them  as  epizootic,  yet  they  oc- 
curred quite  frequently  during  certain  years  and  in  given  herds. 

The  disease  usually  persists,  should  the  animal  survive,  until 
parturition,  after  which  it  generally  disappears.  The  tendency 
for  it  to  disappear  after  parturition  seems  to  be  largely  due  to 
the  decreased  load  which  the  animal  has  to  bear  becau.se  of  the 
expulsion  of  the  fetus  and  its  annexes  and  the  decreased  drain, 
upon  the  maternal  system  when  freed  from  the  nutritive  demands- 
of  the  fetus.  In  the  diagnosis  of  paraplegia  we  must  carefully 
distinguish  it  from  other  maladies  causing  similar  symptoms. 
We  have  already  stated  that  paraplegia  may  be  due  to  some  acci- 
dent, such  as  a  strain  or  other  injury  to  the  limbs  or  spine.  The 
po.ssibility  or  probability  of  such  injury  should  be  excluded  as- 
far  as  po.ssible. 

We  have  already  related  that  osteomalacic  may  induce  symp- 
toms of  paraplegia.  It  is  not  readily  diagnosed  clinically  from 
the  affection  under  consideration.  They  are  much  alike  in 
causes  so  far  as  known.  If  a  fracture  or  lameness  occurs  with- 
out  warrant   it    may  be  very  suggestive  of  csteomalacie. 

We  should  carefully  differentiate  paraplegia  from  dropsy  of 
the  amnion,  in  which  the  collection  of  the   fetal   fluids  may  be 


Paraplegia  433 

so  great  that  the  animal  is    unable    to    rise  when    down    simply 
because  of  the  enormous  weight. 

Paraplegia  is  also  to  be  distinguished  from  parturient  paresis, 
or  "milk  fever,"  which  in  rare  cases  appears  during  pregnancy, 
instead  of  after.  The  differentiation  between  the  two  is  not  verj'^ 
eas5",  since  in  a  mild  form  of  parturient  paresis  the  animal  may 
look  bright.  Parturient  paresis,  however,  occurs  chiefly,  in 
those  rare  cases  in  which  it  is  seen  during  pregnancy,  only  a  few 
days  prior  to  the  end  of  gestation,  and  isusualh-  accompanied  by 
a  sub-normal  temperature,  as  in  the  ordinary  paresis  after 
calving.  This  will  be  more  fully  dealt  with  under  "  Parturient 
Paresis."  Parturient  paresis  occurs  solely  in  vigorous,  well  fed 
cows,  while  paraplegia  not  due  to  accident  is  .seen  in  improperly 
nourished,  anaemic  cows. 

There  may  be  difficulty  in  differentiating  between  overfeeding 
and  paraplegia.  It  is  a  well  known  fact  that,  in  the  cow,  para- 
plegia is  a  common  symptom  of  .serious  disorder  and  that  we 
have  more  or  less  complete  paraplegia,  paralysis  and  coma  fol- 
lowing overeating  and  the  decomposition  of  food  in  the  rumen. 
The  history  of  the  overfeeding  should  of  itself  usualU'  serve  to 
distinguish  between  the  two  maladies.  However,  the  treatment 
is  largely  alike. 

The  prognosis  is  variable.  Paraplegia  due  to  the  various 
accidents  enumerated  is  curable  in  .so  far  as  the  causes  and  effects 
are  removable. 

In  the  enzootic  outbreaks  of  paraplegia  observed  by  us,  the 
results  have  not  proven  satisfactory.  The  forced  decubitis  was 
not  readily  removed  during  pregnancy  and  the  long  wait  until 
the  advent  of  parturition  led  too  often  to  fatal  results.  Our 
mortality  has  been  high,  perhaps  largely  because  our  patients 
were  too  distant  and  our  handling,  consequently,  wanting  in 
proper  oversight. 

Parturition,  by  removing  the  mechanical  weight  of  the  fetus 
and  its  annexes,  perhaps  at  times  including  some  degree  of 
hydrops  of  the  amnion  and  allantois,  exerts  a  favorable  influence 
upon  the  course  of  the  di.sease.  Parturition  also  favors  recovery 
by  relieving  the  mother  from  the  nutritive  demands  of  the  fetus. 
The  earlier  parturition  occurs  after  the  advent  of  the  disease, 
the  more  favorable  the  outlook  for  the  patient. 
28 


434  Veterinary  Obstetrics 

The  treatment  of  paraplegia  of  pregnancy  should  be  directed 
toward  the  securing  of  the  best  possible  environment  for  the 
patient  and  providing  abundant  nutritious  food.  The  animal 
should  be  given  a  comfortable,  well  bedded  dry  stall  where  it  can 
not  slip  when  attempting  to  rise. 

In  all  cases,  an  intelligent  effort  is  to  be  made  to  relieve  the 
patient  of  superfluous  weight.  Bulky  innutritions  food  should 
be  withdrawn  and  the  alimentary  tract  relieved  from  any  exist- 
ing overload.  This  may  be  partly  accomplished  by  means  of 
laxative  foods,  such  as  roots  and  bran  with  an  extra  allowance 
of  salt.  But  in  decubitis  there  is  a  constant  tendency  to  digestive 
torpidity,  which  should  be  combatted.  Strychnine  given  hypo- 
dermically  in  doses  of  one  half  to  one  grain,  repeated  three 
times  a  day,  answers  splendidly  for  an  average-sized  cow.  Not 
only  does  it  overcome  the  intestinal  torpidit}',  but  at  the  same 
time  affords  a  most  effective  tonic.  It  may,  with  great  advan- 
tage, be  combined  with  moderate  doses  of  eserine  or  arecoline 
until  the  alimentary  tract  has  been  satisfactorily  unloaded. 
This  is  preferable  to  alkaline  purgatives  and  oils,  being  safer  to 
administer,  more  prompt  and  efficient  in  action  and  probably  less 
dangerous  to  the  life  of  the  fetus. 

Enemas,  advised  b}-  Fleming  and  others,  are  of  little  use  in 
ruminants,  the  principal  point  for  our  attack  being  the  gastric 
apparatus,  with  loo  or  more  feet  of  intestine  intervening. 

Our  attitude  toward  the  existing  pregnancy  is  to  be  carefully 
considered.  Whatever  thecau.se  of  the  paraplegia,  the  presence 
of  the  fetus,  fetal  fluids  and  membranes  intensifies  the  malady 
by  the  mechanical  weight.  The  nutritive  demands  of  the  fetus 
upon  the  mother  add  to  the  gravity  of  the  case,  especially  when 
we  recall  the  fact  that  the  digestive  and  nutritive  powers  of  the 
animal  are  much  depressed  by  the  recumbency. 

Shall  we  hasten  parturition  ?  Our  answer  should  be  based 
upon  a  thorough  consideration  of  all  the  surroundings.  If  it 
appears  safe  to  await  normal  parturition,  this  should  be  done. 
If  the  case  is  progressing  unsatisfactorily  and  much  time  must 
yet  elapse  before  parturition  is  to  be  regularly  expected,  pre- 
mature birth  should  be  induced.  In  some  cases  this  has  yielded 
us  good  results  where,  otherwise,  a  fatal  termination  appeared 
to  be  the  only  pro.spect. 


Amaurosis  435 

The  premature  evacuation  of  the  uterus  having  been  deter- 
mined upon,  the  obstetrist,  under  all  due  aseptic  precautions,  is 
to  carefully  and  gradually  dilate  the  cervical  canal,  rupture  the 
fetal  membranes,  cause  the  fetal  fluids  to  escape,  secure  the 
fetus,  arrange  the  presenting  parts  in  the  proper  position,  and, 
exerting  sufficient  traction  upon  the  presenting  parts,  gradually 
cause  the  needed  dilation  of  the  cervical  canal  and  complete  the 
extraction  of  the  fetus.  The  process  should  not  be  hastened, 
but  as  gently  accomplished  as  is  possible.  In  our  experience, 
the  operation  in  the  cow  requires  for  its  proper  performance 
three  to  five  hours. 

When  begun,  the  delivery  should  be  completed  without  au}^ 
intermission  of  effort.  Should  the  cervix  be  dilated  and  the 
membranes  ruptured,  in  the  weakened  condition  of  the  uterus, 
infection  of  the  membranes,  death  and  decomposition  of  the 
fetus,  metritis  and  sepsis  of  the  mother  are  extremely  liable  to 
follow. 

The  fetus  removed,  the  uterine  cavity,  or  rather  the  cavity  of 
the  fetal  membranes,  should  be  flushed  out  with  tepid  water  in 
order  to  remove  blood  coagula  and  fetal  fluids.  A  small  amount 
of  carbolic  acid  or  other  antiseptic  may  be  added  to  the  uterine 
douche. 

The  fetal  membranes  are  to  be  allowed  to  remain  in  the  uterus 
for  18  to  24  hours,  when  thej'  are  to  be  mechanically  removed, 
if  practicable,  followed  b\'  antiseptic  douching  of  the  uterine 
cavity.  If  the  membranes  are  inseparable  except  by  lacerating 
the  maternal  placenta,  their  removal  should  be  further  delayed 
and  their  putrefaction  prevented  or  ameliorated  by  the  frequent 
introduction  into  the  uterus  of  large  volumes  of  tepid  water,  to 
which  a  little  carbolic  acid  has  been  added.  The  introduction 
of  the  tepid  fluid  not  only  keeps  the  organ  cleansed  but  also 
favors  its  involution  and  the  expulsion  of  the  retained  membranes. 

Amaurosis. 

Fleming  quotes  Riss  ( Recueil  de  Med.  Veterinaire,  1831), 
who  observed  two  cases  of  amaurosis  in  pregnant  mares,  which 
appeared  late  in  gestation  and  disappeared  promptly  after 
parturition.  We  have  observed  one  instance  of  amaurosis 
appearing  in  a  mare  late  in  gestation,  but  the  disease  remained 
permanent   after  parturition.      In    case  the  disease  was  proba- 


436  Vcteri7iary  Obstetrics 

bly  a  result  of  periodic  opthalmia  and   had  but  remote,  if  any, 
relation  to  pregnancy. 

St.  Cyr  and  other  authors  refer  to  the  rare  occurrence  during 
pregnancy,  of  eclampsia  (especially  in  bitches),  parturient 
paresis  and  mammitis.  They  have  little  special  significance  and 
will  be  considered  later,  when  dealing  with  those  maladies,  occur- 
ring post-partum. 

Rupture  of  the  Prepubian  Tendon. 
Edema  of  the  Abdominal  Floor. 

Writers  on  veterinary  surgery  and  obstetrics  generally  include 
rupture  of  the  prepubian  tendon  among  the  ventral  hernise, 
without  directing  special  attention  to  this  characteristic  and 
very  serious  lesion  with  its  premonitory-  symptoms. 

The  eventual  lesion  consists  of  a  transverse  rupture  of  the 
prepubian  tendon,  immediately  in  front  of  the  pubis,  between 
the  two  abdominal  rings.  Both  of  these  rings  are  usually  in- 
volved and,  when  the  rupture  becomes  complete,  obliterated,  all 
tissues  between  the  two  openings  being  torn  asunder. 

The  disease  or  accident  is  practicalh-  confined  to  the  mare  ;  we 
have  seen  one  instance  in  the  cow,  and  have  found  no  record  of 
its  occurrence  in  other  animals. 

So  far  as  known,  the  rupture  takes  place  only  in  advanced 
pregnancy,  rarely  prior  to  the  clo.se  of  the  tenth,  usually  during 
or  after  the  completion  of  the  eleventh  month. 

The  causes,  so  far  as  determined,  are  : 

1.  The  increased  strain  upon  the  abdominal  floor  caused  by 
the  presence  of  the  gravid  uterus,  which  represents  at  the  close 
of  pregnancy  probably  30  to  40  per  cent  of  the  total  weight  of 
the  abdominal  contents. 

2.  Degenerative  changes  in  the  tissues  of  the  abdominal  floor, 
including  the  prepubian  tendon,  closely  associated  with  profuse 
edema  of  this  region. 

3.  Very  rarely  there  is  a  definite  history  of  violence.  In  one 
instance  ob.served  by  the  author,  a  mare,  becoming  mired  in  deep 
mud  with  her  hind-feet,  over-exerted  herself  in  gaining  the  bank 
of  the  stream,  thus  pulling  the  hind  limbs  forcibly  backwards, 
and  with  them  the  pubis,   causing  its  chief  anterior  stay,    the 


Rjipture  of  the  Prepiibian    Tendon  437 

prepubian  tendon,  to  give  way.  No  edema  or  other  evidence  of 
disease  preceded  the  accident. 

Almost  always  there  can  be  no  reasonable  presumption  of 
accident,  the  rupture  being  what  we  may  designate  as  spontane- 
ous and  usually  comparatively  gradual,  frequently  being  pre- 
ceded for  days  or  weeks  by  premonitory  warnings. 

The  disease  may  be  more  common  in  draft  mares  than  in  those 
of  lighter  breed,  but,  as  our  experience  has  been  largely  with 
the  former  class,  the  grounds  for  comparison  are  not  conclusive. 
We  have  observed  the  lesion  most  frequently  in  idle  mares  which 
were  well  fed. 

The  first  symptom  noticed  is  an  extensive  edema  of  the  ab- 
dominal floor,  beginning  just  in  front  of  the  mammary  gland  and 
extending  thence  forward  and  backward  until  it  reaches  from  the 
anterior  pectorial  region  to  the  perineum,  covering  the  entire 
floor  of  the  body  for  a  depth  of  2  to  4  inches.  The  edema  pre- 
sents the  usual  clinical  characters,  except  that  it  is  possibly 
somewhat  firmer  than  generally  .seen  and  somewhat  more  inclined 
to  be  painful  to  the  touch. 

The  exact  relationship  of  the  edema  to  the  rupture  of  the 
tendon  is  undetermined,  our  observation  leading  us  to  believe 
that  the  former  is  an  expression  of  serious  degenerative  changes 
which  are  taking  place  in  the  deeper  parts.  The  edema  appar- 
ently involves  the  tendon  itself  from  the  first  and  diminishes  its 
resisting  powers  by  forcing  the  fibers  apart,  as  well  as  weakening 
them  directly. 

The  movements  of  the  patient  soon  become  restricted  to  such 
locomotion  as  is  essential,  and  this  is  marked  by  care  and  delib- 
eration. The  restriction  of  movement  may  be  partly  due  to  the 
mechanical  impediment  of  the  edema,  but  it  appears  rather  to 
result  from  pain  and  a  premonition  of  injury. 

This  restriction  of  motion  generally  precedes  the  rupture  of  the 
tendon  and  is  increased  as  the  rupture  extends. 

Should  the  tendon  remain  intact  until  relieved  of  its  excessive 
load  through  parturition,  the  edema  quickly  disappears  and  the 
parts  become  normal,  but  in  many  cases  the  tendon  gives  way 
before  the  foal  is  born.  The  mare  then  succumbs  or,  recovering, 
is  ruined  in  value.     The  foal  generally  perishes. 

When  the  tendon  begins  to  part  between  the  two  abdominal 
rings,  characteristic  symptoms  arise  which  serve  to  distinguish 


438  Veterhiary  Obstetrics 

it  from  other  lesions.  The  spinal  column  of  the  horse  forms  an 
arch  from  the  first  dorsal  vertebra  to  the  sacrum.  This  arch  is 
chiefly  maintained  by  the  linea  alba,  originating  from  the  sternum 
in  front  and  ending  behind  on  the  pubis,  as  the  prepubian  tendon, 
thus  acting  as  a  powerful  tie.  If  the  prepubian  tendon  parts  at 
the  abdominal  rings,  the  arch  of  the  spine  can  be  no  longer  com- 
pletely maintained  and  the  back  drops  downwards,  as  is  shown 
at  C  in  Fig.  82,  producing  lordosis,  or  "  sway  back."  while  the 
pubis  becomes  displaced  backwards.  This  causes  the  external 
ilial  tuberosity  to  descend  and  the  ischial  tuberosity  to  become 
displaced  upwards,  decreasing  the  slant  of  the  hip,  as  we  have 
intimated  at  B  in  Fig.  82,  in  contrast  to  the  normal  slant  at  A. 

The  rupture  of  the  tissues  between  the  abdominal  rings  oblit- 
erates these  and  relaxes  the  fixation  of  the  mammae  in  them. 
The  abdominal  tunic  also  becomes  ruptured  on  the  same  level, 
the  skin  becomes  greatly  stretched,  the  milk  glands  are  displaced 
downwards  and  forwards,  as  indicated  by  the  position  of  the  teat 
atT  in  Figs.  82,  83,  84  and  85,  and  the  glands  become  less  con- 
spicuous because  of  the  compression  from  the  stretching  of  their 
capsule  derived  from  the  ruptured  abdominal  tunic. 

In  Figs.  82-84,  the  displacement  is  comparatively  mild.  In 
some  cases  it  is  much  greater,  as  shown  in  Fig.  85,  from  St.  Cyr. 
No  other  form  of  rupture  could  cause  such  displacement  of  the 
mammary  gland,  as  it  is  firmly  fixed  to  the  abdominal  ring  so 
long  as  that  remains  intact. 

The  umbilicus  is  also  necessarily  displaced  forwards  and  down- 
wards, as  shown  at  U  in  Figs.  83  and  84.  The  rupture  having 
involved  the  entire  prepubian  tendon,  and  the  abdominal  tunic 
having  given  way,  the  rent  may  extend  on  either  side  outwardly 
from  the  external  side  of  the  abdominal  ring  until  it  includes  the 
entire  abdominal  floor.  Through  this  great  rent,  the  gravid 
uterus  and  other  viscera  drop  down  upon  the  skin  and  skin 
muscles  and,  pushing  the  abdominal  tunic  and  musculo-tendinous 
portions  of  the  abdominal  floor  forwards,  bear  the  skin  and  skin 
muscle  downward  until  the  hernial  sac  may  reach  the  tarsus  or 
even  lower.  Early  in  the  progress  of  the  lesion,  firm  upward 
pressure  with  the  hand,  in  the  premammary  region,  discloses  a 
tense  hernial  touch  without  a  distinct  boundary.  As  the  rupture 
progresses,  the  hernial  touch  becomes  more  pronounced. 

The  downward  displacement  of  the  abdominal  viscera,   with 


Rupture  of  the  Prcpubian    Tendon 


439 


the  backward  displacement  of  the  pubis,  causes  the  flanks  to 
sink  in  and  greatly  reduces  the  transverse  diameter  of  the  body 
at  this  point. 

The  skin  and  skin  muscle  tend,  by  their  elasticity,  to  check  or 
stop  the  progress  of  the  rupture,  in  which  they  are  aided  some- 
what by  the  resistance  of  the  uterine  ligaments  and  the  mes- 
entery, which  aid  in  supporting  the  visceral  weight  when  the 
organs  have  become  displaced  downwards.  In  some  cases  in 
our  practice,  the  skin  and  its  muscle  did  not  suffice  to  stay  the 
progress  of  the  rupture,  but  gave  way,  causing  eventration  and 
necessitating  immediate  destruction  of  the  patient. 


Fig.  82.    Rupture  of  thk  Prepuhi.\n  Tkndon  in  the  Pregnant  Mare- 
A,  Acquired  .slant  of  hip.     B,  Estimated  normal  slant  of  hip. 
C,  Estimated  normal  spinal  line.     T,  Teat  displaced  downwards 
and  forwards. 


440  Veterinary  Obstetrics 

In  those  very  rare  instances  where  violence  has  played  an 
essential  part  in  causing  the  rupture,  there  need  be  no  pre- 
monitory edema.  The  symptoms  appear  very  suddenly  :  the 
tumor  is  large,  the  pain  intense,  the  expression  anxious,  the 
body  bedewed  with  cold  sweat,  the  respiration  hurried,  the  pulse 


J 

V. 

TA 

// 

^U 

f 

C 

c 

■ 

-  i 

■     > 

X 

/ 
/> 

Fig.  83.     Rupture  of  the  Pre-pubian  Tendon  in  the  Pregnant  Mare. 
Dissected  abdominal  floor  of  Fig.  82. 

TA,  Abdominal  tunic,  showing  ruptured  margin  displaced  forwards. 

M,  Transversalis  muscle,  the  abdominal  tunic  removed,  showing  pos- 
teriorly the  ragged  margin  at  point  of  rupture. 

CC,  Sclerotic  connective  or  cicatricial  tissue  constituting,  with  the 
skin,  the  posterior  portion  of  the  floor  of  the  hernial  sac. 

T,  Teats  displaced  forwards.     U,  Umbilicus. 


Rupture  of  the  Prepubian    Tendon 


441 


rapid  and  weak  and  the  patient   tends   to  quickly  collapse  from 
shock  or  hemorrhage. 


Fig.  84.     RiPTURE  OF  the  Prepubi.\n  Tendon  in  the  Pregnant  Mare. 
Sagittal  or  median  section  of  abdominal  floor,  from  Fig.  82. 

I,  Section  extending  through  pelvis  and  sternum. 
II,  Detail  of  anterior  portion. 
Ill,  Detail  of  posterior  portion. 
P,P,  Peritoneum.     E,  Extent  of  rupture  in  the  abdominal  floor. 
A, A,  Sub-peritoneal  fat,  occupying  entire  area  except  that  comprised 

in  E,  where  peritoneum  is  absent  as  a  result  of  the  rupture. 
C,  Curled  connective  tissue,  the  pelvic  remnants  of  the  pre-pubian  ten- 
don, posterior  to  the  point  of  rupture. 
C,  Cicatrical  tissue  occupying  the  space  between  the  ruptured  ends  of 

the  pre-pubian  tendon,  devoid  of  peritoneum  and  adipose  tissue. 
T,  Displaced  teat.     U,  Umbilicus  displaced  forwards. 
F,  Skin  and  skin  muscle.     TA.  Abdominal  tunic. 
M,  Transversalis  muscle.     St,  Sternum. 


442 


Veterinary  Obstetrics 


The  character  and  extent  of  the  lesions,  with  the  repara- 
tive efforts  in  a  surviving  case,  are  well  shown  in  F'igs.  83  and 
84,  in  which  it  is  seen  that  the  peritoneum,  prepubian  tendon 
and  abdominal  tunic  have  all  parted  just  anterior  to  the  pubis 
and  passed  forward  about  half  way  to  the  sternum,  dragging 
with  them,  for  a  part  of  the  way,  the  teats.  Posterior  to  these 
and  occupying  the  area  previously  filled  by  them,  is  an  extensive 
expansion  of  dense  connective  tissues,  C,  which  has  assumed  the 
functions  of  the  ruptured  parts. 

In  Fig.  84  it  is  shown  that  the  subperitoneal  fat.  A,  does  not 
invade  the  ruptured  area,  E,  but  seems  to  depend  for  its  forma- 
tion upon  the  presence  of  the  peritoneum. 

The  prognosis  of  complete  rupture  of  the  prepubian  tendon 
is  very  grave,  since  most  mares,  along  with  their  foals,  perish 
before  the  conclusion  of  the  pregnancy-  during  which  the  rupture 
occurs. 


Fig.  85.     Rupture  or  Pre-pubi.\n  Tendox.     Mare. 
A,B,  Hernial  sac.    C,  Teat  displaced  downward  and  forward.     (St.  Cyr. ) 

If  the  parturition,  following  the  pregnancy  during  which   the 
is  safely  passed,   the  animal  may   thereafter 


il  me  pariuruion,  loiiowing  tne  pregn 
accident  occurred,  is  safely  passed,   the 


Rupture  of  the  Prepubian    Tendon.  443 

breed  without  danger  or  difEcult3^  but  is  so  unsightly  that  her 
value  for  this  purpose  is  seriously  diminished.  She  may  do 
ordinary  slow  work,  but  here  the  unsightliness  becomes  still  more 
serious  and  few  persons  are  willing  to  use  such  an  animal. 

The  foal  in  the  uterus  at  the  time  of  the  rupture  usually 
perishes,  but,  if  the  mare  survive,  succeeding  foals  may  be  born 
with  the  same  safety  as  though  the  lesion  did  not  exist. 

When  a  threatened  or  beginning  rupture  is  promptly  recognized, 
and  appropriate  measures  for  prevention  or  relief  applied,  the 
prognosis  is  highly  favorable. 

The  advice  of  Fleming,  that  extensive  edema  of  the  abdominal 
floor  in  pregnant  mares  is  unimportant  and  may  be  .safely  ignored 
and  that  the  disease  will  quickly  disappear  after  parturition 
with  little  or  no  attention,  has  led,  when  followed,  to  serious 
disaster  in  our  hands. 

Edema  in  advanced  pregnancy  in  the  mare  is  a  serious 
condition,  which  calls  for  prompt  and  energetic  handling. 
It  should  always  be  regarded  as  a  precursor  of  rupture  of  the 
prepubian  tendon.  If  left  without  attention,  many  of  the  mares 
will  succumb  from  rupture  ;  if  proper  attention  is  rendered  the 
danger  will  be  almost  wholly  averted. 

Treatment.  In  the  handling  of  threatened  rupture  of  the 
prepubian  tendon,  mechanical  support  of  the  greatly  overloaded 
and  weakened  abdominal  floor  should  receive  our  first  considera- 
tion. Whenever  extensive  edema  occurs  along  the  floor  of  the 
abdomen  in  a  mare  far  advanced  in  pregnancy,  unless  the  condi- 
tion is  clearly  referable  to  unimportant  causes,  we  urgently  advise 
the  immediate  application  of  an  abdominal  bandage  of  canvass  or 
other  strong  material.  The  bandage  should  be  constructed  with 
8  or  ID  strong  buckles  and  billets  and  fitted  to  the  oval  form  of 
the  abdomen  by  means  of  a  gore  placed  in  the  center  of  the  canvas. 
We  do  not  at  all  times  have  the  required  time  for  properly  con- 
structing the  bandage,  and,  in  order  to  avert  immediately  threat- 
ening disaster,  an  emergency,  many-tailed  bandage  should  be 
quickly  applied.  In  order  to  adapt  this  to  the  oval  form  of  the 
abdomen,  the  tails  should  be  cros.sed  so  that  the  most  posterior 
of  one  group  of  tails  shall  be  tied  to  one  of  the  most  anterior  of 
the  other  end,  and  the  remaining  tails  united  upon  a  .similar 
plan.  The  spine  and  the  point  where  the  ends  of  the  bandages 
are  tied  should  be  amply  padded  to  avoid  pressure-necrosis  of  the 


444  Veterinary  Obstetrics 

skin  from  the  buckles  or  knots,  and  should  be  carefully  read- 
justed daily  c>r  as  often  as  conditions  may  dictate. 

In  applying  the  emergency  bandage  to  cases  where  the  tendon 
has  already  parted  or  its  rupture  seems  very  imminent,  it  is  im- 
portant to  get  it  quite  tight.  In  order  to  facilitate  this,  it  is  best 
to  tie  a  .solid  loop  in  each  upper  tail,  that  is,  in  each  tail  of  the 
bandage  which  passes  over  the  back,  through  which  each  lower 
tail  may  run  as  through  a  pulley.  The  bandage  cannot  be  properly 
tightened  at  the  first  effort.  One  after  another  of  the  tails  is  to 
be  tightened  as  well  as  convenient  at  the  first  tying.  As  soon  as 
all  are  fa.stened,  go  back  to  the  first  ones  and  tie  them  over  again 
and  continue  the  process  until  the  desired  support  is  secured,  and 
the  great  weight  of  the  viscera  lifted  from  the  abdominal  floor 
and  largely  transferred  to  the  spine  through  the  bandage. 

The  decrease  in  the  weight  of  the  abdominal  viscera  is  also  of 
very  great  importance.  We  should  les.sen  the  weight  of  the 
digestive  viscera  by  withdrawing  all  bulky  food  and  replacing  it 
with  limited  quantities  of  concentrated  aliment.  We  might 
hurry  the  unloading  of  the  intestinal  tract  by  the  aid  of  small 
doses  of  eserine  sulphate,  or  arecoline,  such  as  half-grain  doses 
every  half  hour,  until  the  desired  effect  has  been  induced. 

If  the  tendon  has  parted,  the  induction  of  premature  labor 
should  receive  careful  consideration. 

As  a  rule,  the  foal  perishes  unless  aid  is  given.  Even  under 
close  watching,  the  uterine  contractions  go  on  unobserved  and 
cause  the  death  of  the  foal  through  separation  of  the  placenta 
before  adequate  expulsive  force  is  brought  into  play.  Most  of 
the  expulsive  power  is  destroyed  when  the  abdominal  floor  gives 
way,  leaving  the  uterus  alone  to  expel  the  fetus.  It  therefore 
seems  desirable  to  anticipate  this  danger  to  the  fetus  by  bringing 
about  artificial  delivery  not  later  than  the  completion  of  the 
eleventh  month,  in  a  way  to  best  safeguard  the  life  of  the  fetus. 
The  premature  delivery  is  best  effected  by  carefully  dilating  the 
OS  uteri  with  the  hand  ;  grasping  and,  if  necessary,  cording  the 
fetal  parts  presenting,  and  applying  moderate  traction  to  com- 
pensate for  the  lost  expulsive  power  of  the  abdominal  muscles. 
It  is  to  be  remembered  that  it  is  best  to  have  the  patient  in  lateral 
recumbency  during  delivery,  since  this  raises  the  fetus  approxi- 
mately to  a  level  with  the  pelvic  inlet.     When  the  mare  is  in  the 


Herjiia  of  the   Uterus  445 

standing  position  the  fetus  drops  down  below  the  pelvis,  through 
the  immense  rupture,  and  rests  upon  inert  parts. 

If  premature  delivery  is  not  decided  upon,  the  mare  should  be 
closely  watched  and  prompt  aid  should  be  given  at  the  first  signs 
of  labor. 

After  delivery,  the  bandage  may  be  removed  at  once  and  the 
case  dismissed  if  the  tendon  has  not  ruptured  ;  if  it  has  ruptured, 
the  bandage  should  be  readjusted  and  retained  until  such  time 
as  the  ruptured  tissues  have  healed  and  the  weakened  abdominal 
floor  has  been  reenforced  by  the  new  formation  of  connective 
tissue,  as  indicated  at  C,  in  Fig.  84. 

The  mare  may  be  retained  until  the  foal  is  ready  to  wean, 
and  then  destroyed  ;  she  may  be  kept  permanently  as  a  brood 
mare,  with  reasonable  assurance  that  thereafter  she  will  foal  un- 
aided ;  or  she  may  be  used  at  moderate  work  without  discomfort. 

In  the  very  severe  cases,  where  the  skin  and  skin  muscles  are 
giving  way  so  that  eventration  is  imminent,  or  where  accompanied 
by  shock  and  serious  internal  hemorrhages,  the  mare  should  be 
promptly  destroyed,  after  performing  Caesarian  section  if  it  is 
desired  to  save  the  foal. 

Hernia  of  the  Uterus  or  Hysterocele. 

As  Hernia  of  the  Uterus,  we  describe  a  condition  of  varying 
significance,  due  to  any  cause,  except  rupture  of  the  prepubian 
tendon  which  we  have  already  described  in  the  preceding  chapter, 
by  which  a  portion  or  all  of  the  gravid  uterus  escapes  through 
the  muscular  walls  of  the  abdomen.  This  accident  or  condition 
may  occur  in  any  of  the  domestic  animals  and  at  any  point  of  the 
abdominal  floor.  Any  ventral  hernia  may  become  occupied  by  a 
portion  of  the  gravid  uterus  in  any  of  those  animals  where  the 
non-gravid  organ  is  of  sufficient  length  to  drop  into  the  opening 
so  that  impregnation  may  occur  in  the  herniated  organ.  The 
hernia  may  also  occur  later,  when  the  gravid  organ  is  borne  down 
by  the  weight  of  its  contents.  If  the  .hernial  ring  is  suffi- 
ciently large  to  allow  the  escape  of  a  fetus  or  fetuses  through  it, 
the  gravid  uterus  drops  into  the  hernial  sac.  The  causes  are  the 
same  as  those  of  other  herniae,  and  have  no  special  relation  to  ob- 
stetrics except  that  the  fetus  passes  through  the  hernial  ring, 
becomes  developed  within  the  hernial  sac  and  offers  obstacles  to 
birth. 


446  Veterhiary  Obstetrics 

The  hernia  may  be  due  to  traumatism,  or  to  a  congenital  defect 
in  the  abdominal  wall,  either  at  the  umbilicus  or  the  inguinal 
ring.  Sometimes,  in  the  development  of  the  fetus,  the  umbilical 
ring  remains  so  large  that  the  abdominal  viscera  permanently 
protrude  through  it,  against  the  skin.  Such  an  animal,  when 
grown,  if  permitted  to  become  pregnant,  and  the  hernial  ring  is 
very  large,  is  liable  to  uterine  hernia  and  the  fetus  or  fetuses 
may  develop  in  the  hernial  sac.  Herniae  of  such  dimensions  are 
rare  in  our  larger  domestic  animals,  but  umbilic  herniae  are  occa- 
sionally met  with,  in  the  mare,  of  such  size  that,  were  she  allowed 
to  go  without  treatment  and  be  bred,  a  uterine  hernia  would  in- 
evitably result. 

In  some  animals,  especially  in  the  bitch  and  sow,  the  ovary 
and  uterine  cornua  pass  from  their  ordinary  position  through  the 
inguinal  ring  and  reach  the  location  of  the  testicle  in  the  adult 
male,  in  the  perineal  region.  As  a  consequence,  in  case  of  preg- 
nancy, the  young  may  develop  in  this  herniated  portion  of  the 
uterus,  outside  the  abdominal  cavity. 

The  diagnosis  of  uterine  hernia  is  comparatively  easy.  The 
fetus  or  fetuses  are  so  superficially  .situated  that  they  may  be 
recognized  by  palpation.  Sometimes  the  tumor  is  not  reducible 
because  the  fetus  has  become  larger  than  the  hernial  ring  and 
consequently  cannot  be  returned  into  the  abdomen  by  pressure. 

The  significance  of  these  hernise  will  vary  greatly  according  to 
conditions.  If  occurring  as  the  result  of  a  recent  accident,  when 
no  hernial  ring  or  sac  has  become  established,  the  hernia  tends 
to  enlarge  rapidly  because  of  the  presence  in  it  of  the  gravid 
uterus  and  other  viscera.  In  any  hernia  with  a  well  established 
ring  and  sac,  into  which  the  gravid  uterus  enters,  the  tendency 
is  for  the  sac  to  continue  to  grow,  but  for  the  ring  to  remain  un- 
disturbed. They  have  little  risk  generally  for  the  life  of  the 
mother  until  parturition  comes  on,  when  they  may  become  a 
serious  menace  to  the  lives  of  both  mother  and  fetus.  If  the  fetus 
should  be  of  too  great  size  to  readily  pass  through  the  hernial 
ring  or  if  there  be  an  extensive  hernia  of  recent  date  which  has 
destroyed  the  expulsive  powers  of  the  abdominal  walls,  active 
obstetric  interference  may  be  demanded  in  order  to  save  the  lives 
of  parent  and  offspring. 

It  is  inadvisable,  as  a  rule,  to  attempt  to  breed  animals  which 
have  hernise  of  such  a  character  that  it  is  probable  that  a  fetus  or 


Rupture  of  the  Gravid  Uteriis.  447 

fetuses  may  find  lodgement  therein.  When  a  ventral  hernia 
occurs  during  pregnancy,  the  parts  should  be  immediately  and 
carefully  supported  by  a  wide  bandage  so  as  to  prevent  the  ex- 
tension of  the  newly- formed  rupture.  Females  having  congen- 
ital hernia  at  the  umbilicus  or  inguinal  ring  should  not  be  bred 
for  zootechnic  reasons,  as  well  as  because  of  the  probability  of 
obstetric  difficulty. 

When  such  animals  have  been  bred,  however,  and  the  question 
of  the  preservation  of  the  life  of  the  mother  or  fetus  arises,  we 
may  bring  about  artificial  abortion  in  behalf  of  the  life  of  the 
mother  or  may  resort  to  hysterotomy  with  a  view  to  saving  the 
life  of  the  fetus  and  perchance  of  the  mother  also. 

Rupture  of  the  Gravid  Uterus. 

Rupture  of  the  gravid  uterus  is  not  common  in  domestic 
animals,  though  doubtless  it  occurs  more  frequently  than  re- 
cognized. It  may  occur  from  a  great  variety  of  causes,  may  be 
of  any  degree  and  accompanied  or  followed  by  various  symptoms. 

On  page  58  we  have  already  alluded  to  the  record  of  the  rupture  of  the 
non-gravid  uterine  cornu  of  a  cow  during  coition.  On  page  260  we  have 
noted  a  case  where  a  veterinarian,  through  error,  ruptured  the  uterus 
in  attempting  to  dilate  the  cervical  canal  in  a  case  of  sterility.  On  page 
424  we  have  mentioned  the  possibility  of  uterine  rupture  in  dropsy  of  the 
amnion. 

On  page  417  we  have  alluded  to  those  cases  of  rupture  of  the 
gravid  uterus  in  which  the  fetus  has  escaped  more  or  less  com- 
pletel}'  from  the  uterine  body  without  causing  fatal  lesions,  the 
fetus  and  its  membranes  not  undergoing  decomposition  but  re- 
maining indefinitely  as  an  inert  body  to  constitute  a  form  of 
extra-uterine  pregnancy. 

In  a  subsequent  chapter,  "  Torsion  of  the  Uterus,"  we  shall 
have  occasion  to  speak  of  a  transverse  rupture  of  the  uterus  or 
vagina  as  a  consequence  of  the  revolving  of  the  gravid  organ 
upon  its  long  axis  to  such  an  extent  as  to  caii.se  its  tissues  to 
part,   leading  to  various  complications  of  a  very  grave  character. 

Rupture  of  the  gravid  uterus  may  occur  as  a  result  of  emphy- 
sema of  the  fetus,  which  will  be  considered  later. 

When  dealing  with  the  subject  of  dystocia  we  shall  have  occa- 
sion to  discuss  the  not  infrequent  uterine  ruptures  due  some- 
times to  mal-position  of  the  fetus,  far  more  frequently  to  errors 


448  Veterinary  Obstetrics 

on  the  part  of  incompetent  persons  while  attempting  to  overcome 
difficult  labor. 

When  labor  has  been  completed,  ruptures  of  the  uterus  may  still  occur 
through  incompetent  handling  of  retained  placenta  or  as  a  consequence  of 
prolapse  of  the  uterus. 

Since  these  various  ruptures  are  sufficiently  considered  in  their 
proper  places,  it  is  desirable  that  we  should  here  confine  ourselves 
to  the  comparatively  rare  instances  of  rupture  of  the  gravid  uterus 
not  included  in  the  other  classes  of  cases  mentioned.  We  wish, 
consequently,  to  draw  attention  here  to  those  cases  of  rupture  of 
the  gravid  uterus  not  due  to  torsion  or  to  diseases  of  the  fetus, 
uterus  or  fetal  membranes  and  occurring  independently  of  dystocia 
or  attempts  at  delivery.  Saint  Cyr  terms  these  longitudinal 
or  oblique  ruptures. 

The  causes  are  variable.  Generally,  .so  far  as  known,  such 
ruptures  are  the  result  of  impacts  of  blunt  bodies  against  the 
abdominal  floor,  such  as  the  kick  of  a  hor.se,  the  impact  of  a 
wagon  pole,  falling  upon  projecting  stones,  etc. 

The  symptoms  are  not  at  all  uniform  but  dependent  upon  the 
extent  of  the  rupture  and  other  conditions. 

The  rupture  may  be  incomplete,  the  mechanical  insult  or  other 
cau.se  serving  merely  to  induce  a  more  or  less  serious  strain  or  par- 
tial rupture  of  the  muscular  walls  of  the  organ.  Such  a  lesion 
may  result  in  appearances  of  ill-health,  possibly  slight  colic  or 
other  symptoms  leading  to  the  belief  that  some  digestive  di.sturb- 
ance  exists. 

Later  the  weakened  uterine  walls  may  give  way  either  as  a  re- 
sult of  the  weight  of  the  fetus  or  the  greatly  augmented  intra- 
uterine ten.sion  owing  to  uterine,  contractions.  Then  follow 
rapidly  symptoms  of  great  depression,  weak  pulse,  accelerated 
breathing,  cold  body  surface  with  probably  cold  sweats,  followed 
in  a  few  hours  by  death. 

If  the  fetus,  fetal  membranes,  and  liquids  are  aseptic,  the 
.symptoms  induced  are  chiefly  tho.se  of  shock  and  internal  hemor- 
rhage. If  the  uterine  contents  are  infected,  and  the.se  contents 
suddenly  escape  into  the  peritoneal  cavity,  there  follows  promptly 
the  very  grave  depre.s.sion  of  acute  peritonitis. 

External  manipulation  of  the  abdomen  may  reveal  the  fetus 
free  within  the  abdomen  and  the  fetal  fluids  outside  the  uterus 
presenting  the  appearances  of  ascites. 


Prolapse  of  the    Vagina  449 

Exploration  per  vaginam  reveals  no  data  of  value  except  the 
cervix  be  dilated  so  that  the  hand  may  be  passed  into  the  uterus, 
when  the  absence  of  the  fetus  in  the  uterine  cavity  becomes  evi- 
dent. The  membranes  have  more  or  less  completely  escaped  and 
the  rent  in  the  uterus  is  easily  recognizable. 

If  the  cervix  is  closed,  the  hand  introduced  into  the  rectum 
may  yield  all  needed  data  for  a  po.sitive  diagnosis.  The  uterine 
body,  somewhat  retracted  and  without  fetal  contents,  is  recog- 
nizable.* Outside  the  uterus,  lying  more  or  less  free  in  the  peri- 
toneal cavity,  the  fetus  may  be  detected. 

The  treatment  of  rupture  of  the  gravid  uterus  in  domestic 
animals  has  not  yet  been  made  practical.  In  most  cases  of  the 
character  here  described,  the  patient  dies  without  a  positive  diag- 
nosis having  been  reached,  and  the  actual  nature  of  the  accident 
is  only  revealed  post  mortem. 

If  recognized  during  the  life  of  the  patient  there  is  scant  basis 
for  hope  of  overcoming  it  by  surgical  means.  Caesarian  section 
is  indicated,  if  thereby  there  is  a  hope  that  the  fetus  and  its 
membranes  may  be  removed,  the  hemorrhage  from  the  ruptured 
uterine  walls  controlled  and  the  life  of  the  mother  saved.  (The 
operation  of  laparotomy  is  described  later  when  dealing  with  ob- 
stetric operations.  )  In  such  cases,  the  operation  should  include 
the  removal  of  the  fetus  and  its  membranes,  and  the  closing  of 
the  uterine  walls,  with  the  consequent  arrest  of  hemorrhage. 

Ante-partum  Prolapse  of  the  Vagina. 

Prolapse  op  the  Vaginal  Portion  of  the  Uterus. 

Prolapse,  or  eversion,  of  the  vagina  is  observed  in  the  preg- 
nant cow  and  ewe  and  more  rarely  in  other  domestic  animals. 
Fleming  attributes  the  occurrence  of  this  prolapse  during  preg- 
nancy to  a  relaxation  of  the  genital  organs,  and  claims  that  it 
occurs  mostly  in  those  animals  of  a  lymphatic  temperament 
which  are  good  milkers,  have  wide  pelves  and  are  fed  abundant- 
ly upon  bulky  food.  He  also  believes  that  cows  which  are  kept 
on  sloping  floors  are  liable  to  this  disease  and  that  injuries  of 
various  kinds  may  cause  it.  He  claims  that  it  occurs  chiefly  in 
adult  animals  which  have  previously  given  birth  to  young.  We 
have  observed  it  also  in  primiparse.  The  disease  usually  appears 
29 


450  Veterinary  Obstetrics 

during  the  later  stages  of  gestation,  sometimes  only  a  few  days 
prior  to  parturition,  while  at  other  times  it  may  precede  the 
advent  of  labor  two  to  four  weeks. 

The  actual  cause  is  not  well  known.  We  have  ob.served  it 
more  frequently  in  the  ewe  than  in  the  cow.  In  the  ewe  it 
can  not  well  depend  upon  lying  upon  a  floor  sloping  backward. 
Sheep  are  not  confined  in  stanchions  and  ordinarily  lie  upon  a 
level  floor,  so  that  there  is  no  .sloping  backward  of  the  body.  So 
far  as  we  have  observed,  the  affection  is  seen  almost  entrrely  in 
closel}'  housed  pregnant  animals.  We  have  especially  noted  the 
affection  in  ewes  which  were  being  bred  for  winter,  or  "hot 
house  "  lambs.  In  these  cases  the  ewes  are  bred  about  August 
or  September,  so  that  they  may  give  birth  to  lambs  during  mid- 
winter, which  are  fitted  for  the  early  market  when  prices  are 
high.  The  ewes  are  closely  confined  in  very  warm  stables  and 
highly  fed.  Under  the.se  conditions  we  have  found  as  high  as  5 
to  10%  of  a  herd  of  ewes  affected  with  this  malady.  So  far  as 
we  have  observed,  the  conditions  under  which  the  di.sease  arises 
in  the  cow  are  similar.  We  do  not  recall  having  .seen  a  case  of 
prolapse  of  the  vagina  in  a  pregnant  animal,  except  it  was  clo.sely 
housed  or  had  met  with  some  accident. 

The  symptoms  of  the  malady  consist  essentially  of  a  prolapse 
of  the  vagina,  which  projects  more  or  less  beyond  the  vulvar 
opening  as  a  bright,  red  tumor.  After  it  has  been  prolapsed  for 
a  period  of  time  it  becomes  swollen  and  the  mucosa  much  thick- 
ened and  ver^'-  greatly  irritated.  The  prolapsed  part  may  become 
covered  over  with  dried  blood  clots,  bedding  and  dirt  of  various 
kinds,  accompanied  by  more  or  less  suppuration.  During  the 
earlier  stages  and  in  very  mild  cases,  the  prolap.se  may  be  visible 
only  when  the  animal  is  lying  down,  and  disappear  spontaneously 
when  she  gets  up.  If  the  tumor  remains  when  the  animal  is 
standing,  and  is  pushed  back  by  the  hand,  the  vulvar  opening  is 
abnormally  large,  the  result  of  the  prolonged  stretching  of  the 
sphincter  muscles  by  the  presence  of  the  tumor. 

In  many  ca.ses  the  prolap.se  does  not  cau.se  great  inconvenience 
to  the  animal.  In  others  there  is  considerable  irritation,  with 
straining,  which  increases  the  size  of  the  tumor  and  gradually 
results  in  sj'stemic  disturbances  which  may  cause  the  animal  to 
lo.se  flesh  and  vigor  and  finally  to  succumb. 

Judging  from  our  clinical  ob.servations,  the  essential  causes  of 


Prolapse  of  the    Vagina  451 

the  disease  are  a  depression  of  the  general  vigor  of  the  animal  by 
the  close  confinement  and  overfeeding,  combined  with  a  height- 
ened intra-abdominal  pressure,  due  to  the  presence  of  the  gravid 
uterus,  intensified  hy  bulky  feeding.  These  lead  to  an  infection 
of  the  vaginal  mucosa,  which  induces  swelling  accompanied  by 
straining — a  chronic  catarrh  of  the  vagina  with  exalted  intra- 
abdominal pressure.  Sometimes  the  tumor  projects  for  a  consid- 
erable distance  beyond  the  vulva  and  the  cervix  uteri  may  even 
appear  and  protrude  beyond  the  vulvar  lips.  (Prolapse  of  the 
Vaginal  Portion  of  the  Uterus. )  In  most  cases,  especially  in  the 
ewe,  the  entire  circumference  of  the  vagina  protrudes,  as  an 
irregular,  ring-like  tumor.  In  other  cases,  especially  in  the  cow, 
only  the  floor  of  the  vagina  protrudes.  Along  with  the  vaginal 
floor  the  urinary  bladder  may  be  everted  and  protrude  beyond 
the  vulvar  lips  enclosed  within  the  vagina,  constituting  vesico- 
vaginocele.  In  this  condition,  the  urethra  is  found  close  to  the 
lower  commissure  of  the  vulva  and  its  canal  extends  upward  and 
backward  into  the  urinary  bladder,  which  now  lies  reversed,  with 
its  fundus  extending  backward. 

When  the  prolapsed  organ  attains  a  large  size  and  remains 
exposed  for  a  long  time,  it  becomes  excoriated  and  ulcerated  and 
the  mucous  membrane  vastly  thickened  so  that  it  may  be  ex- 
tremely difficult  to  bring  about  its  replacement. 

Prognosis.  Once  established,  prolapse  of  the  vagina  in  preg- 
nant animals  persists  until  parturition  is  completed,  unless  over- 
come by  proper  handling.  There  is  no  visible  tendency  toward 
spontaneous  recovery.  On  the  contrary,  the  malady  tends  to 
become  aggravated  with  time. 

The  protruding  organ  comes  in  contact  with  bedding,  manure 
and  other  infecting  and  irritating  objects.  Occasionally  it  is 
rubbed  against  the  walls  of  the  building  or  other  objects,  causing 
laceration.  Feces  from  the  patient  must  pass  over  the  tumor  and 
soil  it.  The  tail  is  constant!}'  in  contact  with  the  tumor  and 
serves  to  abrade  it. 

Under  these  conditions  the  prolapsed  organ  becomes  more  and 
more  inflamed,  thickened  and  painful.  Straining  occurs  fre- 
quently. The  mucosa  becomes  greatly  thickened  and  dark  col- 
ored, and  more  or  less  gangrene  may  occur. 

When  vesico-vaginocele  exists,  the  inverted  position  of  the 
bladder,  outside  the  body  cavity,  renders  urination  very  difficult. 


452  Vetermarv  Obstetrics 

All  aid  normalh^  coming  from  the  compression  of  the  abdominal 
walls  is  lost  and  the  expulsion  of  urine  must  be  accomplished  by 
the  contraction  of  the  bladder  walls  alone,  against  serious  obsta- 
cles to  the  escape  of  the  urine  through  the  urethra.  The  accu- 
mulation of  urine  in  the  bladder,  causing  the  distension  of  the 
organ,  increases  greatly  the  size  of  the  prolapse  and  intensifies 
the  suffering  of  the  patient. 

The  straining  consequent  upon  the  prolapse  tends  somewhat 
toward  dilation  of  the  cerv'ical  canal  and  favors  the  extension  of 
the  infection  from  the  vagina  along  the  cervical  canal  into  the 
uterine  cavity.  Such  infection  tends  to  sooner  or  later  bring 
about  the  death  of  the  fetus,  followed  by  its  septic  decomposition. 

The  expulsive  powers  of  the  genital  canal  are  at  once  weakened 
so  that,  should  the  fetus  perish,  its  expulsion  is  doubtful.  In- 
stead it  is  liable  to  be  retained,  decompose,  and  induce  fatal  sep- 
sis of  the  mother.     This  is  especially  true  in  the  ewe. 

The  affection  in  the  ewe  is  highly  fatal,  and  most  of  the  ani- 
mals succumb  unless  handled  carefully  and  early.  In  the  cow  the 
affection  has,  in  our  hands,  proven  more  amenable  to  treatment. 
When  the  vaginal  portion  of  the  gravid  uterus  is  so  far  displaced 
that  it  protrudes  beyond  the  vulva,  the  gravit}^  of  the  malady 
becomes  heightened. 

A  serious  feature  of  the  malady  is  the  weakening  of  the  in- 
flamed vaginal  walls.  In  .some  cases  they  become  so  fragile  and 
inextensible  that  they  rupture  during  the  pa.ssage  of  the  fetus 
through  the  vagina  or  during  manipulation  by  the  obstetrist  or 
others.     The  accident  ends  in  fatal  peritonitis. 

Treatment. — The  treatment  of  this  malady  will  vary  materi- 
ally in  individual  cases.  If  it  is  observed  that  the  animal  is 
forced  to  lie  with  the  posterior  parts  depressed,  as  in  case  of  a 
cow  in  a  sloping  stanchion,  the  declivity  of  the  stall  floor  should 
be  corrected.  Since  the  exalted  intra-abdominal  pressure  has 
much  to  do,  in  a  mechanical  way,  with  the  causation  of  the  dis- 
ease, this  tension  should  be  largely  overcome  by  giving  a  con- 
centrated diet  in  limited  amount  and  of  a  laxative  character,  to 
reduce  the  volume  of  the  abdominal  contents  as  far  as  practicable. 

In  those  cases  where  the  di.sease  is  well  established  and  the 
mucous  membrane  inflamed,  general  precautions  do  not  serve  to 
overcome  the  disease.  The  prolapsed  organ  must  be  returned  to 
its   position    promptly  and  means  applied   which   will  cause   it 


Prolapse  of  the    Vagina  453 

to  remain  in  its  normal  situation.  In  order  to  maintain  the  organ 
in  position,  we  need  overcome  the  straining,  due  to  the  pain,  and 
the  infection.  Before  the  prolapsed  organ  is  replaced  into  its 
position  it  must  be  cleansed  thoroughly.  After  its  reposition  it 
is  to  be  straightened  out  in  its  normal  situation  ;  the  replacement 
must  be  as  complete  and  perfect  as  possible.  After  it  has  been 
replaced,  we  should  introduce  into  the  cavit}'  of  the  organ  reme- 
dies which  will  overcome  the  infection  and  ameliorate  the  pain. 

The  reposition  of  the  extruded  organ  is  not  always  easy,  be- 
cause of  the  straining.  First,  the  part  should  be  bathed  with  a 
tepid  antiseptic  solution,  for  which  lysol  is  especially  useful  be- 
cause of  its  unctuous  character.  Care  is  to  be  taken  that  the 
antiseptic  is  not  too  irritant.  The  lysol  solution  should  not  ex- 
ceed I  %.  It  may  even  be  omitted  and  tepid  water  alone  used. 
If  the  organ  is  very  irritable  and  painful  and  its  reposition  causes 
great  resistance  we  may  apply  to  it  one  of  the  local  anaes- 
thetics, such  as  cocaine,  or  eucaine  in  order  to  overcome  the  re- 
.sistance  in  returning  the  organ  and  to  diminish  the  straining  after 
it  has  been  replaced.  An  addition  of  adrenalin  to  the  anaes- 
thetic solution  blanches  the  mucosa  and  decreases  the  congestion. 
The  replacement  of  the  organ  in  the  cow  should  be  brought 
about  by  gentle  and  careful  pressure  with  the  palms  of  the  hands, 
until  it  has  retreated  within  the  vulva,  when  one  hand  should  be 
introduced  and  the  walls  of  the  organ  straightened  out  in  their 
normal  position.  If  for  any  reason  the  animal  should  be  re- 
cumbent, great  difficulty  may  be  found  in  replacing  it.  When- 
ever possible,  the  animal  should  be  caused  to  stand,  preferably 
with  its  hind  feet  upon  higher  ground  than  the  fore-feet,  so  that 
the  anterior  part  of  the  body  slopes  downward  and  the  abdominal 
viscera  drop  forward  away  from  the  pelvis. 

The  ewe,  or  other  small  patient,  should  be  seized  by  the  hind 
legs  and  suspended  with  the  head  downward,  when  the  diseased 
organ  will  return  to  its  position  spontaneously  or  with  very  slight 
pressure.  After  the  organ  has  been  replaced,  the  operation  may 
be  completed  by  pouring  into  the  vagina,  through  a  funnel  or 
tube,  a  tepid  antiseptic  solution.  This  tends  to  smooth  out  all 
irregularities  and  make  the  replacement  complete.  In  the  ewe 
we  have  found  that  a  i-iooo  solution  of  corrosive  sublimate  is 
not  so  highly  irritant  in   the  diseased  vagina  as   it  would  be  in 


454  Vctermary  Obstetrics 

the  normal  organ,  and  is  usually  borne  without  apparent 
irritation. 

In  order  to  prevent  a  recurrence  of  the  eversion,  and  bring 
about  disinfection  and  a  decrease  in  the  irritation  of  the  part,  we 
have  found  iodoform,  or  iodoform  and  tannin,  highly  beneficial. 
In  the  cow,  the  powder,  enclosed  in  a  gelatine  capsule,  which 
maybe  opened  with  the  hand,  may  be  introduced  deeply  into  the 
vagina  and  scattered  about  in  the  cavity.  In  the  ewe  or  other 
small  animal  the  powder  can  readily  be  dropped  into  the  vagina 
by  holding  the  vulvar  lips  apart  with  retractors  or  by  introduc- 
ing a  long  pair  of  dressing  forceps  deeply  into  the  vagina  and 
opening  them,  holding  the  walls  of  the  canal  apart  and  dropping 
the  powder  into  the  organ,  while  the  patient  is  suspended  by  its 
hind  limbs. 

Another  effective  means  for  applying  iodoform  and  tannin  or 
other  astringents  or  local  anaesthetics  is  by  means  of  supposito- 
ries, which  maybe  made  by  mixing  the  desired  drugs  with  tallow 
and  enough  wax  to  give  the  proper  cou.sistency,  and  then  pour- 
ing these  into  a  suitable  mould,  according  to  the  species  and  size 
of  the  animal.  After  they  have  hardened,  they  are  introduced 
into  the  vagina.  Such  treatment  is  very  soothing  to  the  irritated 
organ  and  does  much  to  overcome  the  infection  and  straining, 
which  go  hand  in  hand. 

Fleming  and  others  recommend  the  application  of  bandages, 
trusses  or  sutures  to  retain  the  diseased  organ  in  position.  We 
have  not  found  the.se  very  satisfactory  because  there  is  no  way, 
by  either  plan,  to  prevent  the  vagina  from  being  pushed  out 
against  the  mechanical  devices,  thereby  causing  irritation  by 
pressure  against  these  objects.  We  have  not  successfully  con- 
trolled the  straining  until  we  have  eliminated  its  cause  or  causes — 
until  we  have  overcome  the  infection  and  inflammation.  When 
this  has  been  accomplished,  the  disease  ceases.  In  other  cases 
Fleming  advises  the  use  of  the  ring  pessary,  but  the  application 
of  this  can  only  intensify  the  infection.  While  it  may  keep  the 
vagina  in  place,  it  does  not  cure,  but  merely  disguises  the  exist- 
ence of  the  malady. 

It  is  not  improbable  that  the  prolapse  is  often  due  to  fetal 
death.  The  general  assumption  is  that  the  prolapse  induces  the 
death  of  the  fetus  and  thereby  complicates  the  disease,  but  the 
reverse  may   be   true.      We   know   that,    following  parturition^ 


Prolapse  of  the  Vagina  455 

endometritis  frequently  induces  vaginal  prolapse,  which  persists 
until  the  endometritis  is  definitely  relieved,  and  this  fact  raises 
the  question  whether  a  macerating  fetus  in  the  uterus  may  not 
similarly  cause  prolapse  of  the  vagina  in  the  pregnant  animal. 
If  so,  it  would  evidently  be  bad  surgery  to  apply  mechanical 
devices  to  overcome  a  prolapse  dependent  upon  causes  still 
existing,  which  the  means  applied  would  intensify,  instead  of 
overcome. 

The  bandage,  truss,  suture,  pessary  or  other  mechanical  means 
for  retention  not  only  tends  to  aggravate  the  malady  in  many 
cases,  but  is  a  constant  danger  for  the  animal  when  parturition 
arrives.  There  is  one  redeeming  feature  in  all  the.se  mechanical 
appliances  when  parturition  arrives  :  they  are  each  and  all  thrust 
aside  ;  sutures  are  torn  out,  with  resulting  deformity  ;  and  labor 
generally  proceeds  in  spite  of  the  obstacles.  This  indicates  that, 
if  the  irritation  in  the  vagina  is  sufficiently  great,  each  of  the.se 
means  is  ineffectual  in  retaining  the  prolapsed  organ.  The  ap- 
plication of  each  of  the.se  mechanical  devices  will  be  described 
under  "Prolapse  of  the  Uterus"  as  a  post-parturient  accident. 

We  have  suggested  above  the  use  of  astringents  in  combina- 
tion with  iodoform,  applied  to  the  disea.sed  organ.  Astringents 
are  not  to  be  carried  too  far.  If  applied  too  abundantly  as  a 
powder  or  in  aqueous  solution  they  may  prove  too  dessicant  and 
harden  the  vaginal  walls.  Pushed  too  far,  they  may  even  cause 
dessicant  necrosis  of  the  mucous  and  muscular  walls.  Such  des- 
sication  endangers  the  life  of  the  patient  by  inviting  a  rupture  of 
the  rigid  or  necrotic  vaginal  walls  at  the  time  of  parturition. 
The  vaginal  mucosa  should  be  kept  moist.  If  necessary,  the 
softness  and  pliability  are  to  be  maintained  by  the  application  of 
oil  or  heavy  fats  with  the  iodoform  or  other  disinfectants. 

Systemic  medication  should  not  be  neglected.  We  have  indi- 
cated that  amongst  the  chief  causes  were  a  general  atonic  state 
combined  with  close  confinement  and  heavy  feeding. 

The  intestinal  tract  should  be  promptly  and  judiciously  un- 
loaded in  order  to  overcome  the  abnormal  intra-abdominal  ten- 
sion as  well  as  to  relieve  the  digestive  system  from  an  overload  of 
aliment  demanding  digestion.  If  the  object  can  be  promptly  at- 
tained by  the  use  of  laxative  foods,  the  administration  of  drugs 
may  not  be  demanded.     Generally,  the  veterinarian  is  not  war- 


456  Veterinary  Obstetrics 

ranted  in  permitting  such  dela}',  but  should  promptly  administer 
purgatives.  The  promptest  and  safest  of  these  are  the  alkaloids, 
eserine  and  arecoline.  Given  in  small  doses  they  act  within  an 
hour,  and  if  they  fail  to  do  so  the  dose  may  then  be  repeated.  To 
an  ordinary  cow  V2  to  i  grain  of  arecoline  or  eserine  may  be 
given.  The  ewe  may  take  >^  to  i  of  a  grain,  repeated  in  in- 
creased doses  until  the  desired  effect  is  obtained.  Saline  cathar- 
tics may  be  used  instead,  but  they  are  very  slow  in  action  and 
cause  disagreeable  disturbances  of  the  appetite.  They  have 
greater  danger  for  the  life  of  the  fetus. 

The  general  tone  of  the  system  should  be  favored  by  the  ad- 
ministration of  tonics,  especially  of  nux  vomica  or  strychnine. 

When  the  affected  animal  has  reached  the  normal  duration  of 
gestation  and  the  prolapse  is  .severe  and  inveterate,  artificial  de- 
livery should  be  induced  without  delay.  The  os  uteri  should  be 
gradually  dilated  and  the  fetus  secured  and  brought  away  with 
light  and  careful  traction. 

We  are  strongly  inclined  to  hasten  parturition,  especially  if 
the  normal  duration  of  pregnancy  has  been  about  completed. 
The  size  of  the  ewe  may  render  this  difficult.  If  the  ewe  is  large 
and  the  obstetrist's  hand  small,  the  task  is  greatly  lightened  and 
the  operation  rendered  more  safe.  The  operation  should  be 
carried  out  in  the  same  manner  as  described  on  page  428.  When 
the  smallness  of  the  vulvo- vaginal  canal  or  the  large  size  of  the 
operator's  hand  precludes  artificial  delivery  through  the  genital 
canal,  hysterectomy  may  be  considered  and  applied  if  deemed 
judicious.  We  shall  describe  this  operation  among  "Obstetric 
Operations." 

A  heifer  entered  in  our  ambulatory  clinic  had  suffered  seriou.sly 
from  vesico- vaginocele  for  24  hours.  The  animal  had  reached  the 
end  of  the  ninth  month  of  gestation.  When  we  were  called,  she 
was  lying  prone  in  the  stanchion,  unable  to  rise,  even  with  assist- 
ance. She  was  somewhat  emaciated,  apparently  very  feeble, 
and  there  was  possibly  some  degree  of  h5'drops  amnii.  The  floor 
of  the  vagina,  within  which  w^as  the  bladder  filled  with  urine, 
was  extruded  through  the  vulva  and  returnable  only  with  great 
difficulty.  It  was  impossible,  from  the  beginning,  to  retain  the 
organ  in  position  after  its  return  and  it  was  evident  that  the  only 
hope  for  the  patient  lay  in  immediate  delivery. 


Hemorrhage  from  the  Gravid  Uterus  457 

The  animal  was  dragged  from  the  stanchion  to  a  suitable  place 
for  operating,  where  the  posterior  parts  could  be  somewhat  ele- 
vated. After  much  tedious  and  patient  labor,  the  os  uteri  was 
dilated  and  the  fetus  removed.  The  afterbirth  was  left  in  the 
uterus  and  its  cavity  was  filled  with  a  warm  disfecting  solution. 
The  prolapsed  organ  remained  in  position  without  any  mechan- 
ical appliance  and  the  animal,  relieved  of  the  weight  of  the  fetus, 
was  soon  able  to  regain  her  feet  and  made  an  uneventful  recovery. 

In  all  cases  of  this  malady,  we  would  advise  that  the  chief 
effort  be  directed  toward  overcoming  the  causes  and  that  close 
attention  be  given  to  the  cleanliness  of  the  parts  and  to  keeping 
them  in  position  by  the  gentlest  possible  means.  In  many  cases 
the  repeated  replacement  and  dressing  of  the  parts  may  be  essen- 
tial and,  in  some  comparatively  rare  cases,  the  truss  or  sutures 
may  be  allowable.  However,  we  would  urge  the  avoidance  of 
mechanical  appliances,  so  far  as  practicable. 

It  must  be  borne  in  mind,  also,  that  the  disease  is  due  very 
largely  to  clo.se  housing  and  consequently  we  may  accomplish 
much  good  by  causing  the  animal  to  take  in\  igorating  exercise. 
This  should  not  be  severe  but  .should  be  abundant  and  regular. 
Such  exercise  aids  in  many  ways  :  it  stimulates  the  action  of  the 
bowels  and  decreases  the  fullness  of  the  abdomen  ;  it  invigorates 
the  general  system  and  imparts  an  increased  tone  to  the  affected 
organ  ;  and  it  serves  to  direct  the  patient's  attention  from  irrita- 
tion in  the  part  and  thus  prevents  straining.  The  movements  of 
the  animal  further  tend  to  bring  about  a  correct  position  of  the 
uterus  and  vagina. 

Metrorrhagia. 
Hemorrh.\ge  from  the  Gravid  Uterus. 

Hemorrhage  from  the  gravid  uterus  is  very  rarely  observed 
in  our  domestic  animals.  Carsten- Harms  records  the  accident 
in  the  cow  and  mare,  and  admits  its  occurrence  in  all  domestic 
mammals.  The  symptoms  consist  fundamentally  of  colic,  strain- 
ing similar  to  labor  pains  and  an  escape  of  blood  from  the  genital 
organs.  The  symptoms  are  not  constant  and  any  one  of  them 
may  be  absent  in  a  given  case.  Should  hemorrhage  occur  from 
the  cervix,  the  blood  may  escape  from  the  vulva,  and,  if  moderate, 
no  symptoms  occur  except  the  visible  hemorrhage  it.self.  It 
may  even  be  that  colic  or  other  disease  which  might  later  be  re- 
garded as  a  symptom  of  metrorrhagia  actually  causes  the  hemor- 


458  Veter27iary  Obstetrics 

rhage  and  may  precede  it  by  several  days.  The  straining  may 
vary  greatly  in  degree  and  may  not  be  very  prominent. 

The  hemorrhage  from  the  vulva  will  neces.sarily  vary  greatly  ac- 
cording to  the  case  ;  in  some  instances  it  may  be  very  extensive 
and  apparent,  while  in  others  the  blood  may  all  be  retained  in 
the  uterine  cavity.  If  the  hemorrhage  is  very  extensive,  whether 
the  blood  e.scapes  from  the  uterus  or  not,  it  produces  the  usual 
symptoms  of  internal  bleeding,  such  as  colic,  imperceptible  pulse 
and  blanched  muco.sa.  In  such  severe  cases  the  animal  necessarily 
becomes  very  weak  and  .staggers.  The  surface  of  the  body  be- 
comes cold,  and  there  is  profuse  sweating  in  the  mare.  The 
heart-beat  is  violent  but  the  arterial  impulse  is  weak. 

The  diagnosis  of  uterine  hemorrhage,  in  pregnant  animals,  is 
not  easy  except  by  manual  exploration.  It  is  necessary  to  de- 
termine the  source  of  the  bleeding,  and  the  manipulations 
necessary  to  this  are  sometimes  undesirable.  We  were  once  en- 
gaged with  a  very  serious  case  of  dystokia  in  a  mare,  which 
occupied  our  time  for  some  six  hours.  The  work  was  performed 
in  close  proximity  to  other  pregnant  mares.  When  we  had 
finished  our  work  we  observed  that  another  mare,  which  was 
almo.st  ready  to  foal,  was  di.scharging  blood  from  the  vulva  and 
was  considerably  excited.  The  mare  was  secured  and  quieted, 
after  which  she  seemed  to  be  well  in  every  respect  ;  there  was 
no  pain,  the  pul.se  and  temperature  were  normal  and  the  animal 
appeared  perfectly  well  except  for  the  discharge  of  a  moderate 
quantity  of  bright  red  blood  from  the  vulva.  The  flow  soon 
stopped  and  it  .seemed  to  us  inadvisable  to  undertake  the  manipu- 
lations necessary  to  determine  the  source  of  the  bleeding,  whether 
from  the  uterus,  vagina,  bladder  or  some  other  part.  We  con- 
sequently desisted  from  making  any  examination  and  allowed 
the  case  to  go  without  interference,  with  the  result  that  preg- 
nancy was  completed  without  further  incident  and  a  living  foal 
was  born. 

We  hold,  therefore,  that  it  is  not  essential  in  all  cases  to  make 
a  definite  diagnosis  when  manipulation  might  imperil  the  life  of 
the  fetus.  Under  the  circumstances  which  we  have  related, 
manual  exploration  of  the  vagina  to  determine  the  source  of  the 
hemorrhage  would,  in  our  judgment,  have  been  unnecessarily 
hazardous,  more  so  than  had  the  animal  not  been  greatly  excited. 

The  hemorrhage  may  cease  and  gestation  continue  for  the 
normal  period  of  time  and   either  living  or  dead  young  be  pro- 


Hemorrhage  fron  the  Gravid  Uterus  459 

duced.  There  may  be  but  a  single  hemorrhage  or  it  may  recur 
several  times.  In  severe  cases,  the  hemorrhage  may  prove  fatal 
to  the  mother. 

The  causes  must  be  referred  to  a  rupture  of  some  of  the  uterine 
vessels,  which  may  be  due  to  the  presence  of  a  tumor  or  other 
disease  or,  as  is  probably  most  frequently  the  case,  to  some  trau- 
matic injur}'. 

The  prognosis  of  uterine  hemorrhage  in  the  pregnant  animal 
is  usually  very  grave,  alike  for  the  mother  and  the  fetus. 

The  treatment  will  depend  greatly  upon  circumstances.  First 
of  all,  we  should  .secure  the  most  absolute  quiet  possible  in  the 
hope  that  the  blood  may  form  a  thrombus  and  the  hemorrhage 
from  the  wounded  vessels  cease.  Harms  recommends  an  applica- 
tion of  cold  water  or  of  cooling  mixtures  or  ice  bags  to  the  pos- 
terior part  of  the  abdomen  in  the  vicinity  of  the  uterus,  by  which 
he  hopes  to  favor  the  formation  of  thrombi.  Ergot  and  hydrastis 
Canaden.sis  may  be  given  internally  as  styptics,  but  their  effect  is 
not  always  satisfactory.  When  the  hemorrhage  is  very  threat- 
ening, it  may  be  desirable  to  bring  about  immediate  delivery  of 
the  fetus.  We  would  have  one  or  more  of  three  objects  in  view 
in  bringing  about  the  evacuation  of  the  uterine  cavity,  i.  We 
may  thereby  save  the  life  of  the  fetus,  although  not  yet  fully 
matured.  2.  We  may  cause  the  hemorrhage  to  cease  spontane- 
ously by  permitting  an  involution  or  contraction  of  the  uterus 
when  freed  from  its  contents.  3.  We  may  be  enabled  to  apply 
remedies,  of  a   topical  character,  directly  to  the  bleeding  parts. 

The  method  of  bringing  about  evacuation  of  the  gravid  uterus 
has  already  been  di.scussed  on  page  428.  The  conditions  here 
demand  the  greatest  possible  celerity  compatible  with  safety, 
once  the  operation  has  been  determined  upon.  We  cannot 
readily  bring  about  prompt  evacuation  of  the  uterus  in  the  cow, 
because  the  cervix  is  so  firmly  contracted,  but  in  the  mare,  with 
the  very  dilatable  os  uteri,  delivery  can  be  brought  about  very 
quickly. 

After  emptying  the  uterus  of  its  contents,  cold  water  or  as- 
tringents may  be  injected  into  its  cavity,  or  it  may  be  packed 
thoroughly  with  gauze  saturated  with  astringents,  such  as  alum. 
Those  astringents  or  styptics,  like  the  persulphate  or  iron  and 
some  others  which  are  irritant,  should  not  be  applied,  because 
they  tend  to  induce  straining,  which  serves  to  cause  the  hemor- 
rhage to  continue  and  defeat  the  practitioner's  aim. 


DISEASES  OF  THE  FETUS  AND  ITS  MEMBRANES. 

The  fetus  is  contained  in  the  hermetically  sealed  uterine 
cavity  of  the  mother  and  is  further  protected  by  the  fetal  en- 
velopes and  fluids  which  surround  and  protect  it  from  trauma- 
tic injuries  and  from  thermic  changes,  so  that  it  is  well  guarded 
against  dangers  from  without.  The  maternal  system  furnishes, 
through  the  placenta,  abundant  nourishment  and  removes  by  the 
same  avenue,  its  excretions.  When  describing  the  placenta  we 
noted  that  its  structure  is  such  that,  while  freely  permitting  the 
passage  of  nutrient  substances,  from  the  mother  to  the  fetus,  and 
waste  products  from  fetus  to  mother,  it  generally  serves  as  an 
efficient  barrier  against  the  passage  of  disease-producing  micro- 
organisms. The  fetus  is  thus  protected  upon  every  hand  in  an 
unusual  degree  against  disease  or  accident. 

Nevertheless  the  fetus  is  subject  to  many  forms  of  disease  and 
accident  which  may  imperil  its  life  or  bring  about  changes 
which  render  it  of  little  value  when  born. 

In  the  preceding  pages,  in  tracing  the  development  of  the 
fetus,  we  have  from  time  to  time  mentioned  some  aberrations  in 
the  development  of  the  fetus,  such  as  monstrosities  and  defects 
which  more  or  less  destroy  the  value  of  the  young  animal. 

Though  some  of  the.se  aberrations  in  development  render  the 
fetus  incapable  of  living  at  the  time  of  birth,  and  others  have 
little  danger  to  the  life  of  the  young  animal  but  simply  affect  its 
value,  none  of  them,  as  a  rule,  lead  to  death  of  the  fetus  during 
its  intra-uterine  life. 

On  the  other  hand,  various  di.sea.ses  of  the  fetus  or  of  its  mem- 
branes lead  more  or  less  frequently  to  its  death  and  expulsion. 

Death  of  the  Fetus. 

Death  of  the  fetus  occurs  in  all  species  of  animals  and  at  any 
stage  of  intra-uterine  life  from  the  beginning  to  the  end.  In  the 
majority  of  cases,  when  death  of  the  fetus  occurs,  it  is  promptly 
expelled.     This  we  know  as  abortion. 

In  other  instances,  which  are  far  more  rare,  the  dead  fetus  is 
not  expelled  but  is  retained  within  the  uterus  for  a  more  or  le.ss 
indefinite  period.  The  retained  dead  fetus  may  pursue  a  variable 
course,  according  to  circumstances.  It  may  undergo  aseptic 
wasting  or  mummification.  There  may  occur  a  maceration  or 
460 


Mil  m  tn  ifica  Ho  «  46  r 

softening,  in  which,  if  there  is  infection  present,  it  is  not  accom- 
panied by  the  ordinary  features  of  putrefaction.  The  fetus  may 
undergo  ordinary  putrefactive  decomposition,  with  the  formation 
of  gases.  The  recognized  causes  of  fetal  death  are  considered  in 
the  following  chapters. 

Mummification.  When  a  fetus  dies  within  the  uterus  and 
escapes  infection,  its  fluids  and  soft  parts  gradually  become  ab- 
sorbed, until  finally  there  remains  a  hard,  dry,  blackened  fetal 
mass.  The  skeleton  is  complete  and  perhaps  normally  formed, 
the  skin  intact  and  probably  covered  with  hair,  while  the  soft 
parts  are  wasted,  hard  and  dry.  See  Fig.  86  and  compare  with 
Fig.  81.  The  cadaver  of  the  fetus  is  usually  without  odor  and 
has  apparently  escaped  infection  wholly. 


Fig.  86.     Mummikicatiox  of  Fetus.     Cow. 

This  condition  is  dependent  primarily  upon  the  firm  closure, 
or  hermetic  sealing,  of  the  os  uteri  and  naturally  occurs  with 
greatest  frequency,  if  not  wholly,  in  ruminants,  where  the  long 
and  narrow  cervical  canal  is  surrounded  by  a  great  abundance  of 
dense  and  firmly  contracted  tissue,  which  holds  and  keeps  the 
canal  thoroughly  closed.  Among  ruminants  it  is  .seen  most  fre- 
quently in  the  cow.  As  a  general  rule,  death  of  the  fetus  occurs 
from  the  5th  to  the  6th  or  7th  month  and  rarely  somewhat  later, 
so  that  the  mummified  fetus  usually  measures  from  12  to  16  <5r 
18  inches  in  its  greatest  diameter.  In  rare  cases  it  may  almost 
reach  the  normal  measurement  of  a  fully  developed  calf. 

The  cause  of  death,  in  cases  of  mummification,  is  not  known 
and  presumably   varies  according  to   circumstances.     It  is  only 


462  Veterinary  Obstetrics 

essential  that  the  death  has  been  brought  about  by  some 
cause  which  has  not  been  dependent  upon,  or  accompanied  by, 
an  opening  of  the  cervical  canal  and  that  no  infection  has 
gained  access  to  the  fetus  or  its  membranes. 

The  symptoms  of  death  and  mummification  of  the  fetus  are 
negative.  No  signs  of  disease  are  present.  It  may  first  be 
suspected  when  the  animal  is  found  to  be  .sterile,  without  signs 
of  estrum.  While  the  fetus  is  alive  there  is  no  departure  from 
the  ordinary  signs  of  pregnancy  and  when  it  peri.shes  the  event 
is  not  marked  by  any  external  manifestations.  The  signs  of 
pregnancy,  however,  cease  to  accumulate  :  the  abdomen  does 
not  increa.se  further  in  size  ;  the  milk  glands  do  not  continue  to 
develop.  On  the  other  hand,  there  is  no  external  evidence  that 
the  animal  is  not  pregnant.  The  presence  of  the  mummified 
fetus  prevents  ovulation  and  estrum.  The  cow  remains  quiet 
and  tends  to  fatten.  Finally  she  passes  her  normal  period  for 
calving  and  no  signs  of  parturition,  or  the  approach  of  it,  appear. 
If  at  this  period  a  careful  examination  be  made  per  rectum,  it 
will  be  found  that  the  uterus  contains  a  hard,  rigid,  unyielding 
ma.ss,  in  which  some  parts  of  the  fetus  may  be  recognized.  The 
fetal  fluids  have  largely  disappeared  and  the  uterus  closely  in- 
vests the  munim}'.  If  undisturbed,  the  mummy  remains  in- 
definitely in  the  uterus  as  a  permanent  source  of  sterility.  In 
some  rare  cases,  for  reasons  unknown,  the  mummy  is  expelled 
after  a  variable  duration  of  time  and  the  cow  may  again  ovulate 
and  conceive. 

In  the  vast  majorit}'^  of  cases  the  condition  is  not  discovered  or 
su.spected.  The  cow,  remaining  unfruitful  for  a  long  period  of 
time  and  in  the  meantime  becoming  fat,  is  .sold  to  the  butcher, 
and  upon  slaughter  the  actual  condition  is  discovered. 

The  treatment  of  this  condition  neces.sarily  falls  under  the 
head  of  vSterility.  Except  as  a  cause  of  sterility,  mummification  of 
the  fetus  is  without  significance  and  does  not  injure  in  any 
way  the  well-being  of  the  mother  nor  affect  the  value  of  her  flesh 
for  human  food. 

•When  an  examination  is  made  to  discover  the  cause  of  sterility 
and  the  presence  of  the  mummified  fetus  is  discovered,  the  only 
course  to  pursue  is  clearly  that  of  the  extraction  of  the  fetal  ca- 
daver. If  it  can  be  determined  by  rectal  exploration  that  the  corpus 
luteum  resulting  from  the  pregnancy  still  persists,  it  would  appear, 


Maceratio7i  and  Decomposition  of  the  Fetus  463 

according  to  Hess,  that  the  expulsion  of  the  fetus  might  be 
brought  about  by  the  artificial  pressing  out  of  this  body,  there- 
by inducing  uterine  contraction,  which  may  be  further  favored 
by  massage  of  the  uterus  per  rectum.  This  failing,  our  only 
recourse  is  the  mechanical  dilation  of  the  cervical  canal  and  the 
extraction  of  the  mumm3\  In  the  extraction  of  this  unyielding 
mummy,  considerable  difficulty  may  be  encountered  if  it  is  of 
very  large  size  or  when  one  or  more  of  the  limbs  project  in  an 
unfavorable  direction.  It  may  be  necessary  to  perform  em- 
bryotomy. 

Maceration  and  Putrid  Decomposition  of  the  Fetus. 

When  the  fetus  perishes  in  the  uterus  and  the  os  uteri  is  per- 
vious and  permits  the  entrance  of  micro-organisms,  the  fetal  body 
quickh'  undergoes  maceration  or  putrefaction.  The  exact  type 
of  decomposition  varies  in  different  cases.  In  one,  it  may  simply 
amount  to  a  softening  and  solution  of  the  fetal  body  and  mem- 
branes, with  some  fetor.  In  other  cases  putrefaction  takes  on  the 
ordinary  type,  with  a  great  fetor  and  the  formation  of  large  vol- 
umes of  gases.  When  the  putrefaction  is  rapid,  so  that  the  uter- 
ine walls  can  not  readily  and  quickly  expand  to  accommodate 
the  large  volume  of  gases,  rupture  of  the  uterus  may  occur.  If 
the  decomposition  and  formation  of  gases  are  not  so  rapid,  the 
walls  of  the  uterus  become  inflamed  and  thickened  and  lose  their 
contractile  power.  There  is  an  abundance  of  pus  formed  from 
the  mucous  membrane.  Sometimes  the  cavity  of  the  uterus  as- 
sumes the  type  of  an  abscess  which  eventually  opens  upon  the 
exterior,  either  directly  through  the  abdominal  walls,  or  indi- 
rectly through  the  os  uteri,  vagina,  intestines,  or  rumen.  When 
the  disease  pursues  such  a  course,  the  uterine  walls  become  ad- 
herent to  that  part  through  which  the  opening  is  to  •occur  and 
eventually  the  fetus,  with  other  putrid  contents  of  the  uterus,  is 
expelled.  Through  the  abscess  opening  there  may  enter  into  the 
uterine  cavity  particles  of  food  from  the  intestinal  tract.  When 
the  uterine  abscess  empties  itself  through  the  cervical  canal  into 
the  vagina,  the  os  uteri  becomes  slightly  dilated  and  portions  of 
the  fetus  may  from  time  to  time  be  expelled  through  this 
opening. 

The  symptoms  of  maceration  or  putrefaction  of  the  fetus  are 
extremely    varied.     When   portions  of    the    fetus   are  expelled 


464  Veterinary  Obstetrics 

through  an  abscess  opening  upon  the  surface  of  the  abdomen, 
the  diagnosis  is  easily  reached.  When  the  uterine  contents  are 
being  discharged  intermittently  through  the  vagina,  it  is  possible 
to  determine  the  nature  of  the  disease  by  examination  of  the  ma- 
ternal organs  or  of  the  expelled  parts.  When  the  discharge  of 
the  fetus  and  uterine  contents  takes  place  through  the  digestive 
tract,  there  is  usually  a  fetid  diarrhea  at  the  time  of  discharge, 
which  may  reveal  its  nature  by  the  presence  of  fetal  bones  or 
of  other  fetal  parts. 

When  the.se  fetal  parts  are  not  being  discharged,  thesj-mptoms 
are  not  so  clear.  There  is  usually  marked  depres.sion  of  the 
patient,  and  indications  of  some  profound  internal  disease,  with 
symptoms  indicative  of  septicaemia.  There  is  emaciation,  with 
a  general  appearance  of  bad  health,  poor  appetite,  etc. 

Such  symptoms  are  not  always  present,  however,  and  in  some 
cases  the  patient  may  remain  apparently  well  while  a  fetus  is 
rapidly  decomposing  in  the  uterine  cavity  and  is  gradually  es- 
caping to  the  exterior  through  the  genital  canal  or,  more  fre- 
quently, through  some  artificial  channel.  An  examination  per 
rectum  may  reveal  the  greatly  distended  and  fluctuating  uterus 
and  even  the  character  of  its  contents.  The  fact  that  an  animal, 
which  has  been  supposed  to  be  pregnant,  has  pa.ssed  beyond  the 
normal  date  for  parturition,  and  has  become  unwell,  should 
arouse  the  suspicion  of  the  veterinarian  and  lead  him  to  make  a 
detailed  examination.  If,  in  addition,  there  have  been  more  or 
less  evident  signs  of  labor  at  or  near  the  proper  time  for  parturi- 
tion, the  symptoms  become  highly  suggestive. 

The  cause  of  retention  and  decomposition  of  the  dead  fetus  is 
exceedingly  variable  and  depends  for  the  most  part  upon  some 
impediment  to  its  expulsion  after  death.  The  prevention  of  ex- 
pulsion depends  frequently  upon  torsion  of  the  uterus,  especially 
in  the  cow  and  ewe,  more  rarely  in  the  mare  and  other  animals. 
In  numerous  cases  of  uterine  torsion,  in  the  ewe  and  cow,  the 
uterus  becomes  transversely  parted  in  its  cervix  or  the  vagina  is 
ruptured  transversely  and  the  gravid  uterus  drops  down  upon 
the  floor  of  the  abdomen,  a  detached  mass.  The  fetus  decomposes,, 
because  infection  has  gained  admission  to  the  uterine  cavity 
during  torsion,  and  the  detached  organ  serves  as  an  asbcess cavity. 
This  finally  evacuates  it.self  through  the  floor  of  the  abdomen  or 
through  the  intestinal  tract. 


Maceraiioti  and  Deco7nposition  of  the  Fettcs  465 

In  other  cases,  the  retention  and  decomposition  of  the  fetus 
may  depend  upon  induration  or  constriction  of  the  cervix,  upon 
mal-presentation  of  the  fetus  or  some  form  of  monstrosity  pre- 
venting normal  delivery.  Artificial  delivery  at  the  proper  time 
has  been  neglected  or  has  failed. 

The  treatment  of  retention  of  the  fetus,  accompanied  by 
maceration  or  putrid  decomposition,  depends  upon  the  removal 
of  the  fetus  and  disinfection  of  the  diseased  uterine  cavity.  The 
method  for  bringing  about  the  removal  of  the  uterine  contents 
will  depend  upon  the  cause  and  will  be  considered  under  the 
various  heads  which  may  induce  this  condition,  such  as  Torsion 
of  the  Uterus,  Constriction  of  the  Cervix  Uteri,  Fetal  Dystokia 
and  other  chapters  related  to  the  causes  which  we  have  suggested. 


30 


ABORTION.     STILL  BIRTH.     PREMATURE  BIRTH 

The  term  abortion  admits  of  a  variable  interpretation  and  is 
used  with  a  different  meaning  by  various  writers  and  by  the 
same  writers  in  different  cases.  Generally  speaking,  we  un- 
derstand abortion  to  mean  the  expulsion  of  the  fetus  from  the 
uterus  at  such  a  stage  of  its  existence  that,  if  still  living,  it  is 
not  sufficiently  developed  to  live. 

When  a  living  fetus  is  expelled  prematurely  and  in  a  state  of 
development  which  renders  survival  possible,  the  accident  is  desig- 
nated premature  birth.  In  human  obstetrics  it  has  been  attempted 
to  fix  a  given  date  or  period  in  gestation  which  should  constitute 
a  dividing  line  between  abortion  and  premature  birth.  This 
point  cannot  be  definitely  fixed  and  has  in  fact  been  changed 
somewhat  recentl}^  b}'  the  introduction  of  incubators  in  human 
obstetrics  for  the  preservation  of  the  lives  of  prematurely  born 
infants.  It  has  been  thereby  rendered  possible  to  save  the  lives 
of  infants  born  at  a  stage  of  development  which,  in  previous  years, 
would  have  led  to  their  death. 

The  designation  of  still-birth  is  applied  to  those  young  which 
are  expelled  at  an  age  when  they  are  sufficientlj^  developed  that 
they  might  live,  but  have  in  fact  perished  prior  to  their  expul- 
sion. 

Another  element  has  entered  into  veterinary  obstetrics  which 
serves  to  complicate  our  definition  of  abortion.  We  have  an  in- 
fectious disease  which  exerts  its  fundamental  and  marked  influ- 
ence upon  the  life  of  the  fetus,  and  which  we  know  as  infectious 
abortion.  In  speaking  of  this  disease,  we  are  consequently  deal- 
ing with  an  infection  and  it  matters  but  little  to  us  at  what  stage 
the  fetus  becomes  affected  with  the  malady  or  what  its  results 
may  be.  If  the  fetus  dies  in  the  uterus  and  is  thereafter  ex- 
pelled at  any  stage  of  gestation,  the  occurrence  is  designated 
infectious  abortion,  even  though  the  expulsion  of  the  dead  fetus 
does  not  occur  until  the  close  of  the  normal  period  of  gestation. 
If  the  fetus  is  expelled  alive,  even  though  it  has  reached  such  a 
period  of  development  that,  under  normal  conditions,  it  might 
live,  but,  under  the  influence  of  the  infection  acquired  within  the 
uterus,  succumbs  early  to  the  malady,  we  designate  it  infectious 
466 


Sporadic  or  Accidental  Abortion  467 

abortion.  Even  if  the  fetus  should  become  infected  late  in  ges- 
tation, be  born  alive  and  comparatively  vigorous  though  suffer- 
ing from  the  infection  acquired  while  in  the  uterus,  and  finally 
overcome  the  effects  of  the  disease  and  live,  we  should  still  speak 
of  it  as  infectious  abortion.  Thus,  in  speaking  of  abortion  in 
domestic  animals,  we  include  a  variety  of  conditions,  which  it  is 
difficult  to  include  under  one  definition. 

We  recognize  three  classes  of  abortion  in  domestic  animals  : 

1.  Sporadic  or  accidental  abortion,  in  which,  owing  to  disease 
of,  or  accident  to,  the  fetus  or  mother,  the  fetus  may  be  expelled 
dead  or  in  a  state  of  disease  which  renders  it  impossible  for  it  to 
live. 

2.  Enzootic  abortion,  due  to  some  infectious  disease  of  the 
mother,  which  brings  about  the  death  and  expulsion  of  the  fetus 
as  a  complication  of  the  maternal  disea.se. 

3.  Infectious  abortion — an  infection  of  the  fetus  and  its  mem- 
branes which  cau.ses  the  death  and  expulsion  of  the  fetus  or  its 
expulsion  in  a  living  and  enfeebled  state  at  an)-  period  of  gesta- 
tion from  the  date  of  conception  to  the  normal  completion  of 
pregnancy,  without  directly  inducing  material  evidence  of  dis- 
ease in  the  mother. 

I.  Sporadic  or  Accidental  Abortion. 

Any  di.sease  of  the  mother  may  more  or  less  remotely  involve 
the  well-being  and  safety  of  the  fetus  and  may  bring  about  its 
death.  Some  infectious  di-seases  cause  the  death  of  a  large  per- 
centage of  fetuses.  These  we  shall  consider  under  enzootic  abor- 
tion. Clinically,  illness  of  the  pregnant  female  does  not  as  a 
rule  seriously  imperil  the  life  of  the  fetus.  Animals  in  various 
stages  of  gestation,  suffering  from  high  fevers  and  a  great  variety 
of  disorders,  if  they  recover,  usually  carry  the  fetus  safely. 

Painful  diseases  of  the  digestive  canal,  accompanied  by  severe 
tympany  with  exalted  intra-abdominal  pressure,  may  bring  about 
abortion,  but  in  the  vast  majority  of  cases  do  not  do  so. 

The  toxic  effects  of  various  drugs,  especially  of  those  which 
have  some  special  effect  upon  the  genito-urinarj'  organs,  are 
claimed  to  sometimes  produce  abortion.  But  we  do  not  as  a  rule 
observe  such  effects  from  these  drugs.  Harms  asserts  that  he  has 
frequently  administered  aloes  to  pregnant  mares  without  observ- 
ing ill-effects,  but  that,  when  he  gave  an  aloetic  purge  to  a  mare 


468  Veterifiary  Obstetrics 

which  was  suckling  a  foal,  the  latter  died  from  superpurgation  as 
the  result  of  partaking  of  too  great  an  amount  of  aloes  in  the  milk 
of  its  mother.  Harms  had  warned  the  owner  against  permit- 
ting the  foal  to  suck  the  mare,  but  he  milked  her  and  fed  the 
milk  to  the  foal. 

Foods  of  various  kinds  have  been  accused  of  producing  abor- 
tion, but  the  basis  for  the  charge  is  not  very  clear.  It  is  ex- 
ceedingly difficult  to  determine  the  facts  in  the.se  allegations,  be- 
cause many  of  them  go  back  to  a  period  when  the  infectiousness  of 
disea.ses  in  general  was  doubted  and  when  various  influences 
were  invoked  to  account  for  the  prevalence  of  a  disease.  In 
fact,  that  era  of  doubt  has  not  yet  whoU}^  disappeared  and  per- 
haps never  will.  We  find  among  laymen  a  strong  tendency  to 
doubt  the  infectiousne.ss  of  abortion.  Instead  they  invoke  vari- 
ous theories  to  account  for  the  disease.  Even  among  veterinari- 
ans, we  find  doubters  and  skeptics  in  relation  to  infectious  dis- 
eases, who  must  find  some  explanation  for  the  appearance  of  the 
disease,  other  than  infection,  In  the  literature  of  earlier  days, 
we  find  prominent  mention  of  the  injurious  effects  upon  the 
fetus  of  fodder  which  has  been  more  or  less  spoiled  by  rust  or 
moulds  of  various  kinds,  and  especially  tho.se  fodders  which 
have  been  affected  with  smut  and  ergot.  The.se  charges  cannot 
well  be  traced  to  a  definite  and  reliable  source.  Harms  relates 
that  he  has  .seen  ergot  given  to  pregnant  cows  in  very  large 
quantities,  without  effect,  and  that  in  one  case  he  killed  a  preg- 
nant goat  with  ergot  without  producing  any  signs  of  abortion. 
We  have  been  unable  to  find  any  definite  records,  in  veterinary 
literature,  where  ergot  or  any  other  drug  has  cau.sed  abortion 
without  first  seriously  jeopardizing  the  life  of  the  mother. 

We  believe,  therefore,  that,  while  there  may  occasionally  oc- 
cur an  abortion  from  the  improper  feeding  of  the  pregnant  ani- 
mal, the  losses  from  this  cause  have  been  greatly  exaggerated 
and  are  not  especially  important.  We  would  not  be  understood, 
however,  as  suggesting  carelessness  in  the  feeding  of  pregnant 
animals,  but  merely  as  insisting  that  the  safety  of  the  mother 
and  fetus  are  bound  up  together  in  so  far  as  diet  is  concerned 
and  that  whatever  food  may  be  healthful  for  the.  one  is  compara- 
tively safe  for  the  other.  It  is  needless  to  advise  against  the 
use   of  mouldy,  rust}^  or  ergotized  food  for   pregnant    females, 


sporadic  or  Accidental  Abortion  469 

because  of  the  same  cousideratious  which  lead  us  to  advise 
against  it  for  non-pregnant  animals. 

The  low  temperature  of  food  or  water  has  been  invoked  to  ex- 
plain some  cases  of  abortion.  In  our  observation,  however,  the 
ingestion  of  cold  food  or  water  acts  injuriously  only  under  ex- 
ceptional circumstances.  Harms  asserts  that  large  quantities  of 
frozen  food  may  bring  about  abortion  and  we  may  well  believe 
this  because  it  may  produce  very  severe  indigestion  and  toxaemia. 
So  it  is  claimed  that  injection  of  cold  water  into  the  vagina  may 
bring  about  labor  pains  and  the  expulsion  of  the  fetus,  and  also 
that  the  drinking  of  a  large  amount  of  very  cold  water  will  pro- 
duce the  accident.  There  is  another  phase  of  the  question 
which  should  be  considered.  In  many  parts  of  the  country 
pregnant  animals  habitually  drink  ice-cold  water  during  the 
winter  months  ;  they  constantly  eat  food  which  is  out  of  doors 
and  in  many  cases  has  a  temperature  considerably  below  zero  ; 
they  dig  away  snow  from  grass  in  order  that  they  may  eat  it  and 
many  of  them  depend  upon  snow  for  the'r  water  supply.  Yet, 
abortion  does  not  occur  in  such  animals.  If,  however,  a  preg- 
nant mare  is  driven  until  very  warm  and  fatigued,  and  then 
allowed  to  drink  a  large  volume  of  ice-cold  water,  we  may  well 
believe  that  serious  results  to  the  fetus  may  occur.  If  pregnant 
cows  are  kept  in  a  warm  stable  until  they  have  become  exceed- 
ingly thirsty  and  are  then  allowed  to  drink  heavily  of  cold  water, 
a  severe  .shock  to  the  fetus,  as  well  as  to  the  mother,  may  occur. 

Habit  apparently  has  a  strong  influence  in  the  production  of 
abortion  in  individual  animals,  or  possibly  we  might  say  that  in 
the  individual  herself  there  exists  some  peculiarity,  some 
weakness  or  defect  of  the  genital  or  of  the  general  system,  which 
tends  to  prevent  a  fetus  from  arriving  at  full  maturity  and  leads 
to  its  premature  death  and  expulsion.  Such  instances  are  fre- 
quently noted  in  woman  and  are  not  rare  in  the  mare  and  cow, 
but  the  exact  reasons  therefor  are  not  well  understood. 

Twin  pregnancy  in  the  mare  generally  leads  to  abortion  at 
about  the  8th  to  loth  month  of  gestation.  Probably  90%  of 
twin  pregnancies  in  the  mare  thus  end  in  the  death  of  both 
fetu.ses.  In  many  twin  pregnancies  in  the  mare,  the  two  fetu.ses 
die  at  different  periods  but  are  expelled  at  the  same  time,  the  two 
showing  different  stages  of  development.  The  reasons  for  abor- 
tion, in  case  of  twin  pregnancy  in  the  mare,  are  not  understood. 


470  Veterinary  Obstetrics 

It  maj'  be  that  the  two  fetuses  in  some  way  cause  mechanical 
injuries  to  each  other  during  movements  of  the  mare  and  thus 
induce  some  injury  to  the  placenta  and  lead  to  fetal  death. 

Psychic  influences  are  claimed  by  some  to  induce  abortion  in 
rare  cases.  Cases  have  been  related  where  mares  have  aborted 
immediately  after  suffering  greatly  from  fright,  but  even  here  it 
may  be  that  some  physical  injury  resulted  because  of  the  fright. 
It  has  been  stated  by  various  writers  that,  if  one  animal  in  a 
stable  aborts,  the  sight  of  the  accident  may  cause  neighboring 
females  to  also  abort.  Harms  very  properly  remarks  that,  if 
such  a  view  were  correct,  an  animal  giving  birth  to  young  at  the 
regular  time  in  the  presence  of  other  pregnant  females  should 
cause  them  to  abort.  So  far  as  our  literature  indicates,  it  would 
seem  that  psychic  influences  play  a  very  small  part  in  the 
problem  of  abortion.  Large  herds  of  cows,  ewes,  mares  and 
sows  are  permitted  to  regularly  give  birth  to  their  young  in  the 
presence  of  the  other  pregnant  animals,  without  visible  danger 
of  inducing  abortion  or  premature  birth.  Simultaneous  births 
in  a  herd  may  usually  be  regarded  as  coincident  rather  than  con- 
sequent. 

The  castration  of  pregnant  females  usually  causes  abortion, 
although  such  a  result  is  not  inevitable.  The  danger  of  abortion 
following  castration  is  sufficient  to  coutra-indicate  the  operation 
in  pregnant  animals  where  it  is  probable  that  the  accident  would 
imperil  the  life  of  the  mother.  In  some  animals,  like  the  bitch, 
we  habitually  remove  the  fetus  and  uterus  at  the  time  of  castra- 
tion, so  that  the  question  of  possible  abortion  does  not  concern  us. 

Mechanical  irritations  of  the  os  uteri  and  vagina  are  said  to 
endanger  the  life  of  the  fetus,  but  we  have  insufficient  data  to 
clearly  indicate  the  degree  of  risk.  In  practice  we  ordinarily 
make  manual  explorations  of  the  vagina,  in  our  larger  pregnant 
animals,  without  any  apparent  danger.  We  recall  one  case  in 
which  the  owner  of  a  valuable  brood  mare  examined  her  per 
vaginam  because  he  believed  she  was  not  in  foal.  He  dilated 
the  cervical  canal  and  discovered  the  fetus,  which  he  mistook  for 
a  tumor.  Later  I  was  called  and  found  the  fetus,  about  12  inches 
long,  still  alive.  Soon  after  this  examination,  the  mare  aborted. 
This,  however,  does  not  show  that  examination  of  the  vagina  in 
pregnant  mares  is  dangerous,  but  merely  that  when  the  hand  is 
passed  beyond  into  the  uterus,  where  it  eventually  disturbs  the 


sporadic  or  Accidental  Abortion  471 

union  between  the  fetal  membranes  and  the  uterus,  and  causes 
infection,  abortion  is  probable,  if  not  inevitable.  Perhaps  it  is 
through  some  such  examinations  that  the  manipulations  of  these 
parts  have  acquired  the  reputation  of  being  highly  dangerous. 
It  is  evident  that,  if  we  need  make  manual  exploration  of  the 
vaginae  of  pregnant  animals,  we  should  do  so  with  judgment  and 
be  careful  not  to  cause  unnecessary  disturbance. 

Since  .severe  hemorrhage  of  the  mother  tends  to  produce  fatal 
collapse  of  the  fetus  and  is  considered  at  times  to  cause  abortion, 
it  is  well  that  animals  which  are  advanced  in  pregnancy  should 
not  be  submitted  to  operations  accompanied  by  extensive  loss 
of  blood. 

Mechanical  insults  probabh'  play  a  highly  important  part  in 
the  production  of  accidental  abortion.  They  may  act  in  a 
comparatively  direct  manner  upon  the  fetus  as  when  some  vital 
portion  of  its  body  is  lying  in  close  contact  with  the  abdom- 
inal wall  and  receives  a  powerful  blow  from  outside.  More 
commonly,  mechanical  injuries  have  their  effect  somewhat  in- 
directly by  disturbing  the  connection  between  the  fetal  mem- 
branes and  uterus.  Anything  which  can  cause  a  separation  be- 
tween the  maternal  and  fetal  placenta  tends  to  imperil  the  life  of 
the  fetus.  If  the  separation  is  comparatively  slight,  hemorrhage 
occurs  between  the  chorion  and  uterus,  especially  in  animals 
with  diffused  placenta,  as  the  mare.  The  extension  of  this  de- 
tachment over  a  very  wide  area  tends  finally  to  cut  off  the  blood 
supply  to  the  fetus  and  to  induce  uterine  contractions,  with 
expulsion  of  its  contents.  If  an  animal  well  advanced  in  preg- 
nancy falls  violently,  becomes  cast  in  the  harness  or  stall,  or  be- 
comes mired,  the  violence  of  her  movements  may  cause  a  de- 
tachment between  the  chorion  and  uterus  and  lead  to  the  death 
and  expulsion  of  the  fetus. 

The  jamming  and  jolting  suffered  by  pregnant  animals  during 
transportation  by  rail,  and  severe  draft,  is  liable  to  bring  about 
injuries  which  may  lead  to  abortion.  When  pregnant  mares  are 
put  to  work  where  the  draft  is  very  heavy,  or  especially  where 
it  is  intermittent  or  jerky,  the  danger  of  injury  to  the  young  is 
sometimes  very  great.  Mechanical  injuries  are  possible  at  any- 
time, at  work  or  pla}'. 

In  dairies  where  the  cows  are  kept  in  uncomfortable  stanchions. 


472  Veterinary  Obstetrics 

on  slippery,  wet  floors,  there  may  at  any  time  occur  a  slip  or 
fall  which  may  imperil  the  life  of  the  fetus. 

Mechanical  injuries  leading  to  abortion  are  more  common  in 
uniparous  animals,  because  in  these  the  uterus  is  more  fixed  in 
its  position  and  does  not  yield  so  readily  to  external  forces. 
Moreover,  it  is  in  these  animals  that  we  most  frequently  observe 
injuries,  either  at  work  or  in  transport,  as  they  offer  greater 
difficulty  in  handling.  When  they  fall,  their  greater  height  and 
weight  increases  the  impact  and  intensifies  the  strain  upon  the 
placental  attachments.  The  greater  size  and  weight  of  the  fetus 
concentrates  its  impact  upon  a  comparatively  small  area  and  in- 
creases the  injury  to  the  placenta. 

The  recognition  of  an  impending  abortion  is  usually  difficult 
until  near  its  completion.  Usually  the  abortion  occurs  before 
the  owner  or  caretaker  has  become  aware  that  it  is  threatened, 
so  that  the  first  evidence  which  is  observed  is  the  fact  that  the 
abortion  has  taken  place,  as  is  shown  by  the  presence  of  the 
expelled  fetus  and  membranes.  In  cases  where  a  number  of 
pregnant  females  are  kept  together,  it  may  even  be  difficult  to 
determine  which  one  has  aborted,  except  there  can  be  found 
some  marks  upon  the  animal,  consisting  usually  of  .soiled  tail, 
perineum  and  thighs,  due  to  blood  and  fetal  fluids  discharged 
from  the  genital  canal. 

In  other  cases  the  threatened  abortion  is  indicated  by  swelling 
of  the  vulva  and  a  muco-purulent  discharge,  accompanied  .some- 
times by  .swelling  of  the  udder.  The  symptoms  increa.se  general- 
ly as  the  duration  of  pregnancy  increases,  so  that  when  a  late 
period  of  pregnancy  has  been  reached  the  symptoms  are  similar 
to  those  of  normal  birth.  Rarely  the  expulsion  of  the  fetus 
does  not  occur  until  some  time  after  its  death  and  there 
may  be  swelling  of  the  udder,  with  secretion  of  milk,  for  days 
or  weeks  before  the  fetus  is  finally  expelled.  Sometimes  in  the 
mare,  there  is  observed  swelling  of  the  udder  and  secretion  of 
milk  without  apparent  cause,  which  continues  for  several  days 
and  finally  di.sappears.  Later,  in  the  course  of  some  weeks,  the 
mare  aborts  twins,  one  of  w^hich  is  found  to  be  much  less  de- 
veloped than  the  other.  This  suggests  that  the  one  had  peri.shed 
at  the  time  when  the  swelling  of  the  udder  was  noted,  but  had 
not  been  expelled,  and  the  other  had  continued  to  live  and  grow 


Enzootic  Abortio7i  473 

until  finall}^  it  too  perished  and  the  two  were  then  expelled  to- 
gether, in  different  stages  of  development. 

The  course  of  abortion  is  generally  rapid  and  when  once  be- 
gun is  usualh-  completed  quickly,  offering  little  or  no  hope  that 
it  may  be  in  any  way  averted.  If  the  os  uteri  is  still  closed  and 
there  are  simply  some  feeble  labor  pains,  it  is  barely  po.ssible  that, 
by  quieting  the  animal,  the  normal  duration  of  pregnancy  may  be 
reached  and  living  young  produced.  Such  a  result  is  almost 
unknown  clinically. 

Harms  suggests  that  we  may  check  the  labor  pains  by  the  in- 
ternal administration  of  camphor,  with  opium,  alcohol  or  other 
stimulants. 

When  abortion  has  actually  occurred,  it  is  not  pos.sible  to  at 
once  determine  if  it  is  sporadic  or  infectious  and  consequentl}- 
we  should  treat  each  case  of  abortion  occurring  in  a  stable  or 
herd  as  suspicious  of  infection  and  handle  it  accordingly.  This 
will  be  considered  under  Infectious  Abortion. 

The  .sequelae  of  the  sporadic  abortion  are  the  same  as  those  of 
the  infectious  kind,  which  will  also  be  considered  in  that  chapter. 

II.     Enzootic  Abortion  Resulting  from  Infectious  Dis- 
eases OF  THE  Pregnant  Animal. 

When  con.sidering  contagious  cellulitis,  on  page  68,  we  noted  that 
nearly  all  pregnant  mares  suffering  from  this  affection  aborted. 
When  describing  venereal  diseases,  on  page  73,  we  laid  stress  upon 
the  frequency  of  abortion  in  certain  of  these  maladies,  especially  in 
the  granular  venereal  disease  of  cows  and  dourine  of  mares,  in 
which  affections  a  large  proportion  of  the  pregnant  animals  abort. 
In  some  other  infectious  diseases  of  animals,  abortion  is  common. 
It  occurs  frequently  in  foot-and-mouth  disease  and  contagious 
pleuro-pneumonia  of  cows.  In  sheep-pox,  abortion  is  said  to  be 
frequent.  Pregnant  sows  suffering  from  hog-cholera  generally 
abort. 

The  reason  for  abortion  in  these  affections  is  not  well  known. 
As  the  micro-organism  which  causes  some  of  these  diseases  is  not 
fully  determined  or  its  nature  is  in  dispute,  it  is  impossible  to  say 
whether  the  fetus  contains  the  causative  agent  or  not.  It  is 
quite  possible  that  the  death  of  the  fetus,  in  many  of  these  in- 
stances, is  due  to  the  passage,  into  the  fetal  circulation,  of  the 
toxic  products  of  the  malady.     It   is  clearly  possible  that  the 


474  Veterinary  Obstetrics 

micro-orgauism  of  the  disease  itself  may  pass  through  the  pla- 
cental capillaries  and  gain  entrance  into  the  fetal  circulation, 
thus  accomplishing  its  destruction. 

So  far  as  known  at  present,  the  micro-organisms  of  those  in- 
fectious diseases  which  frequently  cause  abortion  in  the  preg- 
nant female  largely  belong  to  the  assumed  ultra-microscopic 
group.  The  causative  agent  can  pass  through  an  ordinary  filter 
and  perhaps  also  through  the  dividing  membrane  between  the 
placental  blood-streams  of  mother  and  fetus.  Among  the  dis- 
eases mentioned  as  causing  abortion,  douriue  constitutes  an  ap- 
parent exception,  the  disease  being  clearly  due  to  the  presence 
of  a  trypanosome.  But  we  do  not  know  that  it  causes  abortion. 
It  prevents  breeding  certainly  enough,  but  whether  it  inhibits 
fertilization  in  the  affected  mares  or  later  destroys  the  young  em- 
bryo is  not  ascertained.  Even  in  the  latter  case  the  parasite  en- 
ters by  the  genital  canal,  is  known  to  exist  in  the  genital  secre- 
tions and  can  directly  attack  the  fetal  membranes. 

The  symptoms  of  abortion  from  such  diseases  present  no  differ- 
ences from  those  of  accidental  abortion  and  can  only  be  differen- 
tiated from  such  by  the  fact  that  the  abortion  occurs  in  imme- 
diate connection  with  the  contagious  fever  itself  and  independent 
of  any  other  known  influence  which  could  bring  it  about. 

This  form  of  abortion  is  important  because  the  loss  to  the 
breeder  is  the  same  as  in  other  abortions,  with  the  additional 
danger  that,  by  complicating  the  disease  of  the  mother,  it  in- 
creases the  mortality  among  pregnant  females. 

There  is  nothing  to  be  done  in  the  way  of  prophylaxis  or  con- 
trol of  such  outbreaks  of  abortion,  aside  from  the  general  meas- 
ures to  be  taken  in  reference  to  the  contagious  disease  of  the 
mother.  In  this  connection  it  might  be  well  to  emphasize  what 
we  have  already  said  on  page  68  in  reference  to  contagious  cel- 
lulitis, which,  becau.se  of  this  tendency  to  abortion,  constitutes 
one  of  the  most  dangerous  diseases  of  stallions  and  brood  mares. 

III.  Infectious  Abortion. 

The  vast  majority  of  abortions  in  domestic  animals  are  due  to 
infection.  The  disease  is  most  common  in  the  mare  and  cow  and 
has  been  ob-served  in  the  ewe,  goat  and  sow. 

According  to  many  authors,    abortion   is   most   common   and 


hifedioiis  Abortion  475 

serious  in  the  cow,  but  it  is  questionable  if  this  is  correct  in  all 
respects.  The  loss  from  single  abortion  is  generally  greater  in 
the  mare  than  in  the  cow.  A  large  proportion  of  calves  are 
destroyed  at  once  or  soon  after  birth  because  they  are  virtually 
worthless  or  their  raising  entails  more  expense  than  their  ulti- 
mate value  when  grown.  The  principal  loss  in  the  cow  is  the 
interference  with  the  milk  yield,  which  is  of  course  highly  im- 
portant. In  the  case  of  the  brood  mare,  it  is  desired  to  raise 
each  foal  and  its  death  becomes  a  serious  loss.  Compared  with 
the  calf,  its  individual  value  is  much  greater. 

Therefore,  when  abortion  becomes  widespread  in  a  region 
where  horse  breeding  is  very  extensive  and  where  the  animals 
have  a  high  value,  the  losses  are  enormous  and  it  is  difficult  to 
state,  without  reliable  statistics,  in  which  species  of  animal 
abortion  causes  the  greatest  monetary  losses,  although  we  must 
admit  that  the  economic  lo.ss  from  abortion  in  cows  has  received 
more  attention  and  is  more  apparent.  The  view  is  doubtless 
correct  that  abortion  in  cows  is  more  widespread,  largely  owing 
to  the  fact  that  the  infection  apparently  has  a  better  opportunity 
for  spreading.  The  disease  in  cows  also  has  better  opportunity 
for  perpetuation  owing  to  the  fact  that  cows  are  bred  through- 
out the  entire  year,  whereas,  in  the  mare,  the  breeding  is  more 
concentrated  at  one  season,  and  an  outbreak  of  abortion  may 
vent  its  full  force  by  destroying  all  the  fetuses  in  a  stable  and 
then  cease  to  exist  for  want  of  material  to  sustain  it. 

Most  authors  consider  infectious  abortion  as  a  universal  mal- 
ady which  may  be  transferred  from  one  species  of  animal  to  an- 
other. A  few  cases  have  been  cited,  in  our  literature,  where  in- 
fectious abortion  has  prevailed  simultaneously  on  the  same  farm 
among  cows  and  mares,  but  this  is  a  very  rare  occurrence  and 
quite  contrary  to  the  rule.  Infectious  abortion  occurring  in  dif- 
ferent species  of  animals  simultaneously  upon  the  same  farm  is 
no  more  frequent  than  should  be  expected  as  a  coincidence. 
There  is  no  reason  why  infectious  abortion  of  mares  and  cows 
may  not  co-exist  as  two  distinct  affections  on  one  farm.  In  our 
earlier  experience,  we  observed  chiefly  infectious  abortion  of  the 
mare  and,  in  our  territory,  the  different  species  of  pregnant  ani- 
mals largely  occupied  the  same  enclosures. 

The  abortions  in  the  mare,  in  our  experience,  very  largely 
occurred  in  the  open  pasture  or  field.     Though  there  were  habit- 


476  Veteri7iary  Obstetrics 

ually  pregnant  cows  in  the  same  enclosures,  we  never  observed 
abortion  in  these.  In  fact,  during  a  period  of  12  years  in  private 
practice,  in  a  region  devoted  almost  equally  to  the  rearing  of 
draft  horses  and  beef  cattle,  we  did  not  observe  a  single  outbreak 
of  infectious  abortion  in  cows.  On  the  other  hand,  numerous 
outbreaks  of  infectious  abortion  of  mares  occurred,  which  were 
widespread  and  caused  an  almost  total  loss  of  the  foal  crop. 
During  the.se  outbreaks  of  contagious  abortion  in  mares,  it  also 
occurred  very  naturally  that  the  aborted  fetuses  and  afterbirths 
were  very  frequently  eaten  by  pregnant  .sows.  Yet,  we  did  not 
observe  that  any  of  them  ever  aborted  from  this  cause.  Nor 
have  we  ever  seen  infectious  abortion  in  the  sow,  although  in 
the  region  of  our  practice  swine  breeding  was  one  of  the  leading 
industries  and  many  farmers  habitually  bred  from  jo  to  20  or 
more  sows  each  year.  From  a  clinical  standpoint,  it  seems  very 
certain  that  each  of  our  herbivorous  domestic  animals  has  a  form 
of  infectious  abortion  peculiar  to  itself  and  not  transmissible  in  a 
natural  way  to  other  .species. 

Bang  (Journal  of  Comparative  Pathology  and  Therapeutics, 
Vol.  19,  page  191)  holds  that  abortion  among  mares  may  be  due 
to  the  same  bacillus  or  micro-organism  as  that  which  causes  the 
disease  in  cows  and  concludes  that  it  "  reminds  us  not  to  neglect 
precautions  in  order  to  protect  mares  against  infection  from 
aborting  cows."  Bang  has  by  no  means  proven  his  suspicion, 
as  he  failed  in  his  one  recorded  experiment  with  a  mare  to  pro- 
duce abortion,  and  the  animal  gave  birth  to  a  small  living  foal 
which  continued  to  live  for  two  days.  He  asserts,  however, 
that  he  has  produced  abortion  by  the  injection  of  his  abortion 
bacillus  into  the  veins  of  sheep,  goats  and  rabbits,  in  addition  to 
the  cow.  He  has  not  shown,  however,  that  any  of  these  ever 
contracted  the  di.sea.se,  in  a  natural  way,  from  another  species  of 
animal. 

Ostertag  (Monatshefte  fur  Praktische  Tierheilkunde,  Vol.  12, 
page  385)  records  a  careful  study  of  infectious  abortion  in  the 
mare,  in  which  he  concludes  that  the  cause  of  the  disease  in  this 
animal  is  different  from  that  in  the  cow.  He  finds  that  the 
micro-organism  of  infectious  abortion  of  the  mare  is  a  short 
streptococcus,  instead  of  a  bacillus,  as  described  by  Bang  and 
others  as  the  cause  of  abortion  in  cows. 


Infections  Abortion  of  Mares  477 

Ostertag  produced  further  evidence  of  the  non-identity  of  in- 
fectious abortion,  in  various  species,  by  experiment.  He  inocu- 
lated two  pregnant  goats  with  the  membranes  of  foals  which  had 
been  expelled  as  a  result  of  infectious  abortion,  and  each  of  them 
gave  birth  to  living  and  vigorous  kids.  He  further  attempted  ex- 
perimental inoculation  in  four  pregnant  mares  and  ten  pregnant 
cows,  with  the  result  that  two  of  the  mares  aborted,  the  one  after 
8  days  and  the  other  after  20  days.  Each  fetus  contained  the 
cocci  of  abortion.  The  other  two  mares  gave  birth  to  living 
foals  after  8  and  17  days  respectively.  The  foals  were  weak  and 
the  chorion  of  each  contained  abortion  cocci.  The  foal  expelled 
on  the  8th  day  after  inoculation  died  soon  after  birth,  while  the 
other  recovered  and  developed  normally. 

The  ten  experimental  cows  resisted  the  inoculation  completely. 
Neither  the  introduction  of  portions  of  afterbirth  or  fetal  fluids 
into  the  vaginae  of  pregnant  cows  from  aborted  foals,  nor  the 
inoculation  of  them  with  abortion  cocci  induced  abortion. 

Whether  we  examine  the  question  in  the  light  of  clinical  ex- 
perience, bacteriologic  study  or  inoculation  experiments,  it 
appears  certain  that  the  infectious  abortion  of  one  species  of  ani- 
mal is  fundamentally  and  essentially  different  from  that  of  an- 
other and  that  there  is  no  probability  of  the  disease  spreading 
from  one  species  of  animal  to  another,  in  a  natural  wa3^  Even 
by  artificial  inoculation,  there  is  little  to  indicate  that  the  disease, 
as  such,  can  be  transferred  from  one  species  to  another. 

We  shall,  therefore,  deal  with  infectious  abortion  as  a  .separate 
malady  for  each  of  our  domestic  animals,  although  granting  that 
there  may  be  a  more  or  less  intimate  relationship  existing  be- 
tween them,  but  not  of  a  sufficient  degree  to  render  an  outbreak 
of  abortion  in  one  species  dangerous  for  other  species  which  may 
come  in  close  contact  with  the  affected  animals. 

A.   InfectioUvS  Abortion  of  Mares. 

Fleming  (Animal  Plagues)  records  the  occurrence  of  abortion 
prior  to  the  Chri.stian  era,  though  definite  records  of  the  disease 
were  not  made  to  any  great  extent  until  late  in  the  i8th  century. 
As  with  all  other  infectious  diseases,  there  was  much  doubt  as  to 
the  infectious  character  of  the  malady  until  after  the  middle  of 
the  19th  century,  when  a  large  proportion  of  the  foremost  veter- 


478  Veterhiary  Obstetrics 

inarians  began  to  hold  that  the  prevalence  of  the  disease  was  due 
to  infection  and  not  to  climatic  or  other  chance  influences  acting 
upon  a  great  number  of  animals,  in  the  same  way,  at  the  same 
time. 

Infectious  abortion  of  mares  first  acquired  prominence  in  the 
United  States  about  1886,  when  it  appeared  in  several  states  in 
the  Mississippi  Valley,  in  which  horse  breeding  had  become  a 
very  important  industrj-.  It  soon  acquired  a  very  extensive  dis- 
tribution and  high  degree  of  virulence.  The  unorganized  state 
of  veterinary  science  in  the  United  States  prevented  the  recording 
of  any  definite  statistics  in  reference  to  the  losses,  but  they  were 
certainly  enormous.  At  the  time  of  the  introduction  of  this  dis- 
ease, or  rather  when  it  acquired  general  importance,  the  writer 
was  in  private  practice  at  Bloomington,  111.,  which  was  then  one 
of  the  richest  draft  horse  breeding  districts  in  America,  and  we 
estimated  that  in  1888,  in  one  county,  at  least  2500  foals  perished 
from  infectious  abortion.  Since  these  foals  were  generally  valued 
at  about  $60  per  head  at  weaning  time,  the  monetary  loss  may 
be  estimated  at  $150,000  in  a  single  year  in  one  county.  That 
county  was  in  no  way  es.sentially  different  from  others  through- 
out a  number  of  states. 

Were  reliable  stati.stics  as  to  the  actual  losses  available,  they 
would  be  so  enormous  for  the  entire  Mississippi  Valley  as  to  be 
astounding.  In  some  townships  where  horse  breeding  constituted 
one  of  the  principal  agricultural  pursuits,  the  abortions  exceeded 
.seventy-five  per  cent  of  the  pregnant  mares.  The  losses  were 
most  marked  in  large  breeding  establishments  where  highly 
valuable  mares  were  kept  for  breeding,  purposes  alone.  The 
losses  were  just  as  real  on  small  farms  where  but  a  few  mares 
were  kept,  which,  after  aborting,  could  be  employed  to  some 
extent  in  farm  work.  However,  throughout  this  area,  many 
farmers  maintained  a  number  of  mares  wholly  for  the  purpose  of 
breeding.  In  such  herds,  the  losses  of  the  foal  crop  were  often 
complete.  In  one  .season,  one  of  our  clients  with  a  highlj^  valu- 
able herd  of  imported  draft  mares,  about  50  in  number,  lost  every 
foal  from  infectious  abortion,  save  in  the  case  of  one  mare,  which 
was  in  our  ho.spital  under  treatment  for  a  chronic  disease  and 
consequently  carried  her  foal  to  full  term.  In  another  instance, 
in  the  territory  of  a  neighboring  veterinarian,  a  breeder  had  100 
pregnant  imported  draft  mares,  in  which  the  loss  from  infectious 


Infectious  Abortion  of  Mares  479 

abortion  was  total  as  to  foals,  and  four  of  the  mares  perished  be- 
cause of  sequelae.  Other  similar  instances  might  be  related 
without  number  and  give  a  somewhat  vivid  impression  of  the 
enormous  losses  which  niaj'  be  caused  by  this  malady. 

The  infectiousness  of  the  disease  is  shown  by  clinical  obser- 
vation. In  a  large  proportion  of  cases  it  is  possible  to  trace  the 
beginning  of  an  outbreak  of  abortion  in  a  herd  of  mares  to  the 
temporary  or  permanent  indroduction  of  a  mare  from  a  herd  in 
which  the  malady  already  existed.  A  pregnant  mare  is  bought 
from  an  infected  herd  and  placed  in  the  stable  or  pasture  with 
pregnant  mares,  which,  up  to  the  time,  were  free  from  the 
disease.  Within  a  few  days  abortion  sets  in  and  nearly  or  all 
the  pregnant  mares  in  the  herd  abort  as  a  result.  In  other  cases, 
a  neighbor  has  driven  a  pregnant  mare,  or  one  which  has  re- 
cently aborted,  from  his  own  farm  to  that  of  his  neighbor  and  has 
placed  it  in  close  proximity  to  the  pregnant  mares  or  has  tempora- 
rily placed  it  in  the  stable,  and  even  in  the  same  stall  where  preg- 
nant mares  are  later  brought.  Within  a  few  daj-s,  these  mares 
in  turn  commenced  to  abort.  Or,  the  owner  of  a  number  of 
pregnant  mares  drives  one  of  them  to  a  neighbor's  or  to  a  public 
stable  where  animals  afflicted  with  the  disease  have  been  kept. 
Returning  home,  this  mare  soon  aborts.  After  an  interval,  other 
abortions  follow  and  finally  destruction  of  the  entire  foal  crop. 

Guillerey  ( Archiv  fur  Tierheilkunde,  Vol.  29,  page  37)  gives 
us  some  excellent  data  of  the  way  in  which  an  outbreak  of 
abortion  in  mares  spread  in  his  territory.  G.  was  called  on 
Januarj'  27,  1897  ^o  remove  the  afterbirth  from  a  six  year-old 
mare  which  had  aborted  at  10  months  the  previous  evening.  As 
the  mare  was  unable  to  expel  the  fetus  without  assistance,  the 
owner  asked  four  neighbors  to  assist  him.  Three  daj's  later,  in- 
fectious abortion  of  a  virulent  character  broke  out  in  the  stables 
of  each  of  these  four  friends.  On  the  4th  of  February,  in  the 
same  locality,  two  mares  owned  by  P.  aborted.  Three  days 
previously  P.  had  a.ssisted  a  neighbor  in  a  case  of  difficult  labor 
from  abortion.  In  another  case  he  records  that  a  mare  aborted, 
and  that  neighbors  who  entered  the  stable  conveyed  the  in- 
fection to  their  own  animals,  which,  in  turn,  aborted.  Following 
the  entire  outbreak,  G.  was  able  to  trace  the  source  of  infection 
with  uniformity  from  stable  to  stable  and  from  village  to  village. 


480  Veterinary  Obstetrics 

In  two  small  villages,  where  there  were  68  pregnant  mares,  60 
of  them  aborted. 

An  extensive  array  of  clinical  observations  as  to  the  infectious- 
ness of  the  disease  might  be  added.  They  all  have  the  same 
general  character  and  force.  The  disease  does  not  occur  except 
as  a  result  of  exposure  to  some  animal,  either  directly  or  indirect- 
ly, which  has  previously  aborted,  and  when  this  exposure  does 
take  place  abortion  is  as  liable  to  follow  as  is  the  occurrence  of 
any  other  contagious  disease  known  to  veterinary  science. 

Experimentation  affords  good  evidence  of  the  infectiousness 
of  abortion  in  the  mare.  Ostertag,  as  already  related,  records 
four  cases,  with  abortion  in  two  of  the  animals  and  suggestive 
results  in  the  other  two. 

Guillerey  cites  one  experiment,  which  in  itself  is  admittedly 
inconclusive.  A  piece  of  afterbirth  from  a  mare  which  had 
aborted  was  introduced  into  the  vagina  of  a  mare  in  the  9th 
month  of  gestation.  Two  days  later  there  was  a  muco-purulent 
discharge  and  on  the  3rd  day  the  mare  aborted.  Here  and  there 
in  veterinary  literature,  occasional  cases  are  mentioned  where 
mares  have  been  caused  to  abort  by  experimental  inoculation, 
but  the  number  of  these  is  not  extensive.  So  far  as  these  ex- 
periments have  been  carried,  they  are  strongly  indicative  of  the 
infectious  character  of  the  disease. 

The  bacteriologic  researches  of  Ostertag  and  others  furnish 
additional  proof  of  the  infectious  character  of  the  disease. 
Ostertag  separated  and  cultivated  a  short  streptococcus,  which 
produced  abortion  after  experimental  inoculation.  The  micro- 
organism was  obtained  in  pure  cultures  from  the  aborted  fetus 
and  its  membranes. 

We  have  further  proof  of  the  infectious  character  of  the  disease 
in  the  fact  that  it  may  be  largely  controlled  by  disinfection  and 
the  isolation  of  pregnant  animals.  The  significance  of  this 
proof  will  be  brought  out  in  our  consideration  of  the  control  of 
the  disease. 

In  common  with  the  behavior  of  all  infectious  diseases,  the 
contagious  abortion  of  mares  is  most  frequently  seen  and  attains 
its  greatest  virulence  in  those  regions  where  horse  breeding  is 
most  concentrated  and  the  animals  have  a  high  value.  This 
involves,  as  a  general  rule,  the  close  stabling  of  animals  or  their 
being  kept  in  close  contact  with  each  other  upon  pastures. 


Infectious  Abortion  of  Mares  481 

Infectious  abortion  in  the  mare  ma}'  occur  at  any  stage  during 
pregnancy — an  observation  which  possibly  holds  true  to  a  great 
extent  for  other  domestic  animals.  The  abortion  is  most  fre- 
quently observed,  however,  after  the  fetus  has  acquired  con- 
siderable size,  so  that  it  is  most  usually  noticed  after  the  6th  to 
8th  month  and  even  more  commonlj-  during  the  loth  and  nth 
months.  In  some  of  our  observations,  however,  the  abortion 
had  apparently  occurred  very  early,  although  no  positive  proof 
of  this  was  obtainable.  In  fact  it  is  exceedingly  difficult  to 
obtain  proof  of  abortion  during  the  first  few  weeks  of  pregnancy, 
since  the  small  embryo,  with  its  inconspicuous  membranes,  may 
be  expelled  without  attracting  any  attention  whatever  on  the 
part  of  the  owner  and  does  not  interfere  in  the  least  visible  de- 
gree with  the  general  well-being  of  the  animal. 

In  our  investigations,  there  was  one  well-defined  instance 
where  very  early  abortion  seemed  to  be  well  proven.  An  ex- 
tensive breeding  farm  had  over  100  breeding  mares,  .some  of 
which  were  imported  draft  animals  and  the  others  highly  bred 
trotting  mares.  They  were  unusualh-  well  kept,  under  as  favor- 
able conditions  as  breeding  animals  could  well  be  placed.  The 
mares  were  at  pasture  upon  good  blue-grass,  which  was  quite 
free  from  herbage  having  any  suspicious  character  in  reference 
to  breeding.  The  mares  were  young  and  in  excellent  general 
health.  The  stallions  were  vigorous  and  well  handled  and  had 
previously  shown  them.selves  to  be  regular  and  sure  breeders. 
During  one  season  these  mares  of  both  breeds  seemed  to  con- 
ceive readil)-  upon  being  bred,  and  upon  being  re- tried  to  the 
stallion  they  showed  no  signs  of  estrum  and  were  apparently 
safely  in  foal.  After  they  had  been  re-tried  one,  two  or  three 
times  successfully,  it  was  found  that  later  they  showed  estrum 
and  again  had  to  be  bred.  The  condition  was  xQ.xy  puzzling  to 
the  superintendent  and  no  explanation  was  apparent  during  the 
spring  and  earl}'  summer. 

Finally,  in  early  autumn,  when  some  of  the  mares  had  .safely 
carried  their  foals  for  several  months,  there  was  occasionally 
found  in  the  pasture  a  partially  matured  fetus.  As  the  season 
advanced  well  nigh  all  of  the  few  mares,  which  during  the  breed- 
ing .sea.son  had  constantly  shown  signs  of  being  in  foal,  aborted, 
and  the  foal  crop  was  well  nigh  ruined.  Here  it  would  .seem  that 
there  was  good  evidence  that  many  of  these  mares  aborted  during 
31 


482  Veterinary  Obstetrics 

the  first  60  days  of  pregnancy,  but,  running  in  pasture  as  they 
were,  the  fetuses  would  not  be  discovered,  and  would  probably 
be  picked  up  by  scavenger  animals  or  birds.  The  mares  would 
show  no  signs  of  any  accident  having  occurred,  so  that  it  was 
only  later,  when  a  few  fetuses  had  become  sufficiently  large  to  be 
noticeable,  that  the  true  character  of  the  interruption  in  breed- 
ing was  discernible. 

In  other  instances  we  have  noted  the  disease  occurring  during 
the  late  summer  and  early  autumn,  when  the  mares  had  been 
pregnant  from  four  to  six  months.  In  the.se  outbreaks  the  dis- 
ease was  quite  as  virulent  as  in  tho.se  outbreaks  occurring  during 
the  nth  month  of  gestation.  Many  authors  claim  that  abortion 
in  the  mare  is  more  common  as  gestation  nears  its  end.  This 
difference,  if  it  exists,  is  not  .so  great  as  it  seems,  because  the  ac- 
cident in  the  earlier  stages  of  gestation  is  largely  overlooked  and 
pas.ses  unseen. 

The  symptoms  of  infectious  abortion  in  the  mare  depend 
very  largely  upon  the  stage  of  gestation  at  which  the  disease  ap- 
pears. It  passes  virtually  unnoticed  during  the  earlier  stages  of 
pregnancy.  During  the  first  eight  weeks  of  gestation  it  is  u.sually 
by  mere  chance  that  abortion  is  discovered,  In  one  case  which 
we  observed,  a  mare  was  being  driven  when  the  driver  noticed 
some  object  protruding  from  the  vaginia.  Upon  examination, 
this  was  found  to  be  a  fetus  about  4  inches  in  length,  enclosed  in 
its  membranes.  Such  a  fetus  is  readily  overlooked,  and  its  ex- 
pulsion was  discovered  only  because  the  animal  was  being  driven 
at  the  time.  Even  then  it  might  readily  have  dropped  out 
upon  the  road  without  being  okserved  at  all.  Later  in  preg- 
nancy there  may  occur  slight  symptoms  of  impending  abortion 
for  a  few  hours,  or  possibly  a  day,  before  the  expulsion  of  the 
fetus.  These  .symptoms  consist  essentially  of  some  swelling  of 
the  vulva,  with  a  more  or  less  conspicuous  muco-purulent  dis- 
charge. Later,  according  to  the  period  of  gestation,  there  may 
be  more  or  less  prominent  labor  pains,  with  light  symptoms  of 
colic,  a  few  hours  prior  to  the  expulsion  of  the  fetus. 

Even  in  the  more  advanced  stages  of  pregnancy,  however,  abor- 
tion usually  occurs  without  forewarning  and  the  first  evidence  of 
anything  ami.ss,  so  far  as  the  owner  observes,,  is  finding  the  dead 
fetus  in  the  stable  or  pasture. 


Infectious  Abortio7i  of  Mares  483 

The  course  of  infectious  abortion  in  the  mare  is  usually  very 
rapid  and  unevefftful,  in  close  correspondence  with  normal  par- 
turition. The  fetus  is  quickly  expelled  when  labor  pains  appear 
and,  if  the  abortion  occurs  comparatively  early  during  gestation, 
the  fetus  is  expelled  completely  enclosed  in  its  chorion.  Later  in 
gestation  the  chorion,  and  sometimes  the  amnion,  ruptures  as  in 
normal  parturition  and  the  expulsion  of  the  fetus  is  accompanied 
by  more  evidence  of  labor.  The  fetus  does  not  always  present 
in  a  normal  manner,  but  there  are  frequent  deviations  of  the  head 
and  limbs.  In  case  of  anterior  presentation,  the  head  is  very 
likely  to  be  turned  to  one  side  and  one  or  both  anterior  limbs 
may  be  more  or  less  retained.  In  presenting  posteriorly,  the 
breech  presentation  is  very  common.  These  vicious  presenta- 
tions are  not  serious  obstacles  to  expulsion  up  to  the  8th  or  9th 
month,  but  during  the  loth  and  nth  months  may  bring  about 
light  dystokia.  However,  unless  gestation  has  been  virtually  com- 
pleted, the  dystokia  is  readily  overcome  by  the  veterinarian  and 
the  fetus  easily  extracted.  After  its  extraction,  ii.  cases  where 
the  abortion  occurs  late  in  pregnancy,  there  is  a  marked  tendency 
to  retention  of  the  chorion  ;  whereas,  as  we  have  previously 
stated,  if  abortion  occurs  early,  the  fetus  is  probably  expelled  in 
its  chorion. 

The  sequalse  of  abortion  in  the  the  mare  are  numerous  and 
frequently  serious  in  character.  They  depend  largely  upon  the 
period  of  gestation  at  which  the  abortion  occurs,  as  is  very  well 
shown  by  three  tables  which  Guillerey  submits  in  the  article 
which  we  have  quoted.  In  his  first  table,  in  case  of  an  outbreak 
of  infectious  abortion,  he  relates  17  cases,  each  of  which  were 
followed  by  more  or  less  serious  sequelae,  including  the  reten- 
tion of  the  placenta,  metritis,  metro-peritonitis,  tendinitis,  syno- 
vitis, arthritis,  lympho-phlebitis,  mamniitis,  vaginitis  and  para- 
plegia. Most  of  these  cases  occurred  after  the  loth  month  of 
pregnancy,  and  the  shortest  duration  of  pregnancy  was  seven 
months.  In  his  second  table,  where  the  duration  of  pregnancy 
varied  from  the  fourth  to  the  seventh  month,  the  sequelae  were 
unimportant  and  virtually  absent,  whereas,  in  his  third  table, 
where  the  period  of  gestation  ranged  from  the  seventh  to  the 
ninth  and  exceptionall}'  the  tenth  month,  the  sequelae  occupied 
a  middle  position  between  the  other  two  tables. 


484  Veterhiary  Obstetrics 

The  period  of  incubation  is  comparativeh'  short,  or  we 
might  say  that  it  corresponds  quite  closely  to  that  observed  in 
most  contagious  diseases  of  animals.  According  to  our  personal 
observations,  the  incubation  period  usually  ranges  from  8  to  10 
days.  Guillerey  considers  the  period  of  incubation  from  3  to  5 
days  in  virulent  outbreaks.  In  the  milder  cases,  according  to 
his  observations,  the  duration  of  incubation  was  from  10  to  18 
days.  This  observation  is  interesting  in  that  it  would  appear  to 
indicate  that  the  earlier  during  gestation  infection  occurs,  the 
longer  the  period  of  incubation.  The  observations  of  G.  in  ref- 
erence of  the  period  of  incubation  do  not  materially  conflict  with 
our  own.  He  gives,  in  a  supplementary  table,  the  average  dura- 
tion of  incubation  in  the  mild  outbreaks  as  12  days  and  in  the 
severe  outbreaks  as  four  days. 

The  bacteriology  of  infectious  abortion  in  mares  has  not  been 
determined  in  a  manner  universally  acceptable.  Ostertag  found, 
in  the  blood  of  the  fetal  heart,  in  the  thoracic  cavity,  and  in  the 
intestinal  tract,  short  streptococci  which  were. readily  stained  by 
the  Gram  method.  In  serum  agar,  this  micro-organism  grew  in 
very  small  areas  scarcely  visible  to  the  naked  eye,  while  in  a 
stick  culture  it  assumed  the  form  of  a  thread-like  colony  through- 
out the  length  of  the  tube.  It  also  grew  in  a  serum  bouillon 
and  caused,  after  two  days,  a  general  cloudiness  of  the  entire 
mass.  Sometimes  Ostertag  .secured  pure  cultures  from  the  body 
of  the  aborted  fetus,  while  from  the  surface  of  the  chorion  he 
obtained  the  same  cocci  in  company  with  various  bacteria. 

In  one  experiment  Ostertag  injected  a  pure  culture  of  this 
streptococcus  into  the  jugular  vein  of  a  pregnant  mare.  Twenty 
days  later  the  mare  aborted. 

A  question  of  the  correctness  of  the  findings  of  Ostertag  is 
raised  by  the  fact  that  he  is  in  apparent  conflict  with  Bang,  who 
finds  in  the  infectious  abortion  of  the  cow  a  short  bacillus  instead 
of  a  streptococcus.  Bang  even  claims,  as  we  shall  dwell  upon 
more  particularly  in  the  next  article,  that  his  abortion  bacillus  is 
capable  of  producing  abortion  in  almost  any  pregnant  animal, 
and  would  apparently  have  us  believe  that  the  contagious  abor- 
tion of  various  animals  is  identical  and  interchangeable.  As  we 
have  already  stated,  we  consider  that  clinical  evidence  shows 
very  clearly  the  non-identity  of  infectious  abortion  in  the  vari- 
ous species  of  aninials.     Nevertheless,   we  should   expect   that 


Period  of  Infectio7i  485 

the  mirco-organism  should  be  somewhat  similar  in  the  different 
species  and  should  belong  to  the  same  genus  of  bacteria.  We 
would  compare  the  bacteriology  of  infectious  abortion  to  that  of 
tuberculosis,  in  which  there  is  a  very  close  resemblance  be- 
tween the  bacilli  causing  tuberculosis  in  the  various  species 
of  animals,  so  much  so  that  the  differentiation  between  certain 
forms  is  somewhat  in  controversy,  or  at  least  has  only  recently 
been  definitely  settled.  We  are  strongly  inclined  to  believe  that, 
if  the  infectious  abortion  of  the  cow  is  caused  by  a  bacillus,  that 
of  the  mare  is  also  referable  to  a  bacillus  ;  if  the  infectious  abor- 
tion of  the  mare  is  caused  by  a  streptococcus,  as  Ostertag  claims, 
the  corresponding  disease  in  the  cow  is  likewise  cau.sed  by  a 
streptococcus.  The  evidence  submitted  by  Bang  and  Ostertag 
is  alike  good  in  each  case,  so  far  as  it  goes,  nor  is  there  anything 
definite  to  show^  that  each  may  not  be  correct  in  his  findings. 

There  exists  the  further  possibility  that  the  eventual  explana- 
tion of  this  apparent  conflict  may  rest  upon  a  similar  basis  to 
that  of  hog  cholera,  where  it  has  recently  been  admitted,  upon 
high  authorit3%  that  the  disea.se  can  be  produced  in  a  typical 
form  without  the  presence  of  the  hog  cholera  bacillus.  This 
leads  one  to  conclude  that  the  hog  cholera  bacillus  is  usually 
pre.sent  in  hog  cholera  and  may  have  some  .secondary  relation  to 
the  di.sea.se  or  the  lesions,  and  that  the  essential  cause  of  the 
disease  consists  of  some  micro-organi.sni  which  has  not  yet  been 
discovered.  It  is  so  small  that  it  will  pass  through  a  filter  fine 
enough  to  remove  the  hog  cholera  bacillus,  and  the  filtrate  will  pro- 
duce the  typical  disease  in  the  hog  without  the  presence  of  the 
hog  cholera  bacillus.  It  is  best,  therefore,  to  accept  the  re- 
searches of  Ostertag  and  others  as  tentative,  and  to  await  further 
researches  before  finally  accepting  any  conclusion  as  to  the  funda- 
mental cause  of  the  disease. 

The  Avenue  of  Infection.  The  manner  in  which  the  in- 
fection is  carried  from  one  animal  to  another,  and  the  avenue  by 
which  the  infection  reaches  the  fetus  and  its  membranes,  are 
highly  important,  from  the  standpoint  of  the  control  of  the 
di.sease.  Of  first  importance  is  the  manner  by  which  the  disea.se 
is  introduced  into  a  herd  or  .stable.  According  to  the  observa- 
tions of  Guillerey,  which  have  already  been  cited,  the  disea.se 
was  carried  in  several  instances  from  one  stable  to  another  by 
men.     Neighbors   were   called  by  a  client   to  aid   Guillerey  in 


486  Veterhiary  Obstetrics 

extracting  an  aborted  fetus,  who,  returning  to  their  own  estab- 
lishments, carried  with  them  the  germs  of  the  disease  and  trans- 
mitted it  to  their  own  mares.  This  experience  was  repeated 
several  times,  with  the  uniform  result  that  the  disease  was  spread 
wherever  the  men  went  into  other  stables,  after  having  visited 
those  where  the  disease  existed.  It  appears  quite  unnecessary 
that  the  visitor  to  an  infected  stable  or  pasture  should  handle  the 
mare  which  has  aborted,  the  after- birth  or  the  aborted  fetus,  but 
he  may  readily  carry  the  infection  upon  shoes  or  other  portions 
of  clothing  which  may  chance  to  come  in  contact  with  infected 
bedding  or  ground.  This  method  of  distributing  the  disease 
seems  to  Guillerey  one  of  the  most  important  and  dangerous. 
Neighbors  habitually,  and  without  thought,  visit  each  other's 
premises  and  examine  and  handle  diseased  mares,  and  thus  may 
readily  carry  the  infection  to  their  own  on  other  premises,  in 
such  a  manner  that  it  is  frequently  difficult  to  trace.  Guillerey 
also  observed  cases  of  abortion  which  were  traceable  to  the  use, 
upon  a  pregnant  mare,  of  a  blanket  which  had  been  used  upon 
another  mare,  which  had  recently  aborted.  The  blanket  had  be- 
come somewhat  soiled  by  the  disharges.  In  another  case,  it 
seemed  to  him  that  the  disease  was  traceable  to  a  harness  that 
had  been  used  upon  an  aborted  mare  and  which  had  then  been 
transferred  to  an  uninfected  pregnant  mare. 

If  one  introduces  a  mare  from  an  infected  stable  into  a  stable 
of  pregnant  mares,  whether  the  new  mare  has  recently  aborted 
or  soon  aborts,  she  constitutes  a  certain  vehicle  for  the  transmis- 
sion of  the  disease  into  the  uninfected  stable.  Guillerey  relates 
a  case  in  which  a  peasant  placed  his  pregnant  mare  in  the 
stable  of  a  distant  neighbor,  where  abortion  had  existed.  The 
mare,  in  due  time,  aborted  and  constituted  a  new  center  of  in- 
fection. 

When  the  infection  has  once  been  introduced  into  a  stable  or 
harem  of  mares,  the  spread  of  the  disease  is  rapid  and  certain, 
although  the  exact  method  by  which  it  comes  about  is  not 
definitely  known.  It  probably  occurs  largely  from  direct 
contact.  The  tail  of  the  mare  becomes  readily  and  inevitably 
soiled  by  any  discharges  of  the  vulva  and  creates  an  excellent 
vehicle  by  which  the  infection  can  be  transmitted  to  a  neighbor- 
ing animal.  Since  mares,  as  a  rule,  come  in  comparativel}'  close 
contact,  where  they  may  strike  each  other  about  the  vulva  with 


The  Avenue  of  Infectioyi  487 

their  tails,  it  is  easy  to  understand  how  this  comparatively  direct 
transmission  of  the  disease  may  occur. 

On  the  other  hand,  the  infection  may  occur  in  a  comparatively 
indirect  manner,  since  mares  in  the  same  enclosure  habitually  rub 
against  objects  of  various  kinds,  and  thus,  one  after  another,  come 
in  contact  with  the  same  object.  If  they  use  a  common  sleeping 
ground,  the  bedding,  earth  or  herbage  becomes  soiled  by  the 
discharges  from  an  aborted  animal  and  the  infection  is  obtained 
therefrom  by  a  pregnant  mare.  Thus  it  spreads  rapidly  and 
freely,  whether  the  animals  are  confined  in  close  proximity  in 
the  stable  or  whether  they  are  running  free  in  extensive  pastures 
or  even  upon  comparatively  open  ranges.  It  is  not  known 
whether  the  disease  can  spread  through  the  air  without  an  in- 
termediary bearer. 

Some  investigators  of  the  infectious  abortion  of  cows  have 
come  to  the  conclusion  that  the  bull  plays  a  highly  important 
part  in  the  distribution  of  the  disease  and  in  the  introduction  of 
the  infection  from  one  stable  to  another.  The  conclusion  has 
been  drawn  from  this  that  the  male  animal  in  general  constitutes 
an  efficient  bearer  of  the  disease,  although  himself  not  affected 
by  it  in  any  visible  manner.  It  does  not  seem  that  the  stallion 
plays  a  very  important  part  in  the  distribution  of  infectious  abor- 
tion of  the  mare.  The  incubation  of  the  disease  is  so  rapid  that, 
if  the  infection  is  transmitted  to  the  mare  by  the  stallion,  it 
would  appear  that  abortion  would  occur  very  early  and  would 
not  be  observed.  It  is  not  safe  to  conclude,  however,  that  he 
does  not  spread  the  disease  in  some  cases. 

The  stallion  may  otherwise  be  an  important  factor  in  the 
spread  of  abortion  by  copulation.  We  do  not  know  how  long 
the  micro-organism  of  infectious  abortion  may  live  in  the  vulva 
and  vagina  of  a  mare  whicli  is  not  pregnant  or  which  has  but 
recently  been  bred.  It  is  quite  possible  that  a  stallion  which 
had  first  served  an  aborted  mare,  and  then  covered  a  healthy  one, 
might  transfer  the  organisms  to  the  genital  canal  of  the  health}' 
animal,  which  would  then  act  as  a  bearer  of  the  disease  to  any 
pregnant  mares  with  which  she  might  soon  come  in  contact. 

Reasoning  from  the  observations  of  Guillerey,  that  the  soiled 
hands  or  shoes  of  persons,  or  the  soiled  blanket  or  harness  from  an 
aborted  mare,  can  carry  the  disease  from  one  stable  to  another,  it 
might  readily  follow  that   a    gelding   or   other   horse   placed  in 


488  Veterinary  Obstetrics 

close  proximity  to  a  mare  which  had  recentl}^  aborted,  or  which 
had  come  in  contact  with  soiled  bedding  or  with  the  aborted 
fetus  or  afterbirth,  might  readily  carry  the  disease  and  convey  it 
to  healthy  pregnant  mares. 

The  veterinary  obstetrist  should  not  disregard  the  opportunities 
possessed  by  himself  as  an  important  bearer  of  infectious  abor- 
tion. In  attending  mares  for  dystocia,  retained  placenta,  metri- 
tis, etc.,  resulting  from  infectious  abortion,  his  clothing,  person, 
instruments,  etc.,  become  soiled  and  only  the  most  rigorous  care 
on  his  part  will  prevent  his  becoming  a  menace  to  other  stables 
of  pregnant  mares. 

As  in  other  infectious  diseases  which  are  capable  of  being  car- 
ried by  an  intermediary  bearer,  there  is  the  constant  possibility 
of  the  transmission  of  the  disease  by  means  of  portions  of  the 
aborted  fetus  or  its  afterbirth  being  carried  from  one  place  to 
another  through  the  agency  of  scavenger  animals  or  birds — dogs, 
crows,  buzzards,  etc. 

The  vitality  of  the  organism  and  the  length  of  time  it  may 
persist  and  be  capable  of  infection,  whether  lodged  upon  the 
hair  or  other  portions  of  an  animal,  upon  the  hands  of  men,  upon 
harness  or  blankets,  we  have  no  data  to  show.  Neither  do  we 
know  for  how  long  a  time  the  germs  may  remain  inactive  in 
the  vagina  and  uterus  of  the  mare  and  be  capable  of  transmitting 
the  disease.  The  impression  seems  to  be  that,  after  a  mare  has 
aborted,  the  organism  continues  virile  at  least  as  long  as  there  is 
a  discharge  from  the  genital  apparatus.  It  would  not  be  safe  to 
conclude,  however,  that  the  micro-organism  disappears  as  soon 
as  the  discharge  ceases,  but  rather  that  it  may  remain  in  a  com- 
paratively inactive  state  in  the  vagina  for  weeks,  or  possibly 
months. 

Control  and  Eradication.  The  control  of  infectious  abor- 
tion in  the  mare,  as  in  other  animals,  is  a  complex  problem.  One 
of  the  chief  obstacles  in  the  control  of  infectious  abortion,  as  in 
other  transmissable  diseases,  is  the  diflficultyof  reaching  an  early 
diagnosis.  At  present  we  can  not  always  positively  differentiate 
the  infectious  abortion  from  the  accidental  abortion  of  class  I  or 
the  enzootic  disease  of  class  II.  Accidental  abortion  may  have  a 
definite  history  of  accident  and  a  reliable  record  of  non-exposure. 
Unless  these  data  are  vtxy  positive,  little  dependence  should  be 
placed  in  them.     Enzootic  abortion  due   to  infectious  di.sease  of 


Co7itrol  and  Eradicafio?!  489 

the  mother  may  be  differentiated  from  infectious  abortion  proper 
by  the  symptoms  in  the  pregnant  mare. 

It  has  been  claimed  that  infectious  abortion  can  be  differenti- 
ated from  other  types  by  the  dark,  dirt3^  grayish  or  brownish 
color  of  the  chorion  and  the  abundant  dirty  exudate  upon  its 
surface.  If  a  fetus,  dead  from  other  causes,  remains  in  the  uterus 
until  decomposition  of  the  membranes  begins,  we  know  of  no 
good  reason  why  the  appearances  might  not  be  the  same  as  those 
described  as  characteristic  of  the  infectious  di.sease.  Bacterio- 
logic  differentiation  is  not  yet  available. 

When  an  abortion  occurs  in  a  stable,  unless  it  can  clearly  and 
safely  be  attributed  to  other  causes,  a  tenative  diagnosis  of  in- 
fectious abortion  should  be  made  and  the  case  handled  accordingly. 

It  is  very  difficult  to  prevent  the  introduction  of  the  disease 
into  a  stable  of  pregnant  mares,  when  the  malady  is  prevalent  in 
a  neighborhood.  When  abortion  among  mares  exists  upon  a 
farm  during  a  season  of  the  year  when  the  animals  are  habitually 
out  in  the  fields,  and  the  aborting  mares  are  separated  from  the 
healthy  ones  of  an  adjoining  farm  simply  by  a  fence,  the  trans- 
mission of  the  disease  from  the  one  farm  to  the  other  is  well-nigh 
inevitable  and  can  only  be  guarded  against  by  providing  a  neutral 
territory  between  the  infected  and  the  non-infected  mares. 

It  is  also  essential  that  owners  of  pregnant  mares  should  guard 
them  zealously  against  infection  through  the  introduction  of 
mares  from  stables  where  the  disease  exists.  If  it  becomes  neces- 
sary or  advisable  to  purchase  new  mares  and  bring  them  upon 
the  farm,  and  it  is  not  certain  that  they  are  free  from  the  infec- 
tion, they  should  be  isolated  for  an  ample  period  of  time  before 
allowing  them  to  come  in  contact  with  the  pregnant  animals. 
If  any  well-grounded  suspicion  of  the  animal  exists,  she  should 
be  thoroughly  disinfected,  perhaps  even  subjected  to  a  bath  in 
disinfectants,  which  would  include  the  entire  body,  and  a  special 
disinfection  of  the  vulva  and  vagina. 

It  is  highly  dangerous,  when  abortion  is  disseminated  over  a 
territory,  to  permit  outside  animals  to  come  into  the  stable  or 
enclosure  where  pregnant  animals  are  kept.  We  have  known 
instances  where  a  mare,  which  had  recently  aborted,  was  driven 
into  the  barn-yard  of  a  neighboring  farm  where  the  disease  did 
not  exist,  and,  although  the  stay  of  the  infected  mare  was  of  short 


49©  Veterinary  Obstetrics 

duration,  the  disease  was  nevertheless  carried  and  an  outbreak  of 
abortion  resulted. 

When  the  owner  of  a  stable  of  healthy  mares,  drives  one  of 
them  into  an  enclosure  or  places  her  in  a  stable  where  the  disease 
exists,  the  mare  may  become  infected  and  spread  the  malady  to 
other  animals  upon  the  farm.  In  one  outbreak  observed  by  us, 
(American  Veterinary  Review,  Vol.  21,  page  303)  an  outbreak  of 
infectious  abortion  in  mares  was  apparently  brought  about  in  this 
way.  The  owner  had  a  band  of  some  25  presumably  pregnant 
mares,  which  were  mostly  highly  valuable  trotting  animals,  but 
included  one  grade  draft  mare,  which  was  used  for  general  work 
and  was  driven  here  and  there  to  various  farms  without  an}-  par- 
ticular thought  of  harm.  Somewhere  in  the  course  of  her  work, 
apparently,  she  became  infected,  aborted  and  transmitted  the 
disea.se  to  the  other  mares  upon  the  farm,  leading  to  quite  .serious 
losses,  although  the  course  of  the  di.sease  was  fortunately  arrested 
before  the  loss  of  foals  was  complete. 

The  owner  of  pregnant  mares  will  always  do  well  to  guard 
them  cautiously  against  infection  which  may  be  carried  by  per- 
sons upon  their  clothing,  hands  or  shoes.  Neighbors  coming 
from  farms  where  the  disea.se  exists  .should  on  no  account  be 
permitted  in  the  stable,  barnyards  or  fields  where  the  pregnant 
mares  are  kept.  The  owner  of  pregnant  mares  should  al.so  be 
careful,  in  reference  to  his  own  person,  that  he  does  not  come 
into  stables  or  enclosures  where  abortion  exists. 

Probably  one  of  the  most  dangerous  bearers  of  the  infectious 
abortion  of  mares  is  the  ignorant  or  careless  veterinarian.  We 
have  already  related  that  dystokia  is  common  in  abortion, 
occurring  near  the  end  of  gestation  ;  various  sequelae  also  occur 
after  abortion,  which  cau.se  the  veterinarian  to  be  called  in 
attendance. 

In  the.se  ca.ses  the  obstetrist  necessarily  gets  his  person,  clothing 
and  instruments  soiled  wnth  the  contagion,  and  by  either  of  these 
agencies  may  be  the  carrier  of  the  disease  from  one  stable  or  band 
of  mares  to  another.  The  veterinary  obstetrist  here  assumes  a 
profound  responsibility  and  should  take  ever}-  precaution  known 
to  modern  medicine  to  avoid  the  transmi.ssion  of  .so  .serious  a 
malady  to  animals  belonging  to  other  clients.  He  should  not 
make  a  second  call,  under  any  conditions  or  circumstances,  until 
his   clothing    has   been  changed  and  his  person  has  been   amply 


Cofitrol  a?id  Eradicatiofi  491 

and  safely  disinfected.  Any  instruments  or  appartus  which  he 
has  used  about  an  aborted  animal  should  be  most  scrupulously  and 
thoroughly  disinfected  or  sterilized.  Ropes,  cords  and  other 
cheap  apparatus  used  in  cases  of  dystokia  should  not  be  used 
again,  but  should  be  destroyed.  All  clothing  worn  by  the  ob- 
stetrist  should  be  of  a  character  which  will  admit  of  thorough 
boiling  without  injury,  and  this  should  always  be  done  before  it 
is  used  again.  Even  the  case,  bag  or  other  container  in  which 
the  veterinarian  transports  his  instruments,  clothing,  etc.,  when 
attending  cases  of  this  kind,  should  be  of  a  character  which  will 
admit  of  the  most  scrupulous  disinfection. 

When  the  malady  has  appeared  in  a  stable  or  herd  of  mares, 
energetic  measures  should  be  instituted  for  its  eradication.  The 
following  points  should  be  included  in  any  plan  : 

1.  Immediately  destroy,  by  burning,  the  aborted  fetus  and 
fetal  membranes.  It  is  essential  that  this  be  carefully  and  cora- 
pletel)^  done,  in  such  a  manner  as  to  eliminate  all  danger  of  in- 
fection from  this  source.  If  the  fetus  or  its  membranes  be 
dragged,  or  carried  dripping,  over  a  path  where  pregnant  mares 
may  pass,  they  may  get  the  infection  from  the  infected  path  as 
well  as  from  the  fetus.  Other  animals,  or  persons,  crossing  the 
infected  path  may  pick  up  and  carry  the  infection  to  pregnant 
mares.  A  vehicle  used  for  carrying  away  the  fetus  may  serve  to 
bear  the  infection  to  pregnant  animals.  The  persons  engaged  in 
removing  and  destroying  the  fetus  may  be  more  dangerous  than 
the  aborted  fetus  itself. 

Every  detail  in  the  process  of  the  destruction  of  the  fetus  and 
its  membranes  should  be  carefully  watched  and,  at  every  point  of 
possible  infection,  disinfection  thoroughly  applied. 

2.  The  mare  which  has  aborted  should  be  at  once  removed 
from  the  stable  occupied  by  other  pregnant  mares  and  effectively 
isolated.  Even  then,  it  is  important  to  terminate  the  infection 
as  early  as  possible,  so  that  the  mare  which  has  aborted  may  no 
longer  serve  as  a  possible  center  of  contagion. 

Internally,  the  uterus,  vagina  and  vulva  are  to  be  thoroughly 
disinfected  by  irrigating  the  uterine  cavity  with  a  warm  disin- 
fecting fluid.  For  this  purpose,  2  9^  lysol  or  carbolic  acid  or  a  r 
to  2500  solution  of  corrosive  sublimate  may  be  employed.  The 
disinfection  should  be  repeated  once  daih'  for  three  or  more  daN's, 
and  longer  should  vaginal  discharges  be  present. 


492  Ve/en'narv  Obstetrics 

The  exterior  of  the  mare  which  has  aborted  should  also  be 
thoroughly  disinfected.  Special  attention  should  be  given  to 
the  tail,  perineum,  buttocks  and  posterior  limbs.  These  parts  at 
least  should  be  thoroughly  scrubbed  with  soap  and  hot  water,  to 
which  has  been  added  2  or  y/c  of  lysol  or  carbolic  acid.  Cor- 
rosive sublimate  is  inefficient  here,  as  it  is  precipitated  by  most 
soaps  and  does  not  penetrate  the  hairy  coats  of  the  animal  in  an 
efficient  manner. 

Generally  speaking,  we  regard  the  somewhat  opposite  plan  of 
removing  the  pregnant  mares  from  the  infected  stable  as  ill 
advised.  When  infectious  abortion  has  occurred  in  a  stable 
where  other  pregnant  mares  are  kept,  it  is  fair  to  assume  that 
some  of  them  have  become  infected.  If  removed  to  another 
stable,  they  too  will  abort  and  the  other  stable  will  also  become 
infected.  If  the  disinfection  is  complete,  the  .stable  in  which  the 
abortion  has  occurred  is  as  safe  as  any. 

3.  Remove  all  bedding  from  the  stall  where  the  mare  has 
aborted,  burn  it  or  otherwi.se  render  it  safe,  and  thoroughly  dis- 
infect the  stall.  The  general  rules  of  the  preceding  paragraph, 
relative  to  the  dispo.sal  of  the  fetus  and  its  membranes,  .should 
also  be  applied  to  the  bedding  and  manure  from  the  infected 
stall.  It  must,  on  no  account,  be  dribbled  here  and  there,  to 
.scatter  the  infection  ;  the  undisinfected  vehicle  used  for  carrying 
it  must  not  be  placed  where  pregnant  mares  may  come  about  it. 
If  jt  is  decided  to  preserve  the  value  of  the  manure,  it  must  be 
placed  where  pregnant  mares  cannot  come  in  contact  with  it  for 
two  or  three  months. 

The  di.sinfection  of  the  stall  .should  be  complete.  The  .straw, 
chaff  or  bedding  should  not  be  swept  out  in  a  manner  to  cause 
dust  to  fly  in  every  direction,  but  any  dusty  material  should  first 
be  moistened,  preferably  with  a  disinfectant  or  with  boiling 
water,  then  removed  carefully,  and  the  stall  floor,  manger,  feed 
box  and  adjacent  walls,  thoroughly  scrubbed  with  hot  water,  to 
which  a  reliable  disinfectant  in  sufficient  amount  has  been  added. 

When  infectious  abortion  breaks  out  among  mares  at  pasture, 
they  should  be  promptly  removed  from  the  field  and  placed  in  a 
stable,  and  the  measures  above  outlined  followed.  Disinfection  at 
pasture  is  impo.s.sible,  for  very  evident  rea.sons.  It  cannot  be 
known  when  a  mare  at  pasture  aborts,  especially  when  early  in 
pregnancy.     When  abortion  does  occur,  the  fetus  and  its  mem- 


Control  and  Eradication  493 

branes  may  lie  undiscovered  for  a  long  time  and  act  as  a  focus  for 
the  spread  of  the  disease  to  other  mares.  The  vaginal  discharges 
are  also  dribbled  about  over  the  herbage,  to  more  certainly  dis- 
seminate the  infection.  The  mare  comes  in  close  contact  with 
pregnant  companions  and  may  readily  transmit  the  infection 
directly  to  them. 

4.  Exposed  pregnant  mares  should  at  once  be  thoroughly  dis- 
infected, and  especially  the  anus,  vulva,  tail,  buttocks  and  hind 
legs.  These  parts  should  first  be  thoroughly  scrubbed  with  soap 
and  hot  water  to  which  has  been  added  carbolic  acid  or  lysol. 
After  this  thorough  scrubbing,  the  parts  should  be  daily  disin- 
fected with  a  warm  2  or  3%  .solution  of  carbolic  acid  or  lysol, 
for  six  or  eight  days. 

5.  Immediately  after  the  occurrence  of  an  abortion  in  a  stable, 
or  at  the  commencement  of  control  measures,  the  vaginae  of  all 
exposed  mares  which  have  not  aborted,  and  have  not  been  iso- 
lated, should  be  subjected  to  rigid  disinfection  by  irrigating  them 
with  a  warm  i  to  2000  corrosive  sublimate  solution.  Should  no 
subsequent  abortions  occur,  the  vaginal  disinfection  need  not  be 
repeated. 

After  each  fresh  abortion  in  a  herd,  the  control  measures  out- 
lined should  at  once  be  renewed,  each  separate  abortion  being 
regarded  as  fresh  exposure  of  all  contiguous  animals. 

6.  Ample  precautions  should  be  taken  against  the  spread  of 
the  disease  through  the  medium  of  secondary  bearers.  Blankets 
which  have  been  u.sed  on  mares  which  have  recently  aborted  are 
highly  dangerous  when  used  upon,  or  brought  in  contact  with, 
pregnant  mares.  Harness  may  bear  the  infection,  as  may  curry- 
combs, brushes  and  other  stable  uten.sils. 

Workmen  who  have  handled  an  aborted  fetus,  or  its  afterbirth, 
or  who  have  cared  for  the  aborted  mare,  may  readily  carry  the 
infection  to  pregnant  mares.  Due  precautions  are  to  be  taken 
against  such  accidents.  The  clothing  of  such  persons  should  be 
kept  clean  ;  if  necessary,  it  should  be  disinfected.  The  hands 
especially  become  soiled  with  infection-laden  substances  and 
readily  carry  the  malady.  The  shoes  also  constitute  dangerous 
bearers  of  infection.  The  manure,  or  other  filth  from  the  staU 
where  a  mare  has  aborted,  clings  tenaciou.sly  to  the  shoes,  and 
upon  these  the  infection  may  be  carried  from  one  stable  to 
another. 


494  Veterhiarv  Obstetrics 

If  practicable,  different  persons  should  handle  the  infected  and 
the  presumably  non-iufected  animals,  and  they  should  not  pass 
from  the  infected  to  the  non-infected  stables. 

When  infectious  abortion  exists  in  a  neighborhood,  each  person 
or  animal  approaching  a  stable  where  pregnant  mares  are  kept 
should  be  regarded  as  suspicious  and  treated  accordingly.  Geld- 
ings, and  mares  not  used  for  breeding,  may  serve  as  bearers  of 
the  disease  from  diseased  to  pregnant  mares.  Indeed,  it  is 
probable  that  the  bacteria  of  the  malady  will  live  for  a  time  in 
the  vulva  and  vagina  of  a  mare  which  has  not  been  bred.  Though 
such  an  animal  does  not  become  visibly  diseased,  she  may  never- 
theless be  a  very  dangerous  bearer  of  the  malady  to  pregnant 
mares,  and  such  danger  should  accordingly  be  avoided. 

Breeding  should  be  suspended  during  an  outbreak  of  contagious 
abortion.  If  a  recently  aborted  mare  is  bred,  and  the  stallion  is 
then  u.sed  to  serve  a  mare  from  a  stable  in  which  there  are  healthy 
pregnant  mares,  the  infection  may  first  be  transferred,  through 
the  penis  of  the  stallion,  from  the  diseased  mare  to  the  vagina  of 
the  healthy  one  and  by  her  carried  to  healthy  pregnant  mares. 

When  the  disease  becomes  widely  prevalent  in  an  area,  all 
breeding  animals  might  properly  be  regarded  as  suspicious.  If 
such  a  view  is  taken,  each  mare  may  be  regarded  as  possibly  in- 
fected and,  after  permitting  a  stallion  to  serve  her,  the  penis  and 
surrounding  parts  of  the  male  should  at  once  be  disinfected 
against  a  possible  transmission  of  the  disease  to  the  next  mare 
with  which  he  copulates,  and  the  carrying  of  the  malady  by  her 
to  healthy  pregnant  mares. 

In  the  infectious  abortion  of  cows,  with  which  we  shall  deal  in 
the  succeeding  section,  some  veterinarians  have  recorded  appar- 
ently good  results  in  the  eradication  of  the  disease  by  subcu- 
taneous medication  with  carbolic  acid  ;  others  have  attempted, 
with  apparentl}'  good  results,  the  production  of  serum  immunity. 

If  the  abortion  breaks  out  somewhat  early  during  gestation, 
it  may  be  essential  to  determine  as  positively  as  possible  w^hich 
mares  are  pregnant  and  which  are  not,  and  for  this  reason  it  may 
become  necessary  to  carefully  examine  each  mare  per  rectum,  in 
doing  which  the  veterinarian  should  guard  against  danger  to  the 
fetus,  from  the  manipulation,  as  well  as  against  the  transmission 
of  the  disease  from  one  mare  to  another  through  the  medium  of 
his  soiled  hands  or  clothing.     Consequently  it  would  be  well  for 


Infectious  Abortio7i  hi  the  Cow.  495 

the  veterinarian,  in  case  such  examination  is  made,  to  thorough- 
ly disinfect  the  tail,  buttocks  and  perineum  of  the  mare  about 
to  be  examined  and  then  thoroughly  disinfect  his  arms  and 
hands  after  the  examination,  before  proceeding  to  the  next  mare. 
The  handling  of  dystokia  dependent  upon  contagious  abortion 
is  the  same  as  that  of  dj'siokia  due  to  other  causes.  The  se- 
quelae of  abortion,  such  as  retained  placenta,  metritis,  laminitis, 
etc.,  present  the  same  symptoms  and  are  subject  to  the  same 
rules  of  handling  as  apply  to  these  diseases  following  parturition, 
and  will  accordingly  be  considered  along  with  the  post-parturient 
maladies.  The  disinfection  of  the  animal  should  be  complete. 
The  disinfection  of  the  veterinarian's  person  and  his  equipment 
should  be  emphasized,  although  in  all  obstetric  work  this  pre- 
caution should  be  ample  and  should  render  the  veterinarian 
secure  against  becoming  a  bearer  of  any  infection  to  animals  which 
he  may  later  attend. 

B.  Infectious  Abortion  in  the  Cow. 

For  more  than  half  a  century,  the  leading  veterinarians  of  the 
world  have  recognized  the  fact  that  most  abortions  occurring  in 
cows  are  of  an  infectious  character.  The  infectiousness  of 
abortion  was  quite  generally  denied  until  near  the  middle  of  the 
19th  century,  but  even  during  the  18th  century  there  were  vet- 
erinarians who  had  become  thoroughly'-  convinced  of  its  trans- 
missability.  When  a  very  large  number  of  abortions  occurs  in  a 
given  herd  or  in  a  community  during  a  short  period  of  time,  they 
are  quite  uniformly  traceable  to  infection. 

Infectious  abortion  of  cows  occurs  chiefly  in  dairy  herds  and 
only  rarely  among  animals  bred  for  beef  purposes.  It  is  not  so 
much  a  question  of  the  susceptibility  of  one  animal  as  of  the 
environment  of  the  respective  animals  and  the  interchange  of 
animals,  by  which  the  disease  may  be  spread  from  one  herd  to 
another.  Dairy  cows  are  kept  confined  in  close  contact  with 
each  other  throughout  a  part  or  the  whole  of  the  year,  so  that 
there  is  a  better  opportunity  for  infection   by  ordinary  contact. 

Another  element  which  tends  to  largely  confine  the  malady  to 
dairy  herds  is  the  fact  that  among  dairymen  there  is  frequent  in- 
terchange of  cows  and  bulls  for  breeding  purposes.  Among 
breeders  of  beef  cattle,  the  interchange  of  animals  is  compara- 
tively rare  and  consists  chiefly  in  the  breeder  buying  young  bulls. 


496  Veterinary   Obsteiries 

which  have  not  been  previously  used.  In  those  sections  of  the 
countrv  where  beef  breeding  is  the  principal  industry,  it  is  found 
that  a  large  proportion  of  the  outbreaks  of  contagious  abortion 
occur  in  those  herds  where  pedigreed  stock  is  bred  and  where 
there  is  frequent  interchange  with  other  breeders  or  the  animals 
are  habitually  exhi]:)ited  at  agricultural  fairs,  where  they  become 
exposed  to  the  malady. 

Etiology.  The  bacteriology  of  infectious  abortion  of  cows  has 
not  been  fully  determined,  and  the  findings  of  different  investi- 
gators are  very  contradictory.  Bang,  and  those  in  accord  with 
him  agree  that  the  maladj'  is  due  to  a  short  bacillus.  This  is  a 
non-motile  organism  which  contains  no  spores  but,  when  arti- 
ficially cultivated,  frequently  shows,  at  one  end,  a  spherical  en- 
largement. The  micro-organism  is  easily  stained  with  analine 
dves,  either  aqueous  or  carbolized.  It  does  not  color  by  the 
Gram  method.  It  may  be  artificially  grown  in  an  atmosphere  of 
oxygen  or  in  the  almo.st  complete  absence  of  oxygen,  but  does  not 
grow  rapidly  in  ordinary  air.  It  may  be  grown  on  gelatine,  agar 
and  various  other  media.  In  these  media  it  grows  in  clumps  the 
.size  of  a  pin-head,  which  are  conical  in  form  and  have  very  definite 
outlines  and,  in  transmitted  light,  have  a  bluish  color.  The 
bacillus  perishes  in  the.se  artificial  cultures  in  about  two  weeks 
and  is  readily  destroyed  by  heat  and  disinfectants.  It  is  claimed, 
however,  that  they  may  continue  to  exist  in  the  .secretions  of 
the  uterus  for  month  after  month.  According  to  experiments 
recorded  by  Bang  (Jour,  of  Comp.  Path,  and  Therap.,  Vol.  19, 
page  191 )  the  injections  of  pure  cultures  of  this  organism  into  the 
vaginae  of  pregnant  cows  and  sheep  caused  abortion  or  premature 
birth  in  8  to  10  weeks,  in  which  ca.ses  the  micro-organism  was 
obtained  in  pure  cultures  from  the  vaginal  discharges,  as  well  as 
from  the  exudate  upon  the  surface  of  the  cotyledons  and  the 
chorion. 

Bang  also  injected  abortion  bacilli  into  the  jugular  vein  and, 
in  case  of  two  pregnant  ewes,  living  lambs  were  produced.  The 
specific  abortion  bacilli  were  found  in  the  chorion.  The  same 
experiment  was  tried  upon  a  pregnant  mare,  which  gave  birth 
after  27  days  to  a  very  small  foal  which  died  a  day  later.  Here 
again  he  found,  upon  the  chorion,  bacilli  which  could  not  be 
differentiated  from  tho.se  which  had  been  injected  into  the  vein. 

Bang  injected  a  pure  culture  of  the  micro-organism  into  the 


Infectious  Abortioyi  of  the  Cow  497 

jugular  vein  of  a  pregnant  cow,  which  aborted  90  days  later,  and 
in  the  exudate  upon  the  afterbirth  he  found  the  abortion  bacilli. 
In  this  connection  he  states:  "Since  that  time  we  have  made 
more  or  less  extensive  experiments  with  cows,  sheep,  goats  and 
rabbits,  and  produced  abortion  in  this  way."  One  maj^  infer 
from  these  experiments  that,  while  it  is  not  proven  that  the 
abortion  of  the  mare  is  identical  wdth  that  of  the  cow,  he  suspects 
that  such  may  be  the  case,  and  that,  consequently,  when  con- 
tagious abortion  breaks  out  among  cows,  other  pregnant  animals 
should  be  protected  against  exposure. 

Having  satisfied  himself  that  the  bacilli  could  be  carried  to  the 
uterus  through  the  blood,  Bang  suspected  the  possibility  of  the 
organisms  reaching  the  uterus  through  the  alimentary  canal 
also.  He  administered  ^  of  a  liter  of  an  artificial  culture  of  the 
bacillus  in  bouillon  serum  to  a  pregnant  cow,  on  the  12th  of  June, 
and  on  the  7th  of  Sept.  he  gave  her  a  quantity  of  exudate  from 
an  aborted  cow.  She  gave  birth  to  a  living  calf  on  the  26th  of 
November,  80  da5'S  after  having  been  fed  upon  the  exudate.  In 
the  typical  exudate  upon  the  afterbirth,  there  were  abundant 
bacilli.  Later  he  repeated  this  experiment  under  conditions 
which,  he  claimed,  "excluded  the  possibility  of  infection  in 
any  other  way  than  through  feeding."  The  heifer  aborted  56 
da5^s  later. 

How  the  possibility  of  infection  by  other  avenues  was  excluded 
in  this  experiment  does  not  appear.  If  the  bouillon,  exudate 
and  cotjdedons  were  given  to  these  animals  as  a  drench  or  mixed 
with  food,  we  see  no  reason  why  portions  of  the  liquid  escaping 
from  the  mouth  might  not  soil  the  food  or  bedding,  to  later  be 
accidentally  moved  backward  and  reach  the  posterior  part  of  the 
stall,  making  it  possible  for  the  infection  to  gain  entrance  through 
the  vulva.  If  the  material  were  given  in  any  other  way  than  in 
an  impermeable  capsule,  the  mouth  would  inevitably  become  in- 
fected and  the  cow,  in  licking  her  posterior  parts,  as  she  habitu- 
ally does,  could  transfer  the  micro-organisms  to  that  portion  of 
her  bod}^  whence  they  might  enter  the  vulva. 

Even  should  the  abortion  bacilli  pass  into  the  alimentary  tract, 

we  hav^e  no  evidence  that  they  may  not   resist   the  action  of  the 

digestive  fluids,  appear  in  the  feces  and  enter  the  vulva.     The 

mere  assumption  that   the  bacilli  may  be  taken  up   from  the  in- 

32 


498  Veterinary  Obstetrics 

testines  and  carried  to  the  uterus  involves  the  persistence  of  the 
bacilli  in  the  presence  of  the  digestive  fluids  and  the  possibility  of 
their  appearance  in  the  feces. 

While  it  seems  quite  possible  that  the  infection  may  be  intro- 
duced in  this  way,  we  question  very  much  if  it  constitutes  an  im- 
portant source  of  danger.  If  the  food  were  infected  it  would  be 
virtually  impossible  to  be  sure  that  the  infection  might  not  reach 
the  vagina  and  uterus,  even  though  it  did  not  do  so  through  the 
alimentary  canal. 

The  problem  of  the  transmission  of  infectious  abortion,  either 
equine  or  bovine,  by  the  introduction  of  bacteria  into  the  blood 
or  subcutaneous  tissues,  or  by  penetrating  the  mucous  membrane 
of  the  digestive  tract  after  having  been  swallowed,  is  a  very 
interesting  one  requiring  elucidation.  Can  bacteria,  large 
enough  to  be  recognized  and  clearly  identified,  without  causing 
symptoms  of  maternal  disease,  pass  through  the  maternal  pla- 
centa, without  inducing  visible  injury  to  the  uterus,  and  cause 
a  fatal  disease  of  the  fetus  in  the  uterus  ?  The  evidence  on  this 
point  needs  be  very  much  more  exact  before  accepting  an  aflfirma- 
tive  conclusion. 

Bang  claims  that  the  abortion  bacillus  is  purely  pathogenic  and 
does  not  lead  a  saprophytic  existence.  He  kept  the  baccilli  alive, 
but  dormant,  for  7  months  in  test  tubes  at  a  low  temperature. 
In  one  case  he  found  the  abortion  bacilli  in  an  exudate  surround- 
ing a  mummified  fetus,  which  had  been  dead  apparently  for  nine 
months.  According  to  his  view,  apparently,  the  bacilli  may  live 
for  an  almost  indefinite  period  within  the  uterus  of  the  cow  and 
be  capable  at  a  future  time  of  starting  anew  the  malady. 

As  stated  on  page  476,  the  bacteriolgic  researches  of  Bang  are 
in  apparent  conflict  with  those  of  Ostertag.  While  B.  succeeded 
in  causing  abortion  in  various  species  of  animals  with  the  abortion 
bacillus  of  the  cow,  O.  utterly  failed  to  transmit,  to  the  cow  or 
other  animals,  the  infectious  abortion  of  the  mare  by  the  exudate 
or  afterbirth  from  aborted  animals  or  through  his  abortion  coccus. 

Braiier  (Deutsche  Zeitschrift  fiir  Tiermedicin,  Vol.  XIV,  p. 
95)  recognized  a  micrococcus  as  the  cause  of  infectious  abortion 
in  cows  and  experimentally  induced  the  disease  with  the  micro- 
organism. Franck  also  recognized  a  micrococcus  as  the  cause 
of  the  malady.  Nocard  recognized  both  micrococci  and  bacilli 
in  the  uterine  discharges  and  fetal  fluids. 


Infectious  Abortion  of  the  Coiv  499 

Many  elements  serve  to  confuse  the  question  of  the  bacteri- 
ology of  infectious  abortion.  The  normal  bacterial  flora  of  the 
vulvo- vaginal  cavity  of  the  cow  has  not  been  as  fully  determined 
as  desired.  Nocard  has  investigated  outbreaks  of  what  appeared 
to  be  sirriultaneous  contagions  of  infectious  abortion  and  dysen- 
teria  neonatorum  or  diarrhea  of  the  new-born.  Others  have 
believed  that  infectious  abortion  and  infectious  diarrhea  of  the 
new-born  were  identical. 

The  period  of  incubation  of  the  infectious  abortion  of  cow'S 
is  as  much  in  dispute  as  the  bacteriology  of  the  affection,  and 
adds  to  the  confusion  regarding  the  latter.  Bang  makes  the 
incubative  period  two  to  seven  months.  This  is  wholly  out  of 
harmony  with  clinical  experience  with  infectious  diseases  in 
general.  Most  transmissable  diseases  show  a  period  of  incuba- 
tion ranging  between  three  and  twenty  days,  so  that  an  incuba- 
tion stage  of  eight  to  twenty- eight  weeks  naturally  causes  some 
doubt. 

Braiier,  Lehnert  and  others  record  an  incubative  period  of  nine 
to  twenty  days.  Such  a  period  is  in  harmony  with  the  incuba- 
tion period  of  infectious  abortion  in  the  mare  and  with  the 
incubation  period  of  infectious  diseases  generally. 

The  incubation  period  of  infectious  abortion,  whether  by  ex- 
perimental or  natural  infection,  is  probably  more  variable  than 
most  infectious  maladies.  The  infection  per  vulvam  is  not 
direct.  We  have  no  definite  knowledge  of  the  time  required  for 
the  infection  to  traverse  the  vulvo-vaginal  and  cervical  canals 
before  it  can  attack  the  fetal  membranes.  After  the  infection  of 
the  fetus  and  its  membranes  has  occurred,  expulsion  usually 
does  not  follow  until  after  the  fetus  has  perished.  In  the  cow, 
with  the  rigid  cervix,  it  is  not  improbable  that  in  many  cases, 
the  fetus  is  retained  one,  two  or  more  days  after  its  death  before 
its  expulsion.  Since  we  generally  regard  the  period  of  incuba- 
tion in  infectious  abortion  as  extending  from  the  date  of  expos- 
ure to  the  expulsion  of  the  fetus,  we  evidently  include  not  only 
the  time  generally  alloted  to  incubation  but  also  the  duration  of 
the  disease  itself. 

It  is  highly  important  that  additional  observations  be  made 
upon  the  period  of  incubation.  If  the  infecting  micro-organism 
can  live  in  the  gravid  uterus,  in  the  fetus  or  its  membranes,  for 
six   or   seven    months,  that    fact   is   extremely  discouraging    in 


r^oo  Veterinary  Obstetrics 

connection  with  the  control  of  the  malady.  We  know  no  way 
to  disinfect  the  pregnant  uterus,  and  if  the  infection  may  exist  in 
it  for  seven  months  there  can  be  little  hope  for  the  prompt 
eradication  of  the  disease  from  a  herd. 

The  Method  of  Natural  Infection  doubtless  varies  greatly 
ill  diflfereiit  instances.  Consequently  one  author  will  place  the 
principal  emphasis  upon  a  given  method  and  another  upon  a  dif- 
ferent avenue  of  infection.  Bang  places  considerable  stress  upon 
infection  through  the  alimentary  tract  by  means  of  contaminated 
food.  While  such  a  possibility  should  be  recognized,  we  have 
little  evidence  that  it  plays  a  highly  important  part  in  the  major- 
ity of  outbreaks. 

Some  writers  probably  over-emphasize  the  frequency  wath  which 
the  disea.se  is  tran.smitted  by  the  male  breeding  animal  through 
copulation.  Doubtless  this  mode  of  transmission  is  quite  im- 
portant, and  should  be  fully  recognized  in  all  plans  for  control 
or  eradication.  When,  however,  a  cow  aborts  during  the  5th  to 
7th  month  of  gestation,  we  are  skeptical  about  the  correctness  of 
attributing  the  disease  to  infection  by  copulation.  If  the  cow 
came  in  estrum  during  pregnancy,  and  copulated  with  the  male, 
we  might  readily  admit  that  the  infection  was  probably  trans- 
mitted in  that  way.  Bang,  in  his  published  researches,  makes 
the  period  of  incubation  in  experimental  cases  about  8  to  10 
weeks  and  in  some  rare  cases  as  long  as  12  weeks,  but  when  he 
considers  the  transniis.sion  of  the  infection  by  the  bull  he  ap- 
parently considers  the  period  of  incubation  as  much  as  6  or  7 
months,  which  .seems  to  us  to  raise  a  very  seri(.)us  question  of 
doubt.  If  the  infection  is  capable  of  producing  abortion  at  all, 
and  is  introduced  by  the  penis  of  the  male  at  the  time  of  copula- 
tion, it  would  .seem  more  reasonable  to  expect  the  bacilli  to  destroy 
the  life  of  the  fetus  at  a  very  early  period,  or  perhaps  even  the 
ovum  or  spermatozoa  prior  to  fertilization,  and  cause  an  invisible 
abortion.  We  do  not  believe  that  copulation  constitutes  the  chief 
means  of  transmission  nor  that  v^'e  should  finally  conclude  that 
abortions  occurring  late  during  pregnancy  are  due  to  this  mode 
of  infection. 

Clinical  evidence  indicates  that  the  disease  is  most  frequently 
tran.smitted,  either  directly  or  indirectly',  through  the  vulvo- 
vaginal canal,  from  a  cow  which  has  recently  aborted  to  one 
which  is  pregnant.     If  the  disea.se  breaks  out  in  a  stable,  it  tends 


Infections  Abortio7i  of  the  Cow  501 

to  spread  first  to  those  cows  which  are  nearest  to  the  aborted 
animal.  In  some  outbreaks  which  have  been  recorded,  it  has 
been  shown  to  spread  chiefly  in  the  direction  of  the  slope  of  the 
gutter,  apparently  because  the  liquid  discharges  from  the  vulva 
had  passed  along  the  gutter  and  soiled  the  bedding  of  the  suc- 
ceeding cows.  As  in  the  mare,  it  seems  quite  certain  that  the 
infection  is  readily  transferred  from  one  animal  to  another  by 
persons  who  are  caring  for  the  animals.  Milkers  may  readily 
carry  the  disease  from  one  animal  to  another  upon  their  hands, 
thus  transmitting  it  from  udder  to  udder,  from  whence  it  may  be 
transferred  to  the  vulva  through  the  medium  of  the  tail  or  by 
other  means  which  readily  suggest  themselves. 

Symptoms.  The  symptoms  of  infectious  abortion  in  the  cow 
seem  to  be  somewhat  more  pronounced  than  in  other  animals. 
It  occurs  most  frequently  in  animals  5  to  6  months  pregnant,  al- 
though Bang  records  cases  as  early  as  3  months  and  admits  that 
it  may  occur  very  near  to  the  end  of  gestation  and  that,  in  some 
cases,  the  diseased  fetus  may  be  born  alive  in  a  weakened  state 
and  may  either  perish  within  a  few  days  or  recover  and  continue 
to  live. 

Xocard  .states  that  when  the  calves  are  prematurely  born 
alive,  as  a  result  of  infectious  abortion,  they  sometimes  bawl 
in  a  peculiar  manner,  which  would  suggest  to  one  the  howling  of 
a  rabid  dog.  Nocard  attributes  this  to  involvement  of  the  me- 
dulla oblongata.  He  was  possibly  dealing  with  infectious  diar- 
rhea affecting  the  calf  at  the  same  time. 

There  is  some  tendency  to  the  appearance  of  the  symptoms  of 
genital  catarrh  as  the  forerunner  of  abortion.  The  vaginal  mu- 
cosa becomes  injected  and  the  lips  of  the  vulva  somewhat  swollen. 
Bang  regards  the  malady  essentially  as  an  insidious  uterine 
catarrh.  Naturally  the  injection  of  the  vulvar  mucosa,  accom- 
panied by  vaginal  discharge,  would  follow. 

Whether  the  swelling  of  the  vulva  and  discharge  from  the 
genital  tract  are  the  effects  of  the  death  or  serious  disease  of  the 
fetus  and  of  the  disease  process  taking  place  in  the  fetal  mem- 
branes, or  whether  they  constitute  a  fundamental  part  of  the  dis- 
ease itself,  is  not  known.  It  has  not  been  shown  that  the  vulvar 
tumefaction  and  discharge  precede  the  death  of  the  fetus.  If  the 
swelling  and  discharge  occur  only  after  the  death  of  the  fetus, 
they  should  be  regarded  as  the  precursors  of  the  expulsion  of  the 


502  Veterinary  Obstetrics 

dead  fetus  rather  than  as  a  sign  of  impending  fetal  death.  The 
disease  has  already  worked  its  greatest  harm  by  destroying  the 
life  of  the  fetus.  It  should  be  noted  that  such  a  condition  does 
not  occur  in  the  non-pregnant  animal  as  a  result  of  exposure  to 
infectious  abortion. 

Indeed  we  have  no  evidence  to  show  that  the  micro-organism  of 
infectious  abortion  has  any  power  to  produce  symptoms  of  dis- 
ease of  any  kind  whatever  in  a  non-pregnant  animal.  Even 
when  pure  cultures  are  injected  into  the  jugular  vein,  they  cause, 
according  to  Bang,  only  a  temporary  slight  fever  which  quickly 
abates,  and  no  further  evidence  of  disea.se  is  observed  until  abor- 
tion occurs.  It  would  consequentl}'  seem  that  there  is  .some- 
thing in  the  composition  of  the  fetus,  its  fluids  or  membranes 
which  makes  it  possible  for  organisms  to  multiply  and  to  bring 
about  pathologic  conditions. 

Hutyra  and  Marek  state  that  the  mucous  membrane  of 
the  vagina  sometimes  shows  granular  enlagements  as  large  as 
hemp  seed.  This  seems  to  correspond  with  the  most  prominent 
.symptom  of  the  infectious  nodular  vaginitis  of  cows  and 
may  be  simply  a  co-existence  of  the  two  diseases  in  one  animal. 
It  is  to  be  remembered  also  that  the  nodular  or  granular  venereal 
disease  may  cause  abortion  in  60  to  70  %  of  pregnant  cows.  See 
page  98.  There  occurs  a  white,  reddish  gray  or  yellow  vaginal 
discharge.  Two  or  three  days  later  abortion  occurs.  Reindl 
records  that,  in  the  case  of  a  bull,  he  observed  small  nodules 
upon  the  penis,  which  were  similar  to  those  seen  in  the 
vaginae  of  cows  ju.st  prior  to  their  having  aborted.  This  suggests 
that  he  also  was  dealing  with  the  infectious  nodular  catarrh 
of  cattle,  possibly  complicated  with  true  infectious  abortion. 

When  abortion  occurs  early  in  gestation,  the  fetus  is  usually 
expelled  included  in  its  membranes.  Later  in  gestation  the  fetus 
is  usually  expelled  nakM  and  the  membranes  follow  somewhat 
tardily.  In  a  large  proportion  of  ca.ses,  the  afterbirth  is  retained 
and  requires  artificial  removal.  After  the  abortion  has  occurred, 
if  the  afterbirth  has  come  away  spontaneously  or  has  been 
promptly  removed,  there  frequently  occurs  a  discharge  from  the 
genital  tract,  which  continues  for  two  or  more  da3^s  or  as  many 
weeks.  This  discharge  is  usually  of  a  reddish-brown  or  reddish 
color,  generally  a  repulsive  appearing  liquid  containing  small 
clumps  of  pus  and  fragments  of  afterbirth,  and  in  some  cases  is 


Infections  Abortion  of  the  Cow  503 

more  or  less  fetid.  Large  quantities  of  this  discharge  may  ac- 
cumulate in  the  uterus  and  later  be  expelled  at  intervals,  or  the 
flow  may  be  virtually  continuous. 

Generally  the  aborted  fetus  is  dead,  but  not  greatly,  if  at  all, 
decomposed  when  expelled.  Rarely  the  fetus  is  born  alive.  If 
dystocia  occurs  the  fetus  soon  decomposes.  The  afterbirth  is 
usually  more  or  less  discolored,  there  is  edema  and  injection  of  the 
chorion,  and  between  the  cotyledons  there  is  frequently  seen  a 
muco-puruleut  exudate.  When  a  cow  has  once  aborted  and  is 
bred  soon  afterward,  it  is  claimed  that  she  is  v^ry  liable  to  again 
abort  from  the  infection  which  caused  the  prior  abortion  and  has 
persisted  in  the  uterus  during  the  entire  period.  This  has  not  been 
well  established.  If  the  bacillus  is  already  present  in  the  uterus 
at  the  time  of  copulation,  it  would  seem  more  probable  that  it 
would  destroy  the  life  of  the  spermatozoa  and  of  the  ovum  even 
before  impregnation  took  place.  Should  the  ovum  and  sperma- 
tozoa escape  such  a  fate,  it  would  appear  probable  that  abortion 
would  occur  so  early  during  gestation  that  the  expulsion  of  the 
very  small  embryo  would  pass  unrecognized. 

Diagnosis.  Hutyra  and  Marek,  and  other  writers,  place  great 
diagnostic  value  upon  the  swelling  of  the  vulva  and  the  genital 
discharge,  which  usually  occur  two  or  three  daj^s  prior  to  the  ex- 
pulsion of  the  fetus.  If  the  reliability  of  these  symptoms  can  be 
clearly  established,  they  become  of  fundamental  importance  in  ref- 
erence to  the  control  and  eradication  of  the  disease  by  leading 
to  earlier  diagnosis  of  the  presence  of  the  infection  in  a  given 
individual.  When  the  abortion  has  occurred,  some  authors 
claim  that  the  existence  of  a  fibrino-purulent  exudate  upon  the 
chorion  speaks  for  the  infectious  nature  of  the  disease,  but  it  has 
apparently  not  been  fully  determined  that  the  infectious  abortion 
can  thus  be  safely  differentiated  from  that  occurring  from  other 
causes. 

Once  the  disease  has  become  established  in  a  herd,  the  best 
proof  of  its  character  is  the  gradual  and  more  or  less  rapid  spread 
of  the  affection  from  cow  to  cow.  In  many  cases  this  is  ex- 
tremely rapid  when  the  disease  assumes  a  highly  virulent  t^-pe, 
whereas  in  other  instances,  when  the  disease  has  lost  its  virulence 
in  a  community  or  stable,  the  spread  is  very  much  slower  and 
may  be  spontaneously  confined  to  a  very  small  percentage  of  the 
pregnant  cows  in  the  herd,     Hutj-ra  and  Marek,  citing  Cagny, 


504  Veteri7iary  Obstetrics 

observe  that  sometimes  iu  young  cows  and  mares  there  occurs  a 
swelling  of  the  vulva  and  a  discharge  of  mucus,  along  with  some 
slight  symptoms  of  general  disturbance,  which  later  disappear, 
and  the  animal  completes  the  period  of  gestation  and  gives  birth 
to  vigorous,  living  young. 

Some  investigators  hold  that  a  microscopic  examination  of  the 
discharges  from  the  vagina,  and  the  indentification  therein  of  the 
abortion  l)acillus,  constitutes  one  of  the  most  rapid  and  reliable 
methods  for  diagnosing  the  disease. 

It  would  appear,  however,  that,  while  the  symptoms  recorded 
above  are  all  valuable  in  aiding  the  veterinarian  to  reach  a  con- 
clusion, until  the  disease  is  much  better  known  than  at  present, 
it  is  safer  to  regard  any  case  of  abortion  in  a  dairy  as  suspicious 
of  being  due  to  infection  and  to  treat  it  as  such,  especially  if 
that  malady  already  exists  in  the  vicinity  or  if  a  new  animal  has 
been  introduced  into  the  herd,  which  might  carry  with  it  the 
infection. 

Infectious  abortion  is  to  be  carefully  differentiated  from  the 
granular  venereal  disease,  which,  although  causing  abortion  in 
50  to  70  %  of  the  pregnant  cows  attacked,  is  nevertheless  a  quite 
distinct  malady  and  offers  a  different  problem  in  handling. 

Since  our  account  of  this  disease  on  page  97  has  come  from 
the  press,  the  malady  has  been  definitely  recognized  in  Northern 
New  York  and  is  possibly  extensively  distributed  in  America. 
Its  recognized  existence  in  America  demands  that  it  should 
receive  more  exten.sive  consideration  at  our  hands.  This  we 
shall  accord  to  it  in  an  appendix. 

The  course  of  abortion  in  a  stable  or  herd  is  very  much  like 
that  of  any  other  infectious  disease.  Upon  its  first  appearance 
it  usually  assumes  a  highly  virulent  character  and  for  a  time 
may  increase  in  virulence,  to  later  slowly  and  gradually  abate 
as  if  it  had  consumed  the  fuel  upon  which  it  might  feed. 
Finally  the  disease  gradually  disappears,  unless  new  material  is 
constantly  provided  by  the  introduction  of  new  cows  which  have 
not  previously  been  exposed  to  the  malady.  Investigators  of  the 
disease  usually  claim  that  a  cow  will  abort  two  or  three  times 
from  the  infectious  disease  and,  after  such  a  period,  usually  ceases 
to  abort  and  again  breeds.  A  large  proportion  of  the  cows  which 
abort  two  or  three  times,  however,  are  sold  and  thus  disappear 


Infectio7is  Abortion  of  the  Cow  505 

from  the  herd  and  from  observation,  so  that  the  data  upon  this 
point  are  probably  not  very  reliable. 

The  control  and  eradication  of  the  disease  in  cows  is  a  prob- 
lem which  requires  a  very  careful,  detailed  study  in  each  instance. 
upon  the  part  of  the  attending  veterinarian.  In  a  herd  or  stable 
where  the  di.sease  exists,  the  same  precautions  should  be  insti- 
tuted as  we  have  already  suggested,  on  page  488,  for  the  mare. 
Cows  which  have  aborted  should  be  promptly  removed  from  the 
stable  ;  the  aborted  fetus,  afterbirth  and  .soiled  bedding  should 
be  carefully  removed  and  burned  ;  and  the  stall  and  gutters  should 
be  thoroughly  disinfected.  The  aborted  cow  should  be  effectively 
isolated,  and  the  uterus  daily  flushed  out  wdth  a  warm  antiseptic 
solution,  such  as  i  to  2  %  of  creolin  or  lysol.  The  solution  should 
be  of  sufficient  volume  to  fill  the  uterine  cavity  several  times,  so 
that  the  cleansing  may  be  complete. 

Each  pregnant  cow  should  be  carefully  observed,  and  if  any 
signs  of  impending  abortion  appear,  such  as  a  vaginal  discharge 
with  swelling  of  the  lips  of  the  vulva,  she  should  be  promptly 
removed  and  the  stall  thoroughly  disinfected. 

The  vulva,  perineum,  tail  and  neighboring  parts  of  each  ex- 
posed cow  should  be  thoroughly  washed  daily  for  at  least  two 
weeks  with  strong  anti.septics.  such  as  a  2  or  3  9^  solution  of  creolin 
or  carbolic  acid  or  a  i- 1000  solution  of  corrosive  sublimate. 

Whatever  may  be  the  po.ssibilities  of  the  invasion  of  the  infec- 
tion through  other  avenues,  it  must  be  admitted  from  all  clinical 
data  that  the  most  important,  if  not  constant  portal,  is  the  vulvo- 
vaginal canal.  This  renders  it  fundamentally  important  that  the 
vaginae  of  all  cows,  whether  pregnant  or  not,  in  a  stable  where 
the  disease  exists,  shall  be  thoroughly  disinfected.  A  neglect  of 
this  precaution  may  leave  the  infection  undisturbed  for  days  or 
weeks,  to  later  penetrate  the  gravid  uterus  and  cause  abortion  in 
the  animal  harboring  it,  or  serve  as  a  new  center  of  infection  by 
escaping  in  the  vaginal  discLarges  to  prove  a  menace  to  neighbor- 
ing pregnant  cows. 

It  is  not  advisable  to  use  so  strong  a  solution  for  irrigating  the 
vagina  as  that  suggested  above  for  disinfecting  the  external 
parts,  but  instead  one  should  employ  a  comparativeh-  non-irritant 
antiseptic  solution,  in  order  to  obviate  severe  straining,  such  as 
a  I  to  2  9^  lysol  or  carbolic  acid  solution.  This  should  be  in- 
jected into  the  vaginae  daily  for  two  or  three  days.     We  cannot 


5o6  Veteriyiary  Obstetrics 

readily  use  corrosive  sublimate  solution  in  the  vagina  of  the  cow, 
because  it  produces  too  great  irritation  of  the  mucous  membrane 
and  causes  severe  straining.  In  the  mare,  as  related  on  page  492, 
we  can  introduce  into  the  vagina  a  warm  corrosive  sublimate  solu- 
tion of  the  strength  of  1-2000  or  2500  without  causing  severe 
irritation,  but  the  cow  does  not  endure  it  so  well. 

Brauer  recommends  very  highly  the  use  of  subcutaneous  injec- 
tions of  a  2  '/c  .solution  of  carbolic  acid,  20  or  30  cm^  to  be  given 
ev'ery  two  weeks  during  the  period  of  danger.  Combined  with 
the.se.  he  recommends  the  same  regulations  in  reference  to 
disinfection  which  we  have  already  related. 

The  bull  should  also  have  strict  attention,  as  a  probable  bearer 
of  the  infection.  It  is  highly  inadvisable  to  allow  a  bull  which 
is  in  use  in  a  given  herd  to  serve  cows  from  other  herds  where 
abortion  exists,  and  it  is  equally  imprudent  to  permit  a  cow  from 
an  apparently  healthy  herd  to  be  sent  to  a  bull  which  has  been 
u.sed  among  infected  cows. 

When  there  is  a  suspicion  of  danger  from  the  bull,  and 
it  is  desired  to  use  him,  the  prepuce  and  penis  should  be  carefully 
disinfected  before  and  after  copulation. 

The  disinfection  of  the  prepuce  of  the  bull  is  best  accomplished 
by  means  of  a  piece  of  pure  gum  tubing,  y{  to  3/8  in.  in  diameter 
and  4  to  6  feet  in  length,  provided  at  its  distal  end  with  a  funnel, 
into  which  the  disinfecting  fluid  may  be  poured  and  thence  flow 
by  gravity  through  the  tube  into  the  prepuce.  The  force  of  the 
liquid  may  be  moderated  by  the  height  at  which  the  funnel  is 
held.  The  most  convenient  form  of  rubber  tubing  procurable  is 
the  ordinary  pure  gum  horse  catheter. 

The  distal  end  of  the  rubber  tube  is  inserted  into  the  preputial 
opening  and  held  in  place  during  the  operation.  The  orifice  of 
the  prepuce  about  the  tube  should  be  grasped  and  closed  while 
the  fluid  is  entering,  causing  a  large  volume  of  the  disinfectant 
to  enter  the  sheath  and  fill  the  entire  cavity.  Such  distension  of 
the  cavity  obliterates  the  mucous  folds  and  enables  the  disinfec- 
tant to  reach  every  part  of  the  surface.  Any  reliable  disinfectant 
may  answer  the  purpo.se.  The  .sheath  will  ordinarily  withstand 
a  warm  i  to  2000  corro.sive  sublimate  .solution  or  a  2  to  3  %  lysol, 
creolin  or  carbolic  acid  solution.  The  long  hairs  about  the  pre- 
putial opening  should  be  clipped  away  so  as  to  render  the  part 


Infectious  Abortion  of  the  Cozv  507 

more  readilj^  cleansed.  The  entire  preputial  region  should  be 
scrupulously  cleansed  and  disinfected. 

Great  care  should  be  taken  at  all  times  by  owners  of  dairies  or 
herds  of  breeding  cows  to  prevent  the  introduction  of  the  infec- 
tion into  the  herd.  One  of  the  most  common  means  for  intro- 
ducing abortion  from  a  distance  is  the  purchase  and  introduc- 
tion into  the  herd  of  new  cows  or  bulls  for  breeding  purposes. 
New  breeding  animals  should  always  be  kept  isolated  from  the 
general  herd,  until  it  is  evident  that  thej^  are  free  from  any  in- 
fection. It  may  even  be  advisable  to  thoroughly  disinfect  the 
genitals  of  new  breeding  animals,  as  a  precaution,  before  using 
them  for  breeding  purposes. 

It  is  important  also,  if  the  owner  of  a  herd  desires  to  eradicate 
abortion  from  his  premises,  that  he  shall  not  introduce  new  ani- 
mals while  the  disease  is  active.  Should  it  become  necessary  to 
purchase  new  animals,  they  should  be  kept  apart  from  the  in- 
fected herd  and  cared  for  by  persons  who  do  not  come  in  contact 
with  the  other  animals.  Neither  should  an  owner  sell  animals 
which  have  aborted  and  buy  new  ones,  with  a  view  to  getting 
rid  of  the  disease.  He  can  much  more  readily  control  the  disease 
and  eradicate  it  from  the  premises,  by  keeping  the  infected  herd 
and  applying  means  which  we  now  regard  as  reliable  for  control- 
ling the  malady,  than  by  disposing  of  the  aborted  animals  and 
procuring  new  ones. 

It  is  still  more  unfortunate,  and  to  be  vigorously  condemned, 
for  the  owner  of  an  infected  herd  to  sell  his  cows  for  breeding 
purposes,  without  imparting  to  the  buyer  a  full  knowledge  of 
the  circumstances.  Un.scrupulous  dealers  may  thus  spread  and 
distribute  the  infection  over  a  wide  area  of  countr5^  The  .selling 
of  cows  which  may  be  bearers  of  infectious  abortion  for  any  other 
purpose  than  immediate  slaughter  should  be  strictly  prohibited 
by  law  and,  so  long  as  it  is  not,  a  sense  of  moral  duty  should 
prevent  an  owner  of  such  cows  from  selling  them  in  a  way  to 
render  dissemination  of  the  disea.se  probable. 

C.  Abortion  in  Other  Domestic  Animals. 

Infectious  abortion  in  other  domestic  animals  than  the  mare 

and  cow  is  not  very  common,  but  we  find   instances  recorded  of 

comparatively  severe  losses  from  this  disease  in  sheep,  goats  and 

swine.     In  these  animals  the  disease   has  not  been  extensiv^ely 


5o8  Veterinary  Obstetrics 

studied  and  there  is  nothing  known  regarding  the  character  of 
the  organism  which  causes  the  malady  in  each. 

The  symptoms  and  course  of  the  infection  are  essentially  the 
same  as  in  the  mare  and  cow,  and  the  abortion  usually  occurs  at 
a  corresponding  epoch  in  gestation  ;  that  is  to  say,  they  usually 
abort  earl>  during  the  second  half  of  pregnancy,  but  the  abor- 
tion may  occur  at  any  time. 

In  the  present  state  of  our  knowledge,  we  would  apply  the  same 
fundamental  principles  to  the  control  of  the  disease  which  we 
have  suggested  in  the  mare  and  cow.  It  is  evident  that  we  can- 
not so  effectively  apply  some  of  the  measures  in  these  small  ani- 
mals as  in  the  larger  ones.  We  cannot  so  well  disinfect  the  male 
genital  organs  and  consequently  need  to  take  other  equivalent 
measures  by  isolating  the  male  and  not  using  him  for  breeding 
purposes  for  a  longer  time  than  if  we  were  able  to  thoroughly 
disinfect  the  parts.  Similar  conditions  prevail  in  reference  to  the 
disinfection  of  the  genital  tract  in  the  female,  because  we  cannot 
so  readily  introduce  the  hand  into  the  uterus  and  make  sure  that 
the  afterbirth  has  been  removed,  nor  can  we  readily  introduce 
disinfectants  into  the  uterine  cavity  itself.  Therefore,  we  will 
generally  need  to  isolate  the  aborted  animals  for  a  longer  period 
of  time,  until  we  can  safely  assume  that  disinfection  has  taken 
place  in  a  spontaneous  manner,  before  we  shall  again  permit  them 
to  be  bred  and  thus  take  the  risk  of  continuing  the  spread  of  the 
disease.  Aside  from  these  considerations,  there  is  nothing  in  the 
present  state  of  our  knowledge  to  suggest  any  variations  in  the 
problem  of  control  and  eradication  from  that  which  we  have  al- 
ready considered  in  connection  with  the  di.sease  in  the  mare 
and  cow. 


NORMAL   PARTURITION. 

Normal  parturition  is  the  birth  or  expulsion  of  the  living  fetus 
at  the  natural  time,  without  artificial  assistance  and  in  a  state  of 
development  which  enables  it  to  live.  Although  the  act  of 
parturition  is  a  ph^-siologic  one,  it  is  accompanied  by  pain  and 
severe  exertion  upon  the  part  of  the  mother  and  brings  about 
sudden  changes  in  the  life  of  both  mother  and  fetus  which  in  a 
measure  imperil  the  well-being  of  each. 

The  phenomena  of  birth  vary  greatly  in  detail  in  species  and 
individuals  and  in  no  two  are  they  precisely  the  same,  either  in 
the  period  at  which  they  occur  after  impregnation,  the  length 
of  time  required  for  the  expulsion  of  the  fetus  bj-  the  mother, 
the  amount  of  force  required  for  its  expulsion,  or  in  any  other  of 
the  numerous  details  of  this  act.  The  fetus  may  present  in  many 
different  ways  for  its  passage  through  the  birth  canal,  or  offer  a 
very  wide  degree  of  variations  in  detail  and  yet  be  virtually 
normal.  A  very  slight  divergence  in  a  given  direction  may  cause 
deviation  of  a  part  which  may  render  birth  more  or  less  difficult, 
or  even  impossible  without  aid. 

The  causes  of  parturition  are  not  definitely  known.  We  have 
learned  in  preceding  chapters  that  birth  normally  takes  place 
after  a  somewhat  definite  duration  of  intra-uterine  life,  but  the 
variations  of  the  length  of  time  in  the  larger  animals,  like  the 
mare  and  cow,  may  reach  extremes  of  go  days  or  more,  so  that  we 
cannot  say  that  parturition  is  inevitable  at  ^  certain  time.  We 
know  that  the  uterus  and  other  portions  of  the  genital  tube  un- 
dergo certain  developments  during  pregnancy  which  constantly 
tend  to  fit  them  more  and  more  for  the  act  of  birth,  when  that 
phenomenon  finally  appears,  but  there  seems  to  be  nothing  in 
this  development  which  marks  a  limit  and  designates  a  definite 
stage  at  w^hich  the  uterus  will  necessarily  expel  its  contents. 

In  studying  the  development  of  the  fetus,  we  have  noted  that 
certain  changes  take  place  in  its  organs  of  circulation  and  nutri- 
tion and  that  they  gradually  acquire  a  completeness  which  closely 
simulates  that  which  is  seen  in  the  adult  animal.  In  this  way 
the  organism  becomes  fitted  for  an  independent  exi.stence. 
However,  there  is  nothing  in  this  development  which  seems  to 
mark  a  definite  stage  at  which  the  fetus  must  be  expelled. 
509 


5IO  Veteriyiary  Obstetrics 

According  to  researches  made  by  various  investigators,  there 
is  progressive  fatty  degeneration  of  the  decidua  or  of  that  portion 
of  the  uterine  mucous  membrane  which  constitutes  the  external 
layer  of  the  maternal  placenta,  so  that  eventually  the  nutrition 
of  the  fetus  is  disturbed  and  threatens  to  be  cut  off,  and 
consequently  it  must  be  born. 

This  view  of  the  cause  of  birth  would  suggest  that  the  fetus 
itself  largely  takes  the  initiative  in  the  act,  but  this  would 
scarcely  seem  to  be  true  in  any  important  sense.  It  is  a  quite 
conunon  observation  that,  just  prior  to  birth,  the  fetus  shows 
more  or  less  vigorous  movements,  but  we  do  not  know  whether 
these  are  due  to  some  such  cause  as  the  foregoing  or  if  they  are 
the  result  of  a  re-action  to  the  pressure  exerted  upon  it  by  the 
contractions  of  the  uterus,  preparatory  to  the  expulsion.  We 
very  well  know  by  clinical  experience  that,  if  we  touch  or  grasp 
a  fetus  from  the  vagina  or  rectum,  it  at  once  struggles  and,  if 
we  grasp  one  of  its  extremeties,  it  immediately  attempts  to  with- 
draw it.  Accordingly,  if  the  uterus  begins  contracting  upon 
the  fetus  and  disturbs  its  position,  the  fetus  performs  more  or  less 
vigorous  movements,  in  an  effort  to  adjust  its  position  to  the 
changes  in  form  which  are  taking  place  in  the  uterine  cavity, 
due  to  the  contractions  of  its  walls  and  the  opening  of  the  os 
uteri. 

Movements  of  the  fetus  are  not  essential  to  its  expulsion,  as  is 
frequently  observed  in  cases  of  abortion  and  in  stillbirths,  where 
the  fetus  is  usually  expelled  with  promptness  and  under  the 
same  general  conditions  as  in  normal  birth.  It  is  only  in  excep- 
tional instances  that  a  dead  fetus  is  retained  within  the  uterus, 
and  then  we  usually  have  some  recognizable  cause  for  such  re- 
tention, which  fully  explains  the  departure  from  the  rule  that, 
when  a  fetus  dies,  it  is  expelled. 

In  a  general  way  we  attribute  the  act  of  birth  to  a  reflex  irri- 
tation of  the  nerves  of  the  uterus.  The  causes  of  this  reflex 
irritation  we  do  not  fully  understand  and  they  do  not  seem  to 
always  be  the  same.  On  page  227  we  have  noted  the  fact  that 
abortion  may  be  brought  about  by  the  pressing  out  of  the  corpus 
luteum  from  the  ovary  of  the  pregnant  female.  This  apparently 
induces  contractions  of  the  uterus  which  cause  the  expulsion  of 
the  immature  fetus,  thus  showing,  or  tending  to  show,  that  the 
presence  of  the  yellow  body  in  the  ovary  of  the  pregnant  female 


Normal  Parturition  511 

inhibits  expulsive  muscular  contractions  of  the  uterus.  We 
have  also  learned,  on  page  165,  that  normally  the  corpus  luteum 
begins  to  disappear  late  during  gestation  and  that  at  the  time  of 
birth  it  has  become  completely  atrophied.  The  relation  of  this 
disappearance  of  the  yellow  body  from  the  ovary  to  the  expulsion 
of  the  fetus  has  not  been  studied  and  may  be  quite  interesting, 
as  it  possibly  exerts  a  highly  important  influence  upon  birth. 
We  know  that  the  death  of  the  fetus,  as  alread}^  stated,  tends 
constantly  to  excite  a  reflex  action  in  the  uterine  walls,  which 
brings  about  contractions  and  the  expulsion  of  the  dead  fetus. 
We  know  also  that,  in  case  of  the  aseptic  death  of  the  fetus, 
followed  by  mummification,  the  presence  of  the  cadaver  does  not 
excite  this  reflex  action,  but  permits  the  dead  fetus  to  remain  as 
an  inert  body  in  the  uterine  cavity  for  an  indefinite  period  of 
time.  It  therefore  seems  that  it  is  not  so  much  the  death  of  the 
fetus  which,  in  this  case,  causes  its  expulsion  as  it  is  a  beginning 
of  putrefaction.  It  is  not  impossible  that  the  excretions  of  the 
fetus  after  a  time  become  so  important  in  quantity  and  character 
that,  passing  into  the  blood  of  the  mother,  they  bring  about  a 
certain  irritation  upon  the  central  nervous  system  and  cause  con- 
tractions of  the  uterus,  with  the  expulsion  of  its  contents. 

The  Expelling  Powers.  The  initial  powers  by  which  the 
fetus  is  expelled  from  the  uterus  reside  in  the  unstriped  muscle 
walls  of  the  uterus  itself,  but  the  final  power  is  very  largely  de- 
rived from  the  abdominal  walls,  including  the  diaphragm. 

Labor  pains  are  diminished  or  inhibited  in  many  cases  by  cir- 
cumstances of  varying  character.  When  there  is  torsion  of  the 
uterus  to  an  extreme  degree,  there  are  no  prominent  labor  pains 
present,  because  the  contractile  power  of  the  uterus  is  destroyed. 
In  transverse  development  of  the  fetus  in  the  uterus  of  the  mare, 
the  physical  relations  of  the  fetus  to  the  organ  are  such  that  they 
inhibit  any  very  marked  labor  pains,  and  while  we  have  good 
evidence  of  some  uterine  contraction,  by  the  dilation  of  the  os 
uteri  and  the  expulsion  of  portions  of  the  fetal  membranes,  we 
do  not  observe  the  vigorous  expulsive  efforts  of  normal  parturi- 
tion. It  may  be  stated  that  we  do  not  generally  observe  a  full 
exertion  of  the  expelling  powers  in  any  of  those  cases  wherein 
the  conditions  are  such  that  the  fetus  cannot  pass  from  the  uterus 
through  the  cervix  into  the  vagina. 


512 


Veterhiary  Obstetrics 


The  force  of  the  uterine  contractions  is  not  very  apparent  to 
the  observer.  The  obstetrist  recognizes  them  during  parturition, 
when  he  inserts  his  hand  between  the  fetus  and  uterine  walls 
during  labor.  But,  in  cases  of  d^^stokia,  the  obstetrist  does  not 
note  so  vividly  the  contractions  of  the  uterus,  but  observes  chiefly 
the  great  pressure  which  is  exerted  upon  his  hand  and  arm  when 
the  animal  makes  violent  expulsive  efforts  by  the  contraction  of 
the  abdominal  walls  and  the  increase  thereby  of  the  intra-abdom- 
inal pressure. 

The  uterine  contractions  dilate  the  os  uteri,  expel  the  fetus 
unaided  in  case  the  contractile  power  of  the  abdomen  is  destroyed 
by  extensive  rupture,  and,  after  the  birth  of  the  fetus,  expel  the 
placenta. 

By  observing  the  contractions  of  the  pregnant  uterus  when  it 
is  exposed  to  the  air,  we  find  that  the  movements  are  of  a  char- 
acter closely  analogous  to  intestinal  peristalsis.  At  w^hat  time 
these  contractions  of  the  uterus  begin,  in  relation  to  parturition, 
we  do  not  know.  Probably  contractions  of  a  peristaltic  type 
occur  continuously  throughout  the  entire  period  of  gestation,  not 
of  a  character  to  threaten  the  expulsion  of  the  fetus,  but  of  a  kind 
to  favor  its  normal  dev^elopment  and  maintain  its  normal  position. 

Fleming  maintains  that  during  the  labor  pains  the  entire 
uterus  contracts,  but  that  the  fundus  does  so  most  energetically. 
This  opinion  is  apparently  drawn  from  human  obstetrics,  because 
the  uteri  of  domestic  animals  have  virtually  no  fundus,  and  con- 
sequently contractions  could  not  occur  chiefly  in  that  part. 

Clinical  observations  upon  the  larger  domestic  animals  would 
indicate  that  contractions  of  the  muscular  walls  of  the  uterus 
frequently  commence  two  or  three  days,  or  even  longer,  in  ad- 
vance of  parturition,  and  that  they  are  manifested  by  the  appear- 
ance of  slight  colicky  pains.  This  is  especially  noted  in  the 
mare,  and  suggests  that  labor  is  threatened  and  that  there  is 
actually  some  pain  present,  due  to  the  vigorous  contractions  of 
the  uterine  muscles.  These  symptoms  may  appear  in  a  very 
mild  form  for  several  days  in  succession  before  real  expulsive 
efforts  begin.  Asa  general  rule  they  pass  unnoticed,  and  it  is  not 
until  there  are  added  to  the  uterine  contractions,  the  expulsive 
powers  of  the  abdominal  walls  that  we  really  observe  their 
presence. 


Normal  Parturition 


513 


When  discussing  the  position  of  the  fetus  in  the  uterus  toward 
the  end  of  gestation,  we  took  occasion  to  note  that  it  is  not  rare 
to  find  a  portion  of  it  extending  bej^ond  the  cervix  and  resting 
in  a  cul-de-sac  of  the  uterus  alongside  the  vagina.  When  partu- 
rition comes  on,  if  the  abdominal  muscles  alone  should  act  on 
the  fetus,  they  would  simply  tend  to  push  the  fetus  further  on- 
ward in  this  cul-de-sac  and  threaten  finally  to  rupture  the  uterus. 

If,  on  the  other  hand,  the  uterus  contracts  first,  and  especially 
the  longitudinal  fibers,  their  contraction  would  efface  the  cul-de-sac 
of  the  uterus  alongside  the  vagina.  This  brings  the  presenting 
part  of  the  fetus  into  a  conical  cavity  which  terminates  with  the 
OS  uteri  and  places  the  fetus  in  a  position  and  direction  which  will 
permit  of  its  expulsion. 

The  uterine  contractions  are  essential  for  the  dilation  of  the 
OS  uteri.  Whenever  these  contractions  take  place,  and  conse- 
quently increase  the  intra-uterine  tension,  the  walls  yield  at  the 
point  of  least  resistance.  Normally  this  yielding  occurs  at  the 
cervix,  causing  it  to  become  dilated,  and  later  the  cervix  and  os 
uteri  to  become  wholly  effaced,  so  that  the  uterine  and  vaginal 
cavities  are  merged  into  one  common  passage,  without  any  line 
of  demarcation  between  them. 

The  contractions  of  the  uterus  during  the  act  of  birth  are 
essential  to  the  maintenance  of  the  organ  in  its  position  in  the 
abdominal  cavity.  If  the  expulsive  powers  were  dependent  upon 
the  abdominal  muscles  alone,  the  uterus  would  tend  to  become 
expelled  along  with  the  fetus  and  thus  to  induce  a  prolapse,  but 
the  uterus,  by  its  contraction,  is  able  to  maintain  a  natural  posi- 
tion throughout  the  act  and  to  avoid  being  pushed  back  into  the 
vagina. 

The  dilation  of  the  cervical  canal  is  dependent  partlj-  upon  the 
shortening  of  the  longitudinal  muscle  fibers  of  the  uterus,  but 
largely  upon  the  pressure  of  the  fetal  membranes,  with  the  con- 
tained fluids,  against  its  anterior  opening.  With  the  increase  of 
intra-abdominal  tension,  the  fluids  about  the  fetus  tend  to  move 
most  readily  toward  the  os  uteri  and  push  along  with  them  the 
membranes.  The  fetal  fluids  within  the  membranes  serve  as  an 
elastic  dilator  which,  .slowly  becoming  impacted  in  the  os  uteri, 
gradually  dilates  the  passage  by  exerting  equal  pressure  upon 
every  part. 
33 


514  Veterinary  Obstetrics 

It  is  well  to  note  that  the  os  uteri  is  very  much  more  dilatable 
when  the  force  is  exerted  from  before  backward — intra- uterine 
force— than  from  behind  forward — extra-uterine  force — as  the 
obstetrist  must  largely  do  when  applying  forcible  means  for  dila- 
tion of  the  OS  uteri.  As  the  os  uteri  becomes  dilated  and  the 
cervix  effaced,  the  pressure  within  the  uterus  presses  the  fetal 
membranes,  with  the  contained  fluids,  out  through  the  os  uteri, 
vagina  and  vulva,  until  they  appear  externally. 

The  relations  of  the  various  fetal  membranes  to  each  other,  and 
to  the  contained  liquids,  bring  about  very  marked  differences  in 
the  various  animals.  The  chorion  ruptures  without  having 
moved  from  its  original  position,  or  becoming  extensively  de- 
tached from  the  uterus.  Normally  it  can  not  protrude  far 
through  the  os  uteri.  It  is  essential  that  this  should  be  so  be- 
cause it  is  through  the  maintenance  of  the  intimate  relation  be- 
tween the  chorion  and  the  uterus  that  the  life  of  the  fetus  is 
maintained  during  the  time  of  parturition.  If  the  chorion  should 
become  so  detached  from  the  uterus  as  to  interrupt  the  inter- 
change of  nutriment  or  excretions  between  the  mother  and  the 
fetus,  the  life  of  the  latter  must  quickly  terminate  unless  the  act 
of  birth  is  abruptly  completed.  Normally,  therefore,  the  chorion 
may  push  out  only  a  little  way  from  the  os  uteri  before  rupturing, 
without  interfering  materially  with  its  general  attachments  to 
the  uterus  through  the  placenta.  After  the  rupture  of  the 
chorion,  some  of  the  allantoic  fluid  may  escape  into  the  vagina 
and  later  externally.  Through  this  rupture  in  the  chorion,  the 
posterior  extremity  of  the  amnion  regularly  protrudes  until  it 
reaches  the  vulva  and  projects  out  between  the  vulvar  lips  for 
some  distance. 

The  allantoic  sac  of  ruminants,  that  is,  the  endoblastic  portion 
of  the  allantois,  is  so  disposed  that  it  may  protrude  through  the 
rupture  in  the  chorion  to  constitute  the  first  "water-bag."  In 
the  mare  this  cannot  occur  independently  of  the  chorion.  Rupture 
of  the  protruding  allantoic  sac  occurs  early,  and  is  followed  by 
the  appearance  of  the  second  or  true  ' '  water-bag ' '  which  consists, 
as  in  other  animals,  of  a  portion  of  the  amniotic  sac  enclosing 
some  amniotic  fluid. 

In  the  cow  and  mare  the  protruding  portion  of  the  amnion,  or 
"water-bag,"  appears  as  an  elongated  bladder  with  a  thin,  color- 
less membrane  filled  with  a  clear  fluid.    The  bag  may  extend  for 


Normal  Parturitio7i 


515 


a  distance  of  6  to  10  inches  beyond  the  vulva,  and  contain  from  i 
to  4  or  5  pints  of  amniotic  fluid.    With  each  labor  pain,  more  of 


Fig.  87.     Normal  Position  of  Fetus  of  Cow  at  Time 
OF  Birth.     (SkeIvETT.) 


5i6  Vetermary  Obstetrics 

the  amniotic  fluid  is  pushed  out  into  the  water-bag,  until  finally 
the  tension  becomes  too  great  and  it  ruptures.  Slightly  before 
this  period,  in  normal  cases,  the  presenting  portion  or  portions 
of  the  fetus,  usually  the  two  anterior  feet,  followed  closely  by 
the  nose,  appear  in  the  "water-bag." 

Under  more  or  less  abnormal  conditions,  there  are  great  varia- 
tions in  reference  to  the  behavior  of  the  fetal  membranes  at  this 
stage  of  labor.  In  the  mare  it  is  possible  for  the  chorion  to 
become  completely  detached  from  the  uterus  without  becoming 
ruptured.  Consequently  the  fetus  is  in  some  cases  said  to  be 
expelled  completely  encased  within  all  its  membranes.  This  is 
apparently  a  general  statement  and  we  do  not  know  of  a  well 
authenticated  instance  where  it  has  occurred  in  a  fully  developed 
fetus,  though  it  is  frequently  seen  in  the  mare,  as  well  as  in  other 
animals,  when  abortion  takes  place  at  an  early  period  in  gesta- 
tion. In  one  case  which  we  observed,  the  chorion  ruptured  at 
the  anterior  end  and  was  pushed  over  the  fetus  and  expelled, 
along  with  the  amnion,  while  the  dead  fetus  remained  in  the 
uterus,  owing  to  some  deviation  in  its  extremities  which  inter- 
fered with  its  expulsion. 

In  cases  of  twin  pregnancy,  it  is  essential  that  but  one  fetus 
should  enter  the  birth  passage  at  a  time.  In  the  cow  and  ewe 
ordinarily,  when  there  are  twins,  one  occupies  each  horn  in  part, 
while  a  portion  of  each  fetus  projects  more  or  less  into  the  body 
of  the  uterus  and,  when  labor  pains  come  on,  that  fetus  which 
chances  to  be  most  advanced  ordinarily  gains  the  cervical  canal 
and  pelvic  inlet  first  and  by  its  presence  prevents  the  other  from 
entering.     Thus  the  two  fetuses  are  born  one  after  the  other. 

In  practice,  this  favorable  disposition  of  twin  fetuses  is  occa- 
sionally interrupted  by  some  portion  or  portions  of  each  fetus 
simultaneously  entering  the  pelvic  canal  and  causing  more  or  less 
serious  dystokia. 

We  have  no  evidence  to  show  that  the  uterine  contractions  in 
the  two  horns  may  not  be  essentially  equal,  but  apparently  they 
soon  become  concentrated  upon  that  portion  of  the  organ  which 
contains  the  fetus  in  the  most  advanced  position,  and  consequently 
where  the  contractions  will  prove  most  efficient.  As  soon  as  the 
first  fetus  is  expelled  and  the  passage  thus  vacated  and  dilated, 
the  expulsion  of  the  other  one,  as  a  rule,  follows  very  promptly. 

In  the  mare,  only  a  few  minutes  usually  elapse  between  the 


Normal  Parturition  517 

expulsion  of  the  first  and  the  second  fetus.  In  the  cow,  where 
the  act  of  parturition  is  more  deliberate,  there  is  a  greater  interval, 
sometimes  20  or  30  minutes.  Under  abnormal  conditions  the 
interval  between  the  expulsion  of  the  two  fetuses  may  be  much 
greater.  The  birth  of  the  second  of  a  pair  of  twin  fetuses  may 
be  delayed  for  hours  or  even  days  after  the  birth  of  the  first. 
Any  great  delay  in  the  expulsion  of  the  second  fetus  is  usually 
due  to  some  exhaustion  in  the  contractile  power  of  the  uterus, 
resulting  from  the  expulsion  of  the  first  fetus  and  the  advent  of 
a  subsequent  period  of  rest  before  the  renewal  of  labor  pains  for 
the  expulsion  of  the  second  fetus. 

In  multiparous  animals,  the  entanglement  of  two  fetuses  during 
parturition  cannot  well  occur.  No  fetus,  or  parts  of  a  fetus,  nor- 
mally occupies  the  uterine  body.  The  fetuses  are  wholly  lodged 
within  the  two  cornua.  The  body  of  the  uterus  is  actually  nar- 
rower, when  labor  sets  in,  than  are  the  two  gravid  cornua,  so  that 
it  is  quite  impracticable  for  a  fetus  from  each  horn  to  enter  simul- 
taneously the  body  of  the  uterus.  One  fetus  enters  at  a  time  and 
it  is  assumed  that  they  enter  alternately  from  the  two  cornua,  so 
that  the  two  are  emptied  nearly  together,  that  is  to  say,  that  one 
horn  is  not  completely  emptied  of  its  fetuses  until  the  other  is 
also  emptied  of  all  but  one. 

Symptoms  of  Parturition.  Preliminary  to  the  completion 
•of  pregnancy  there  appear  certain  signs  which  indicate  to  us, 
with  more  or  less  certainty,  the  near  approach  of  labor. 

One  of  the  most  conspicuous  of  these  is  the  increased  func- 
tional activity  of  the  milk  glands.  In  all  of  our  domestic  animals 
there  is  a  tendency  for  the  glands  to  become  gradually  enlarged 
and  ten.se  as  the  period  for  giving  birth  to  young  approaches. 
The  date  at  which  this  enlargement  appears  varies,  being  of 
longer  duration  in  primipara  than  in  those  which  have  previously 
given  birth  to  young.  Usually  a  few  weeks  before  birth  there 
appears  in  the  udder  at  first  a  watery  secretion,  which  may  be 
pressed  from  the  teat,  but  which  bears  only  a  faint  resemblance 
to  milk.  Later  the  secretion  becomes  more  milk-like  and  assumes 
the  characters  of  colostrum,  which  some  claim  is  essential  to  the 
well-being  of  ^the  young.  When  parturition  is  near,  the  milk 
secretion  may  be  so  profuse  that  it  escapes  from  the  teat  in  drops, 
or  in  streams. 


5i8  Veterinary  Obstetrics 

However  reliable  this  is  as  a  sign  that  parturition  is  near, 
it  may  become  very  misleading.  We  have  previously  stated  that 
sometimes  during  various  stages  of  pregnancy  the  glands  become 
swollen  and  contain  milk  and  that  this  may  disappear  and  not  be 
seen  again  until  at  the  close  of  pregnancy,  weeks  or  months 
later. 

Sometimes  the  milk  glands  become  much  enlarged  and  show 
great  functional  activity  long  before  parturition,  so  that  in  the 
mare  we  have  observed  a  profu.se  flow  of  milk  escaping  from  the 
glands  for  two  or  three  weeks  before  the  birth  of  the  foal,  though 
everything  seemed  to  be  normal  and  parturition  was  regular.  We 
have  also  noted  in  previous  chapters  that  we  have  at  times  ob- 
served the  secretion  of  milk  by  a  mule  during  the  estrual  period. 

On  the  other  hand,  it  .sometimes  occurs,  especially  in  the  mare, 
that  almost  no  milk  is  secreted  prior  to  parturition  and  that  the 
glands  are  very  slightly  enlarged.  Such  is  especially  the  ca.se  in 
very  old  mares  which  have  been  bred  for  the  first  time. 

Fleming  suggests  that  this  enlargement  and  increased  func- 
tional activity  of  the  udder  is  due  to  the  diversion  to  it  of  the 
excess  of  blood  from  the  uterus,  which  this  organ  no  longer  re- 
quires. This  explanation  is  not  clear.  The  nutritive  demands 
of  the  fetus  at  the  close  of  intra-uterine  life  seem  to  be  even 
greater  than  at  an  earlier  period.  The  fetus  is  larger  and  grow- 
ing rapidly.  The  uterus  must  receive  an  increased  amount  of 
nutriment,  in  order  to  perform  its  function  of  expulsion  of  the 
fetus  and  placenta  and  repair  of  the  injuries  incident  to  parturi- 
tion. It  is  rather  a  part  of  the  general  plan  of  nature  in  preparing 
for  the  nutrition  of  the  fetus  after  its  birth. 

A  very  important  sign  of  approaching  parturition  is  the  re- 
laxation of  the  sacro-sciatic  ligaments,  which  allows  the  muscles 
passing  over  them  to  drop  inward  causing  a  sinking  of  the  croup. 
This  relaxation  increases  the  dilatability  of  the  vulvo-vaginal 
canal  and  makes  it  easier  for  the  fetus  to  be  propelled  through 
it.  The  relaxation  in  these  ligaments  is  thought  by  some  to  be 
due  to  changes  taking  place  within  the  ligament  it.self,  consisting 
largely  of  an  effusion  of  lymph  into  it,  which  leads  to  its  soften- 
ing. Others  refer  the  phenomenon  to  a  change  in  the  relationship 
between  the  ossa  innominata  and  the  .sacrum  and  coccyx.  The 
sacro-iliac  ligaments,  according  to  this  view,  become  somewhat 
relaxed,    so    that    the  articulation  becomes  less  rigid   and   the 


Normal  Parturition  519 

tuberosity  of  the  ischium  passes  upward  toward  the  sacrum  and 
causes  a  decrease  in  the  tension  of  the  great  sacro-sciatic 
ligaments. 

Another  symptom  of  approaching  birth,  which  is  important,  is 
the  preparation  which  is  taking  place  in  the  vulva.  The  vulvar 
lips  become  somewhat  thickened  and  tend  to  stand  apart  more 
loosely  than  ordinarily.  From  the  vulva  there  generally  appears, 
especially  in  the  cow,  a  more  or  less  abundant  discharge  of  a 
thick,  ropy  mucus,  which  indicates  an  increase  in  the  functional 
activity  of  the  glands  in  the  mucosa  of  the  vagina  and  vulva. 
If  the  lips  of  the  vulva  are  parted,  there  is  observed  an  injection 
of  the  mucosa- 

As  the  time  for  birth  draws  nearer,  certain  psychic  signs  are 
observed,  which  indicate  that  the  period  of  labor  is  rapidly  ap- 
proaching. The  animal  seems  to  be  somewhat  disturbed  and 
anxious.  It  tends  to  move  slowly  and  cautiously  and  exhibits 
some  tendency  to  isolate  itself  from  its  usual  associates.  There 
may  be  interruptions  in  feeding,  suggesting  that  uterine  contrac- 
tions are  taking  place,  which  cause  some  degree  of  discomfort 
or  pain.  These  may  express  themselves  through  an  appearance 
of  anxiety  on  the  part  of  the  animal.  Sometimes  the  advent  of 
the  uterine  contractions  is  suggested  by  the  appearance  of  slight 
colic,  accompanied  by  occasional  pawing  or  lying  down,  or,  in 
case  of  carnivora,  whining  or  groaning.  The  mare  may  show 
evidence  of  pain  by  whisking  the  tail,  a  symptom  which  is  seen 
to  some  extent  also  in  the  cow.  Finally  the  pregnant  animal,  if 
at  liberty,  tends  to  withdraw  from  other  animals  of  its  own  kind 
or  of  other  species  and  seek  a  quiet  and  secluded  place,  where  it 
may  bring  forth  its  young  without  disturbance  or  annoyance. 

In  herbivora,  little  care  is  taken  in  the  selection  of  a  place  for 
giving  birth  to  young,  except  that  it  is  a  quiet  spot  where  the 
mother  and  young  may  for  a  time  remain  more  or  less  in  hiding. 
The  carnivorous  animal  shows  a  tendency  to  select  a  comfortable 
bed. 

The  sow,  in  a  state  of  freedom,  will  habitually  gather  coarse 
herbage  or  small  brush  into  a  conical  mound,  in  which  she  may 
give  birth  to  her  young.  If  allowed  the  fullest  liberty,  at  a 
season  of  the  year  when  vegetation  is  abundant,  she  will  select  a 
spot  where  she  can  gather  an  abundance  of  coarse  weeds  or  fine 
twigs  which  are  covered  with  leaves.     Beginning  at  the  spot 


520  Veterhiary  Obstetrics 

which  she  selects  for  her  nest,  she  will  gather  all  the  herbage  in 
an  ever  widening  circle  and  carry  it  to  the  central  spot,  where 
she  deposits  it  in  the  form  of  a  mound,  until  she  has  acquired 
sufficient  to  suit  her  purposes.  We  have  seen  such  mounds  as 
extensive  as  four  or  five  feet  in  diameter  and  two  or  three  feet  in 
depth.  Into  the  center  of  this  mound  she  crawls  in  such  a  way 
as  to  become  almost  or  quite  hidden  and  there  gives  birth  to  her 
young.  In  confinement,  she  builds  such  a  nest  as  her  environ- 
ment makes  possible  or  demands,  and  it  may  vary  in  every  degree 
from  that  which  we  have  already  described  to  no  bed  at  all  in 
some  cases  where  she  is  denied  the  proper  material  for  its  con- 
struction. Increased  domestication  brings  decreased  instinct  in 
preparing  such  bed. 

The  rabbit  constructs  a  burrow  and  pulls  from  her  own  body  a 
sufficient  amount  of  fur  to  line  a  very  complete  and  cozy  nest  in 
which  to  give  birth  to  her  very  immature  young. 

Exploration  of  the  genital  passages  just  prior  to  labor  reveals 
the  fact  that  the  cervix  of  the  uterus  has  largely  disappeared, 
and  there  simply  remains  a  brief  constriction  at  the  os  uteri  ex- 
ternum. The  OS  may  be  .somewhat  open,  so  that  the  fingers  can 
readily  be  introduced  into  the  uterine  cavity  and  come  in  contact 
with  the  smooth  surface  of  the  chorion  over  the  small  area 
where  no  placental  tufts  exist.  As  labor  progresses,  the  os  uteri 
gradually  dilates  and,  when  the  contractions  of  the  uterine  walls 
become  more  pronounced,  the  dilation  of  the  os  uteri  externum 
rapidly  increases,  until  it  finally  becomes  wholly  effaced  and  the 
uterine  cavity  continuous  with  that  of  the  vagina. 

When  the  os  uteri  has  become  sufficiently  dilated,  the  water- 
bag  passes  into  and  through  the  opening  and  portions  of  the 
fetus  .soon  advance  into  the  os  uteri  and  vagina  and  the  definite 
symptoms  of  labor  quickly  become  established.  The  uterine 
contractions  now  begin  in  earnest  and  are  soon  accompanied  by 
contractions  of  the  abdomen  and  diaphragm.  The  animal  shows 
well  marked  pain  and  suffering.  Depending  somewhat  upon 
species,  the  animal  shows  a  tendency  to  lie  down  and  rise  fre- 
quently, and  in  general  to  show  abdominal  pain.  The  mare 
may  paw  with  the  fore  feet  and  strike  at  the  abdomen  with 
the  hind  feet.  The  animal  ceases  to  feed  and  shows  much 
anxiety,  which  is  indicated  to  some  extent  by  a  disturbance  of 
the  circulation,  con.si.sting  chiefly  in  an  increased  pulse  rate.     In 


Normal  Parhirition  521 

the  mare,  there  may  be  some  sweating.  The  pain  is  somewhat 
intermittent  and  after  each  uterine  contraction,  which  is  of 
variable  length  but  which  rarely  exceeds  two  or  three  minutes, 
there  is  a  pause  in  the  pain  and  anxiety  until  another  period  of 
contraction  comes  on.  As  the  uterus  is  an  unstriped  muscle 
organ,  its  contractions  are  more  or  less  slow,  are  virtually  in- 
voluntary and,  like  other  contractions  of  this  type  of  muscle,  are 
rythmic  and  recur  at  more  or  less  regular  intervals.  The  uterine 
contractions  are  almost  wholly  involuntary,  but  may  be  indi- 
rectly modified  by  fear  or  other  emotions.  As  soon  as  the  fetal 
membranes  pass  into  and  beyond  the  os  uteri,  the  expulsive 
efforts  of  the  animal  increase  in  force  and  the  full  power  of  the 
abdominal  and  other  muscles  of  the  body  is  brought  into  play  in 
a  supreme  effort  to  bring  about  the  expulsion  of  the  fetus. 

When  the  labor  pains  become  fully  established,  the  animal 
assumes  varying  attitudes,  somewhat  according  to  the  species 
and  individual.  Our  larger  domestic  animals  alternate  between 
the  standing  and  recumbent  positions  during  labor,  while  multi- 
parous  animals  lie  almost  continually  and  chiefly  in  lateral  re- 
cumbency. The  larger  animals,  when  standing,  arch  the  back, 
bring  all  the  feet  together  and  strain  violently.  This  straining 
is  aided  materially  by  the  animal  taking  a  deep  inspiration  of 
air,  closing  the  glottis  so  that  the  air  cannot  escape  from  the 
chest,  and  then  powerfully  contracting  the  muscles  of  the  body, 
increasing  enormously  the  intra-abdominal  pressure  and  tending 
to  force  the  contents  of  the  abdomen  in  the  direction  of  least 
resistance.  With  the  contractions  of  the  uterus,  this  force  is 
concentrated  chiefly  upon  the  fetus  and  its  envelopes,  and  forces 
them  toward  and  through  the  dilated  os  and  out  through  the 
vagina  and  vulva. 

Herbivorous  animals  do  not  constantly  maintain  a  given  posi- 
tion during  labor,  but  vary  their  attitude  somewhat  according 
to  the  progress  of  parturition  and  partly  according  to  indi- 
vidual temperament.  During  the  earlier  stages  of  the  act  there 
is  a  greater  tendency  to  maintain  the  standing  position,  than 
later.  When  the  fetus  has  been  well  propelled  into  the  pelvis 
and  the  anterior  feet  and  head  have  passed  beyond  the  vulva, 
there  is  a  very  marked  tendency,  in  the  cow  and  mare,  to  as- 
sume the  recumbent  position,  and  the  animal  may  lie  either  in 
the  sternal  position,  or  prone   upon  the  side,  in  lateral  recum- 


522  Veterinary  Obstetrics 

bency.  Even  here  the  position  tends  to  vary  to  some  degree, 
especially  in  the  mare,  according  to  the  stage  of  the  act.  The 
mare  generally  lies  upon  her  sternum  until  the  head  of  the  fetus 
has  protruded  some  distance  beyond  the  vulva,  when,  should 
she  continue  this  position,  there  would  be  a  tendency  for  the 
fetus  to  strike  against  the  floor  or  ground  and  offer  obstruction 
to  its  further  expulsion.  At  this  period  she  usually  assumes 
lateral  recumbency,  in  which  position  she  is  capable  of  exerting 
the  maximum  expulsive  power,  while  the  fetus  may  be  expelled 
without  obstructing  its  long  passage  by  contact  with  the  ground. 

The  standing  position  of  large  animals  at  the  close  of  the  ex- 
puLsion  of  the  fetus  is  unfavorable  for  the  well-being  of  the  young, 
because  of  the  possibility  of  its  injury  in  falling.  It  is  not  the 
best  position  for  the  mother,  because  she  cannot  exert  the  maxi- 
mum degree  of  force. 

In  the  multiparous  animals  the  contraction  of  the  abdominal 
muscles  plays  a  comparatively  unimportant  part  in  the  expulsion 
of  the  fetus.  This  is  brought  about  chiefly  by  the  contractions 
of  the  muscular  walls  of  the  uterus  itself. 

The  "  water  bag  "  performs  a  highly  important  office  in  the 
expulsion  of  the  fetus.  We  have  already  suggested  that,  in  the 
dilation  of  the  os  uteri,  the  bag  of  water  tends  to  bring  this 
about,  in  the  safest,  gentlest,  and  yet  most  effective  manner 
possible,  by  producing  an  equal  pressure  in  every  direction. 
Later  it  dilates  the  vulvar  opening  also,  although  here  it  is  not 
so  important  because,  when  the  water  bag  reaches  this  part,  the 
membrane  protrudes  through  the  vulva  and  the  fetal  liquid  is 
forced  through  the  vulva  in  a  stream,  to  accumulate  on  the  out- 
side till  the  amnion  ruptures  and  the  fluid  escapes.  Exception- 
ally, the  "  water  bag  "  is  said  to  not  rupture  in  the  mare,  and  the 
foal  to  be  expelled  inclosed  within  it. 

In  normal  parturition,  the  allantoic  and  amniotic  fluids  serve 
to  lubricate  the  passages  throughout  labor,  and  portions  of  the 
fluids  remain  within  the  uterus  after  the  fetus  has  been  expelled. 
The  presence  of  this  fluid  in  the  uterus  serves  to  fill  out  and  efface 
all  irregularities  in  the  form  of  the  fetus  and  prevents  the  uterus 
from  closely  investing  the  body  of  the  fetus  in  such  a  way  as  to 
interfere  with  its  expulsion. 

Should  the  uterus  contract  directly  upon  the  irregular  fetal 
body  and  closely  invest  it  throughout,  it  could  not  exert  that 


Normal  Parturition  523 

power  upon  the  fetus  essential  to  its  ready  expulsion.  The 
uterus  maintains  a  more  or  less  spherical  shape  while  the  fetal 
fluids  are  retained,  and  consequently  presses  alike  upon  all  por- 
tions of  the  fetus,  and  tends  to  press  it  backward  through  the 
vagina  and  vulva. 

When  dystokia  occurs  and  the  fetal  fluids  all  escape,  the  ob- 
stetrist  is  made  to  realize  the  disadvantage  of  the  absence  of 
these  and  the  close  investment  of  the  fetus  by  the  uterine  walls. 
This  condition  prevents  him  from  readily  changing  the  position 
of  the  fetus  or  from  carrying  out  other  manipulations.  After  the 
position  of  the  fetus  has  been  adjusted,  the  obstetrist  still  needs 
the  fetal  fluids.  The  uterine  and  abdominal  contractions  tend  to 
force  out  some  of  these  liquids  with  each  labor  pain,  and  conse- 
quently keep  the  passage  constantly  moist  and  somewhat 
unctuous  throughout  the  entire  duration  of  normal  parturition. 

The  dilation  of  the  passages  is  favored  by  the  part  of  the  fetus 
which  normally  presents.  In  the  larger  herbivora,  the  vast 
majority  of  fetuses  present  with  the  two  anterior  feet,  followed 
shortly  by  the  nose  resting  upon  them  at  about  the  middle  of  the 
metacarpus.  The  three  extremities  constitute  an  elongated 
cone,  which  acts  as  a  wedge  in  gradually  dilating  the  passages. 
If  the  fetus  presents  posteriorly,  the  conditions  are  essentially 
the  same,  in  reference  to  the  mechanical  plan,  and  the  two  hind 
feet  present  together.  As  the  legs  and  thighs  are  advanced  they 
serve  again  as  a  long  wedge  or  cone  to  graduallj^  dilate  the  pas- 
sages for  the  expulsion  of  the  fetus.  In  carnivorous  animals, 
where  the  head  is  proportionately  very  large  and  the  anterior 
limbs  are  comparatively  small  and  flexible,  the  head  usually  ad- 
vances alone  and  the  fetus  is  expelled  with  the  anterior  limbs 
lying  along  the  side  or  floor  of  the  fetal  chest. 

When  the  young  of  large  herbivora  present  anteriorly  there  is 
usually  no  very  serious  impediment  to  their  progress  until  the 
head  of  the  fetus  reaches  the  vulva,  when,  especially  in  primipara, 
there  is  a  delay  in  the  progress  of  the  fetus  because  time  is  re- 
quired to  bring  about  the  dilation  of  the  vulva  to  such  a  degree 
that  the  fetus  can  pass  through  without  serious  injury  to  the 
part.  When  the  head  emerges  from  the  vulva,  the  other  parts 
of  the  fetus  usually  pass  with  less  difiiculty,  though  there  may 
be  marked    resistance  when   the  chest  enters  the  passages  and 


524  Veterinary  Obstetrics 

again  when  the  hips  advance  until  they  come  in  contact  with  the 
pelvic  inlet  of  the  mother. 

It  is  important  to  bear  in  mind  that  in  our  larger  domestic 
animals  the  fetus  lies  en  arc  and  that,  in  passing  through  the 
pelvic  canal,  in  anterior  presentation,  the  head  and  forefeet  must 
pass  upward  and  backward,  and,  when  these  extremities  emerge 
from  the  vulva,  the  expulsion  of  the  other  portions  of  the  fetus 
most  readily  occurs  with  the  head  and  shoulders  passing  first  back- 
ward and  then  downward  and  backward  so  that  the  fetus  retains 
its  arciform  disposition. 

If  we  measure  an  ordinary  fetus,  after  its  delivery,  we  find 
that  the  diameters  of  its  chest  are  greater  than  those  of  the  canal 
through  which  it  has  passed,  and  that  consequently  there  must 
be  some  change  in  these  diameters  during  its  passage  from  the 
uterus.  This  is  brought  about,  in  the  mare  and  cow,  chiefly 
by  the  extreme  extension  of  the  shoulders,  causing  them  to  be 
displaced  forward  from  the  chest  and  lie  chiefly  upon  the  sides  of 
the  neck,  anterior  to  the  first  rib,  with  only  the  prolongation  of 
the  scapula  resting  upon  the  chest.  At  the  same  time  the  sternum 
is  drawn  far  forward,  so  that  the  sterno-spinal  diameter  of  the 
chest  is  greatly  decreased.  This  makes  it  possible  for  the  chest 
to  pass  through  an  opening  which  measures  less  than  its  own 
diameter.  This  change  in  the  relations  of  the  chest  and  anterior 
limbs  occurs  in  the  larger  domestic  animals,  whether  the  present- 
ation be  anterior  or  posterior. 

When  the  hips  reach  the  constricted  portions  of  the  passages 
they  are  not  capable  of  any  great  change  in  form  or  volume  and 
must  necessarily  pass  through  the  birth  canal  approximately  in 
their  normal  form  and  .size  and  sometimes  constitute  a  more  or 
less  serious  impediment  in  the  expulsion  of  the  fetus. 

The  duration  of  normal  parturition  in  animals  is  extremely 
variable,  both  according  to  species  and  individuals,  and  is  de- 
pendent upon  many  circumstances.  It  is  usually  more  prolonged 
in  primipara,  because  the  birth  canal  has  not  previously  been 
dilated. 

In  the  mare,  where  the  vulva  is  very  large  and  the  cervix  of 
the  uterus  very  extensible,  parturition  is  exceedingly  prompt 
and,  we  might  say,  tumultuous.  This  is  necessitated,  in  a  large 
measure,  because  of  the  feeble  attachment  of  the  placenta,  which 
tends  to  very  rapidly  become  separated  and  cause  the  death  of 


Normal  Parhuition  525 

the  fetus  through  the  cutting  off  of  the  nutritive  supply,  includ- 
ing oxygen.  Hence,  foals  generally  perish  if  dystokia  occurs. 
This  is  in  sharp  contrast  to  ruminants,  where  the  fetus  may  con- 
tinue to  live  for  hours  after  labor  has  set  in.  Consequently,  in 
the  mare  the  actual  duration  of  vigorous  labor  usually  does  not 
extend  beyond  a  few  minutes  and  occasionally  occurs  so  quickly 
in  a  work  mare  that  she  can  scarcely  be  unhitched  from  the  plow 
and  have  her  harness  removed  before  the  living  foal  has  been  ex- 
pelled. In  cows  which  have  given  birth  to  a  number  of  calves, 
the  birth  act  is  sometimes  almost  as  prompt,  although  usually  it 
is  more  prolonged  because  the  os  uteri  does  not  dilate  so  readily 
and  the  labor  pains  are  not  so  tumultuous  and  powerful. 

In  multiparous  animals,  the  birth  of  each  young  animal  usually 
follows  quickly  upon  that  of  the  preceding.  A  sow  may  bring 
forth  8  to  10  young  in  less  than  an  hour.  Sometimes  parturition 
becomes  tedious  and  a  sow  may  be  a  day  or  more  in  expeUing  the 
fetuses. 

When  the  fetus  is  expelled,  the  effect  upon  the  umbilic  cord 
wnll  depend  somewhat  upon  the  position  of  the  mother,  but  very 
largely  upon  the  length  of  the  cord.  In  the  mare,  the  umbilic 
cord  is  quite  long  and  the  fetus  may  be  completely  expelled  and 
the  cord  continue  intact  so  long  as  the  animal  remains  in  a  recum- 
bent position.  When  she  arises,  the  cord  will  probably  rupture 
and,  if  not  at  that  moment,  it  must  give  way  when  she  turns  to 
examine  her  young,  if  the  chorion  remains  attached  in  the  uterus. 
In  some  cases,  however,  the  afterbirth  immediately  follows  the 
fetus  and  remains  attached  to  it  by  means  of  the  cord  until  the 
foal  itself  ruptures  it  by  its  struggles. 

The  umbilic  cord  of  the  foal  ordinarily  ruptures  at  a  point 
about  two  inches  from  the  umbilic  ring,  and  just  beyond  a 
point  where  there  is  a  distinct  line  of  demarcation  between  the 
cord  proper  and  the  cordiform  extension  of  the  abdominal  wall, 
which  is  not  covered  with  hairs.  (See  Fig,  90  B.)  The  ex- 
act point  of  rupture  may  vary,  however,  and  the  cord  may 
become  torn  in  two,  5  or  6  inches  or  even  more  from  the  um- 
bilic ring,  or  it  may  give  way  very  close  to  the  ring.  It  has 
been  alleged  that  the  rupture  may  occur  in  the  ring,  but  the 
writer  has  not  observed  such  an  accident  and  its  occurrence 
may  be  doubted.  The  rupture  of  the  umbilic  cord  is  followed 
by   some  hemorrhage,   especially   if   the  placenta   still  remains 


526  Veterinary  Obstetrics 

attached  and  consequently  receives  blood  up  to  the  moment 
of  rupture.  The  umbilic  cord  may  bleed  from  either  end. 
From  the  placental  end  only  that  blood  which  has  already  en- 
tered its  vessels  from  the  mother  usually  escapes.  From  the  fe- 
tal end  there  may  ooze  a  few  drops  of  blood  from  the  broken 
ends  of  the  umbilic  veins.  Some  claim  that  there  may  be 
a  more  or  less  serious  hemorrhage  from  the  umbilic  arteries, 
but  this  accident  we  have  not  observed.  This  can  occur  only 
very  rarely,  because  the  arteries  are  so  elastic  that  they  promptly 
recoil  and  retract  up  into  the  abdominal  cavity,  (Fig.  56), 
drawing  their  connective  tissue  envelopes  along  with  them  in 
such  a  way  as  to  render  hemorrhage  virtually  impossible.  In 
all  animals,  there  is  a  tendency  for  the  mother  to  cleanse  the 
ruptured  navel  cord  with  her  tongue  or  lips.  In  the  cow,  the 
umbilic  cord  is  so  short  that  it  usually  ruptures  before  the  hind 
feet  of  the  fetus  have  escaped  from  the  vulva.  The  necessary 
care  of  the  broken  umbilic  cord  will  be  discussed  under  "Care  of 
the  New-Born  Animal." 


EXPULSION  OF  THE  FETAL  MEMBRANES  AND  INVO- 
LUTION OF  THE  UTERUS. 

The  expulsion  of  the  fetal  membranes  normally  follows  birth 
after  a  very  brief  interval,  depending  upon  the  species  of  animal 
and  the  individual.  The  expulsion  of  the  fetal  membranes  occurs 
most  promptly  in  those  animals  like  the  mare,  in  which,  owing 
to  the  diffuse  placenta,  the  attachments  of  the  chorion  to  the 
uterus  are  not  so  complex  and  consequently  not  so  difficult 
of  detachment.  In  ruminants,  with  the  multiple  placenta  or 
cotyledons,  the  attachments  between  the  fetal  and  maternal  pla- 
centa are  very  intricate  and  the  placental  villi  very  long  and 
branched,  so  that  they  do  not  so  readily  become  detached  from 
the  maternal  organ. 

The  detachment  of  the  placenta  is  largely  the  result  of  the  con- 
traction of  the  uterine  walls,  which,  acting  upon  the  villi  of  the 
fetal  placenta,  tends  to  force  them  out  and  detach  them,  while 
the  decrease  in  the  size  of  the  uterine  cavity  forces  the  detached 
membranes  out  through  the  vagina.  The  contraction  of  the 
uterine  walls  of  ruminants  cannot  act  so  effectively  upon  the 
cotyledons  as  can  the  walls  of  the  uterus  of  the  mare  upon  the 
diffused  tufts.  The  contraction  or  involution  of  the  uterus  and 
the  expulsion  of  the  membranes  are  therefore  correlated  phenom- 
ena which  go  hand  in  hand,  and  when  one  fails  it  tends  to 
interrupt  the  other. 

In  the  mare  we  have  seen  the  entire  placenta  and  all  the  fetal 
membranes  promptly  expelled  from  the  uterus,  while  the  fetus 
remained  naked  in  the  organ,  because  of  some  slight  deviation  of 
a  fetal  part  which  prevented  its  ready  expulsion.  In  this  case 
the  contraction  of  the  uterus,  with  the  escape  of  the  amniotic 
and  allantoic  fluids,  was  sufficient  to  cause  the  detachment  and 
expulsion  of  the  chorion.  Fleming  suggests  that  the  same  acci- 
dent may  occur  in  the  cow,  but  this  we  have  not  observed.  Owing 
to  the  character  of  the  placenta  in  that  animal,  such  an  occurrence 
must  be  extremely  rare,  except  in  ca.ses  of  prolonged  dystokia, 
with  decomposition  of  the  membranes. 

In  some  cases  of  birth,  in  the  mare,  especially  where  there  has 
been  a  slight  delay,  the  fetal  membranes  accompany  the  fetus  or 
follow  it  immediately.  In  cases  of  dystokia  in  the  mare,  as  a 
527 


528  Vetermary  Obstetrics 

general  rule,  the  fetal  membranes  come  away  immediately  fol- 
lowing the  fetus,  or  essentially  at  the  same  moment. 

The  placenta  usually  comes  away,  in  the  mare,  a  few  minutes 
after  birth  and,  in  the  cow,  at  a  somewhat  later  period.  In  the 
multiparous  animals,  the  afterbirth  which  has  belonged  to  a 
given  fetus  must  be  expelled  before  the  succeeding  fetus  from 
the  same  horn  can  be  born,  and  consequently,  as  a  rule,  we  ob- 
serve the  placenta  of  each  fetus  following  it  immediately  and 
usually  still  attached  to  it. 

The  detachment  of  the  fetal  membranes  or  placenta  in  the 
normal  way  has  little  or  no  tendency  to  induce  important  hem- 
orrhage in  animals.  Though  the  hemorrhage  following  detach- 
ment of  the  placenta  in  animals  is  quite  uniformly  of  no  conse- 
quence, it  is  present  in  a  sufficient  amount  that  we  are  able  tO' 
say  that  it  occurs.  However,  in  the  larger  domestic  animals,  it 
generally  amounts  to  a  quantity  which  is  scarcely  capable  of  be- 
ing measured  and  which  is  wholly  without  visible  consequence  to 
the  animal.  We  do  see  hemorrhage,  however,  from  the  placenta 
of  the  larger  animals  when  the  fetal  membranes  are  injudiciously 
and  violently  torn  away.  Following  such  cases  we  have  .seen 
fatal  hemorrhage. 

Frequently  the  fetal  membranes  do  not  come  away  promptly, 
but  are  retained  for  a  greater  or  less  period  and  may  result  seri- 
ously for  the  well-being  of  the  animal.  They  are  especially  liable 
to  be  retained  in  cases  of  abortion  and  also  in  all  those  ca.ses  where, 
for  any  rea.son,  the  involution  or  contraction  of  the  uterus  is  tardy. 

As  soon  as  the  fetus  has  been  expelled  and  the  umbilic  cord 
ruptured,  the  chorion,  and  other  portions  of  the  fetal  membranes 
remaining,  become  essentially  inert  tissue,  without  circulation 
and  without  life.  It  is  highly  essential  that  these  should  come 
away  promptly  and  that  the  involution  of  the  uterus  should  take 
place  quickly.  When  this  fails  to  occur  promptly,  the  fetal 
membranes  quickly  become  infected  and  undergo  decomposition; 
the  uterus  becomes  infected  and  leads  to  metritis,  placentitis,  or 
to  other  more  or  less  serious  infections.  Two  things  are  essential 
to  prevent  the.se  infections :  the  expulsion  of  the  membranes  and 
the  contraction  of  the  uterus.  Even  if  the  membranes  are 
promptly  expelled,  it  is  essential  that  the  uterine  cavity  should 
be  effaced  and  the  walls  come  in  contact,  in  order  to  avoid  in- 
fection in  the  uterine  cavity.     Any  relaxation  or  debility  of  the 


Expulsion  of  Fetal  Membranes  ;  Invohition  of  the  Uterus      529 

uterine  walls  invites  infection.  A  contractile  organ  has  in  itself 
the  power  to  overcome  infection  ;  hence  the  importance  of  the 
normal  contraction  of  the  organ.  Retention  of  the  placenta  will 
be  more  fully  considered  later. 

The  expulsion  of  the  fetus  and  its  fluids  is  at  once  followed  by 
contraction  of  the  uterine  walls,  decreased  vascularity,  reduction 
in  size  and  obliteration  of  its  cavity  bj-  the  walls  coming  in  con- 
tact with  each  other.  The  placentae  disappear,  the  glandular 
layers  of  the  deciduate  placentae  are  detached  and  removed  and 
anew  epithelial  layer  formed  at  the  site  of  placental  attachments. 

The  cervix  uteri  contracts  rapidly  and  the  cervical  canal  is 
well  closed  in  24  to  48  hours.  The  uterus,  once  pregnant,  fails 
to  wholly  regain  the  size  of  the  virgin  organ.  The  broad  liga- 
ments retract  and  again  suspend  the  uterus. 

Collectivel}'  we  know  these  processes  as  involution  of  the 
uterus,  and  regard  them  as  highly  important  to  the  well-being  of 
the  animal.  When  the  uterus  contracts  in  a  physiologic  manner 
it  tends  to  prevent  infection  of  its  walls,  but  if  there  is  inertia  or 
paralj^sis  of  the  walls,  infection  is  probable.  If  afterbirth  or 
other  dead  tissue  remains  in  the  uterus  and  becomes  infected, 
the  infection  not  only  brings  about  an  inflammation  of  the 
uterine  walls,  but  also  increases  the  inertia  or  paralysis  of  them. 

In  most  domestic  animals,  the  mother  habitually  devours  the 
entire  fetal  membranes  immediately  after  their  normal  expulsion. 
This  regularly  occurs  in  ruminants  and  the  sow,  and  some- 
times, it  is  said,  in  the  mare  also.  It  has  been  suggested 
that  the  devouring  of  the  fetal  envelopes  by  the  mother  is  the 
persistence  of  a  precautionary  measure  from  the  wild  state,  for 
the  defense  of  the  mother  and  new-born  against  predatory 
animals,  by  destroying  the  evidences  of  the  recent  birth.  The 
devouring  of  the  membranes  rarely  results  in  accident,  but  there 
have  been  a  few  ca.ses  recorded  where  a  cow  has  become  choked 
upon  her  placenta  and,  in  one  case  personally  related  to  us,  the 
cow  became  choked  while  the  one  end  of  the  placenta  still  re- 
mained firmly  attached  in  her  uterus.  Sometimes  the  placenta 
decomposes  in  the  rumen  or  other  portions  of  the  alimentary 
canal  and  causes  indigestion. 


34 


PRESENTATIONS  AND  POSITIONS  OF  THE  FETUS. 

In  a  general  way,  we  have  already  outlined  the  physiology  of 
labor  and  hav-e  indicated  the  means  by  which  the  fetus  is  expelled 
from  the  uterus  when  it  has  completed  its  intra-uterine  develop- 
ment or  when  it  has  been  thrown  out  because  of  its  death  or 
disease  in  case  of  abortion  or  premature  birth. 

It  is  essential  that  we  should  thoroughl}'  understand  that,  in 
order  for  these  physiologic  processes  to  be  carried  out  in  a  normal 
manner,  it  is  necessary  for  the  attitude  of  the  fetus  to  be  such 
that  it  will  be  practicable  for  it  to  pass  through  the  birth  canal. 
There  are  certain  attitudes  of  the  fetus  which  make  its  passage 
possible,  while  others  render  it  virtually  impossible.  The  possi- 
bilit}'  of  a  fetus  being  born  alive  and  without  assistance  depends 
fundamentally  upon  which  parts  of  the  fetal  body  pre.sent  at  the 
inlet,  and  .secondarily  upon  the  relations  of  the  parts  which 
present  to  the  circumference  of  the  pelvis.  In  dealing  with  the 
mechanism  of  parturition,  we  recognize  two  fundamental  ele- 
ments in  reference  to  the  attitude  of  the  fetus — presentation  and 
position. 

Presentation,  mechanically  expressed,  is  the  relation  existing 
between  the  spinal  axes  of  the  mother  and  fetus.  The  term  in- 
dicates that  portion  or  general  region  of  the  fetus  which  offers 
at  the  pelvic   inlet  at  the  time  of  parturition. 

Position  expresses  the  relation  of  the  presenting  portion  of  the 
fetus  to  the  circumference  of  the  pelvic  inlet.  It  is  the  relation 
of  the  presenting  part  to  the  sacro-pubic  or  the  bis-iliac  diame- 
ter of  the  maternal  pelvis. 

Presentations  of  the  Fetus. 

The  uteri  of  domestic  animals  are  more  or  less  tubular  in  their 
general  outline,  and  the  fetus  represents  an  elongated  oval,  the 
long  axis  of  which  normally  corresponds  with  the  long  axis  of 
the  uterine  cavity.  The  transverse  diameter  of  the  body  of  the 
fetus  approximately  equals  the  dimensions  of  the  dilated  birth 
canal,  through  which  it  must  necessarily  pass  in  being  born. 
The  fetal  chest  has  an  even  greater  diameter  than  that  of  the 
bony  canal  through  which  it  must  pass.  Not  only  is  it  neces.sary 
that  the  long  axis  of  the  fetus  should  be  parallel  to  that  of  the 
530 


Presentations  of  the  Fetus 


531 


mother,  but  even  the  transverse  axis  of  the  fetal  chest  must  ba 
decreased.  We  ma}',  therefore,  recognize  two  normal  attitudes 
of  the  fetus  in  relation  to  its  long  axis — the  anterior  and  pos- 
terior presentations,  in  which  the  anterior  or  posterior  end  of  the 
fetus  respectively  presents  at  the  pelvic  inlet. 

The  mere  fact  that  the  spinal  axes  of  the  mother  and  fetus  are 
parallel  does  not  insure  that  the  attitude  of  the  fetus  is  normal 
or  that  parturition  can  take  place  without  aid,  but  merely  that, 
upon  examination,  some  portion  of  the  anterior  or  posterior  part 
of  the  body  is  met. 


Fig.  88.     Posterior  Presentation. 
Dorso-sacral  position.     (St.  Cyr. ) 

Not  every  fetus,  however,  is  presented  in  such  a  way  that  its 
long  axis  corresponds  to  that  of  the  mother.  Instead,  it  may  be 
perpendicular  to  it,  so  that  the  fetus  presents  transversely,  in 
which  instance  it  cannot  be  born  without  a  correction  of  its  pre- 
sentation, and  therefore  becomes  abnormal. 

The  fetus  may  present  transversely  at  the  pelvic  inlet,  either  by 
its  dorsal  or  ventral  surface,  and  consequently  there  may  occur  a 
dorsal  or  ventral  presentation. 


532 


Veterinary  Obstetrics 


Fig.  89.     Dorsal  Presentation.     (Franck). 


Fig.  90.     Ventral  Presentation.     (Franck). 


Positions  of  the  Fetus. 

Position  is  the  relation  existing  between  an  arbitrarily  selected 
part  of  the  presenting  portion  of  the  fetal  body  and  the  circumfer- 
ence of  the  pelvic  girdle.  A  fixed  point  upon  the  fetal  body,  the 
dorsum  for  the  longitudinal  presentation,  and  the  head  end  for 
the  transverse  presentation,  is  chosen  as  a  basis.     The  pelvic  inlet 


Positions  of  the  Fetus  533 

of  the  mother  is  divided  into  quadrants  which  represent  the  sac- 
rum, pubis  and  right  and  left  iha.  Toward  either  of  these  areas  the 
dorsum  of  the  fetus  ma\-  be  directed,  whether  presenting  by  the 
anterior  or  posterior  end. 

It  does  not  follow  that  the  dorsum  of  a  longitudinall}-  present- 
ing fetus  is  always  directed  toward  the  center  of  one  of  the  four 
areas  mentioned,  but  there  may  be  every  possible  degree  of  vari- 
ation, the  four  cardinal  points  of  the  pelvic  girdle  serving  as  a 
basis  for  the  designation  of  the  intermediary  or  "oblique" 
positions,  or  simple  variations,  by  which  any  one  position  may 
gradually  merge  into  the  next.  In  the  longitudinal  presenta- 
tion, the  fetus  tends  to  spontaneously  assume  that  position  in 
which  its  dorsum  corresponds  to  the  sacrum  of  the  mother. 
This  we  designate  as  the  dorso-sacral  position.  (See  Figs.  87 
and  88). 

It  is  pre-eminently  the  normal  position.  While  it  is  the- 
oretically possible  for  birth  to  occur,  without  assistance,  in 
other  positions  of  the  longitudinal  presentations,  such  has  but 
rarely  been  observed.  In  the  anterior  presentation  and  dorso- 
sacral  position,  the  disposition  of  the  three  extremities,  the  head 
and  two  anterior  limbs,  determines  the  practicability  of  the  fetus 
being  expelled  without  assistance.  In  animals  wath  long  and 
rigid  limbs  and  a  small  head,  such  as  the  large  herbivora,  the 
normal  relationship  is  for  the  two  anterior  limbs  to  be  fully  ex- 
tended, with  the  soles  of  the  feet  presenting  downward,  while 
upon  these  rest  the  head  and  neck  with  the  nose  somewhat  less 
advanced  than  the  two  anterior  feet.  In  the  mare  the  nose  rests 
in  the  vicinity  of  the  fetlocks  ;  in  the  cow  the  no.se  is  somewhat 
nearer  to  the  hoofs.  Any  deviation  in  the  relationship  of  these 
extremities  at  once  causes  difficulty  in  the  pa.ssing  of  the  fetus 
through  the  birth  canal  and  brings  about  more  or  less  .serious 
dystokia. 

If  the  fetus  revolves  upon  its  long  axis  to  the  extent  of  a 
quadrant  of  a  circle,  either  to  the  right  or  the  left,  the  dorsum  of 
the  fetus  corresponds  to  the  right  or  left  ilium  respectiveh^  and 
causes  the  right  or  left  dor.so-ilial  position,  a  position  of  the  fetus 
which  renders  spontaneous  birth  difficult  in  all  cases,  and  usually 
impossible  without  obstetric  aid. 

Should  the  revolution  of  the  fetus  upon  its  long  axis  continue 
a  quadrant  further,  the  dorsum  of  the  fetus  corresponds  to  the 


534  Veterhiaty  Obstetrics 

pubis  of  the  mother,  or  there  occurs  the  dorso-pubic  position. 
This  position  of  the  fetus  is  such  that  birth  cannot  usually  take 
place  without  assistance  and  may  consequently  be  regarded,  for 
all  practical  purposes,  as  abnormal.  In  both  the  dorso-ilial  and 
dorso-pubic  positions,  numerous  deviations  or  misplacements  of 
any  or  all  extremities  may  occur  and  add  to  the  complications 
and  difficulties  of  the  expulsion  of  the  fetus. 

We  have  already  stated  that  the  fetus  normally  lies  en  arc  or 
curved  somewhat  ventralwards.  The  anatomy  of  the  fetus  pre- 
vents this  curvature  from  being  readily  reversed,  and  consequent- 
ly this  curve  of  the  body  should  always  correspond  to  whatever 
curvature  exists  in  the  birth-canal.  A  study  of  the  genital  pas- 
sage of  the  mother  will  show  that  this  curvature,  in  the  main,  is 
concave  above  and  convex  below.  Consequently,  if  the  curved 
body  of  the  fetus  is  to  pass  readily  through  the  canal,  it  must 
present  in  such  a  position  that  its  convex  dorsal  surface  shall  cor- 
respond to  the  concave  line  formed  by  the  maternal  sacrum  and 
coccyx.  Hence  the  dorso-sacral  position  is  the  normal  one,  be- 
cause it  is  that  which  is  most  favorable  to  the  prompt  and  easy 
passage  of  the  fetus  through  the  birth-canal  with  safet}*  alike  to 
the  fetus  and  mother. 

In  those  positions  where  the  curvature  of  the  fetal  body  does 
not  correspond  to  that  of  the  birth-canal,  the  extremities  of  the 
fetus  tend  to  push  against  the  sides  or  walls  of  the  canal  and  be- 
come impacted  therein,  injuring  more  or  less  seriously  the  soft 
parts  of  the  mother  or  blocking  the  progress  of  the  fetus.  It  is 
also  to  be  considered  that  when  the  dorsum  of  the  fetus  cor- 
responds to  the  sacrum  of  the  mother  the  actual  transverse  diam- 
eters of  the  fetal  body  a.ssume  the  most  favorable  relations  to  the 
various  diameters  of  the  pelvis  of  the  mother. 

In  the  smaller  domestic  animals,  the  limbs  of  the  fetus  are  not 
so  long  comparatively,  nor  so  rigid  ;  the  neck  of  the  fetus  is 
usually  much  shorter.  The  body  is  less  curved  and  more  pliable, 
so  that  it  may  be  more  readily  bent  dorsalwards  than  in  the 
larger  animals.  The  head,  in  some  of  the  smaller  animals,  such 
as  the  carnivora,  is  large  and  offers  alone  as  great  an  obstruction 
as  the  head  and  forefeet  together  in  the  larger  animals.  There- 
fore, in  smaller  animals,  the  anterior  feet  and  legs  usually  pro- 
ject backward  beneath  the  fetal  body  and  the  head  advances 
alone.     Because  of  the  more  direct  and  cylindrical   form  of  the 


Positions  of  the   Fetns  535 

body,  the  position  of  the  fetus  in  relation  to  the  circumference  of 
the  pubic  inlet  is  not  so  important,  although  even  here  the  fetus 
is  generalh'  and  most  readily  expelled  in  the  dorso-sacral  position. 

When  the  longitudinal  presentation  is  posterior,  instead  of 
anterior,  the  same  modifications  of  position  prevail  and  are  sim- 
ilarly designated.  There  is  the  dorso-sacral  position,  with  the 
dorsum  of  the  fetus  presenting  toward  the  sacrum  of  the  mother  ; 
the  right  and  left  dorso-ilial  positions,  with  the  dorsum  of  the 
fetus  directed  toward  the  right  or  left  ilial  shaft  of  the  mother  ; 
and  the  dorso-pubic  position,  with  the  dorsum  of  the  fetus 
directed  toward  the  pubis  of  the  mother.  Some  writers  designate 
these  positions  lumbo- sacral,  lumbo-ilial  and  lumbo-pubic  respect- 
ively. 

Authors  are  not  in  accord  upon  the  question  of  whether  we 
can  properly  consider  any  position  of  the  posterior  presentation 
normal  in  the  large  herbivora.  Certain  it  is  that  only  very,  very 
rarely  is  a  calf  or  a  foal  born  alive  in  the  posterior  presentation, 
unless  assistance  has  been  promptly  afforded,  and  birth  greatly 
hastened.  Whenever  the  fetal  body  has  been  so  far  expelled 
that  the  fetal  umbilicus  .has  entered  the  pelvic  inlet  of  the 
mother  and  the  umbilic  cord  is  compressed  between  the  pelvic 
brim  of  the  mother  and  the  ventral  w^all  of  the  fetus,  the  life  of 
the  latter  is  at  once  threatened.  It  must  quickly  die  from  as- 
phyxia unless  very  promptly  expelled  or  extracted  and  permitted 
to  at  once  breathe. 

Precisely  how  long  a  fetus  may  live  after  the  umbilic  cord 
becomes  compressed  between  the  pubis  of  the  mother  and  the 
body  of  the  fetus,  cutting  off  the  fetal  circulation,  is  not  known 
but  it  certainly  cannot  be  for  more  than  a  few  minutes.  Some 
authors  have  suggested  that,  if  the  circulation  be  thus  inter- 
rupted, the  fetus  at  once  inhales  the  amniotic  fluid  and  thus 
drowns  itself.  We  have  found  no  data  to  show  us  to  what  extent 
this  is  true.  It  is  evidently  well-nigh  impossible  for  such  inhala- 
tion of  fluids  to  occur  clinically,  because,  at  the  moment  when 
the  strangulation  of  the  cord  occurs,  the  chest  of  the  young 
animal  is  so  tightly  impacted  in  the  inlet  of  the  pelvis  of  the 
mother  that  it  is  difficult  to  understand  how  amniotic  fluid  or 
anything  else  could  be  inhaled.  When  the  chest  has  passed 
through  the  birth  canal,  the  head  at  once  follows  and  it  only  re- 


536  Veterhiary  Obstetrics 

mains  for  the  amnion  to  be  removed  from  the  nose  to  render 
respiration  possible. 

While  normal  and  easy  birth  in  the  large  herbivora  is  virtually 
limited  to  the  dorso-sacral  position  of  the  anterior  presentation, 
in  the  smaller  domestic  animals  it  is  by  no  means  rare  for  birth 
to  take  place  easily  and  safely,  for  both  mother  and  young,  with 
the  fetus  in  the  posterior  presentation. 

In  the  judgment  of  some  obstetric  writers,  the  expulsion  of  the 
fetus  is  more  difficult  when  presenting  posteriorly  than  anteriorly, 
but  we  have  not  been  able  to  verify  this  opinion.  In  our  expe- 
rience in  the  larger  domestic  animals,  the  posterior  presentation 
is  favorable,  in  so  far  as  the  amount  of  resistance  to  expulsion  is 
concerned,  provided  always  that  the  position  of  the  fetus  is  dorso- 
sacral  and  that  there  is  no  deviation  of  the  posterior  limbs. 
When  so  presenting,  the  posterior  part  of  the  body  forms  a  very 
elongated  cone,  which  tends  to  dilate  the  passages  gradually  and 
causes  the  fetus  to  advance  with  the  least  possible  difficulty. 
Some  obstetrists  suggest  that  the  direction  of  the  hair,  being  op- 
posite to  that  in  which  the  fetus  is  passing,  offers  resistance,  but 
it  should  be  remembered  that  the  fetal  hairs  are  very  soft  and 
flexible  and  that,  if  properly  lubricated  by  the  fetal  fluids,  they 
offer  virtually  no  obstacle.  What  little  resistance  they  may  the- 
oretically offer  is  far  more  than  counterbalanced  by  the  length 
and  regularity  of  the  cone  which  the  posterior  presentation  fur- 
nishes. 

However,  d^'stokia  is  more  liable  to  occur  in  our  larger  animals 
when  the  fetus  presents  posteriorly  than  when  it  offers  anteriorly. 
The  increased  tendency  to  dystokia  seems  to  be  be  due  largely  to 
the  tendency  for  the  hind  limbs  to  become  deviated  from  the  normal 
position  of  extension  and  one  or  both  of  them  to  be  more  or  less 
retained  beneath  the  fetal  body  and  thus  offer  obstruction  to 
birth  which  cannot  be  overcome  except  by  obstetric  aid.  In  the 
mare  and  cow,  also,  there  is  a  constant  tendency  for  the  fetus, 
when  presenting  posteriorly,  to  assume  the  dorso-pubic  or  dorso- 
ilial  position,  by  which  the  arc  of  the  fetal  body  is  contrary  to  the 
curvature  of  the  genital  passage. 

The  posterior  presentation  is  undesirable  and  unfavorable  in 
our  larger  domestic  animals,  not  because  it  fundamentally  offers 
serious  obstacles  to  the  expulsion  of  the  fetus,  but  because  it 
tends  to  imperil    the  life  of  the  fetus  during  the  act  of  birth, 


Position  of  the  Fetus  537 

owing  to  compression  of  the  umbilic  cord  before  the  fetus  is  in  a 
position  to  breathe,  and  also  because  of  the  great  tendency  for 
deviation  of  the  limbs  to  occur  or  for  some  unfavorable  position 
of  the  fetus  to  exist,  which  ma}'  bring  about  more  or  less  serious 
dystokia. 

The  transverse  presentations  of  the  fetus,  whether  dorsal  or 
ventral,  offer,  in  each,  two  positions.  The  fetus  necessarily  lies 
horizontally,  since  any  other  attitude  would  be  unstable,  and  the 
head  must  lie  in  the  right  or  left  flank  of  the  mother,  correspond- 
ing more  or  less  intimately  to  the  right  or  left  maternal  ilium. 
Accepting  the  fetal  head  as  the  fixed  point  of  the  fetus  for  desig- 
nating its  position,  there  may  exist  either  a  right  or  left  cephalo- 
ilial  position,  according  as  the  head  end  of  the  fetus  corresponds 
to  the  right  or  left  ilium  of  the  mother.-''- 

The  presentations  and  positions,  normal  and  abnormal,  which 
a  fetus  may  assume  may  be  tabulated  as  follows  : 

(Anterior  Presentation)    j  Dorso-Sacral  Position 
Longitudinal  -  I  -  Right  or  Left  Dorso-Ilial  Position 

(_  Posterior  Presentation  )    (  Dorso-Pubic  Position 

T,  I  Dorsal  Presentation    )    f  r.  ■   1  ^       t    r^  ^     1    ,     ^,-  .  „     .  . 

Transverse  ^  ^^^^^^^  Presentation  ,   {  ^'^^^^  «^  Left  Cephalo-Ihal  Position 

This  gives  a  total  of  twelve  fundamental  positions,  most  of 
which  are  abnormal.  These  positions  may  be  further  compli- 
cated by  a  great  variety  of  deviations  of  the  extremities. 


*According  to  some  writers,  there  may  be  in  the  dorsal  presentation  a 
cephalo- sacral  position,  but  they  cite  no  clinical  instances  and  the  position 
is  so  unstable  as  to  be  at  least  very  transitor\-  if  not  impossible. 


MANAGEMENT  OF  NORMAL  PARTURITION. 

In  a  general  way  it  is  safer  that  an  animal  be  let  alone  during 
parturition,  and  that  she  be  given  an  amount  of  freedom  which 
will  approach  the  natural  state  as  nearly  as  possible. 

Under  domestication,  the  environment  has  been  so  changed 
and  modified  that  it  is  essential  we  should  consider  the  question 
of  the  care  and  surroundings  of  the  mother  and  fetus  during  the 
period  of  parturition.  The  essential  preparations  should  be  those 
which  insure  freedom  and  comfort.  In  the  larger  animals,  like 
the  mare  and  cow,  which  are  habitually  kept  secured  in  stalls  or 
stanchions  and  frequently  among  a  number  of  other  animals,  the 
.safety  of  both  the  mother  and  fetus  is  increa.sed  by  providing 
greater  liberty  for  the  animal  during  parturition  and  .separating 
her  to  some  degree  from  other  animals  of  the  same  or  other  species. 
Sometimes  the  owner  is  not  able  to  command  proper  quarters  for 
an  animal  while  giving  birth  to  young  and  may  find  it  necessary 
to  keep  her  tied  by  the  head.  In  reality,  this  is  usually  compara- 
tively .safe,  providing  always  that  the  stall  is  so  arranged  as  to 
guard  the  animal  against  the  danger  of  becoming  cast,  and  thus 
injuring  herself. 

Provision  should  be  made  against  injury  to  the  fetus  from 
defects  in  the  stable  or  from  the  presence  of  other  animals.  A 
good  .stall  in  which  the  animal  is  tied  up  by  the  head  is  better 
than  a  poor  box-stall,  because  in  the  latter  the  mother  is  liable  to 
lie  down  with  her  buttocks  against  or  near  to  a  wall  in  such  a 
way  that  the  fetus  cannot  readily  be  expelled,  whereas  if  tied  by 
the  head  in  a  single  stall  such  an  accident  could  not  readily  oc- 
cur, unless  the  stall  were  very  short  or  the  animal  tied  very  long. 
Both  cows  and  mares  repeatedly  give  birth  to  young,  while  tied 
by  the  head  in  a  stable  with  a  number  of  other  animals,  and  are 
usually  unharmed. 

Some  writers  claim  that  the  mother  should  be  able  to  get  to 
the  fetus  at  once,  in  order  to  release  it  from  its  membranes,  but 
clinically  this  is  at  least  unimportant,  if  not  untrue,  and  it  is 
doubtful  if  the  cow  or  mare  ever  saves  the  life  of  her  fetus  by 
quickly  removing  the  fetal  membranes  from  its  nostrils  so  as  to 
permit  it  to  breathe.  Admittedly,  it  is  important  that  the  mother 
538 


Manageme7it  of  Normal  Parturition  539 

be  allowed  to  cleanse  her  fetus  thoroughly  by  licking  and  fondling 
it  as  soon  as  she  has  recovered  from  the  exhaustion  incident  to 
labor.  A  danger  of  great  importance,  in  cases  where  animals  are 
tied  by  the  head  in  a  stable  with  other  animals,  is  that  the  fetus 
may  blunder  into  an  adjoining  stall  and,  especially  a  foal,  may 
be  seriously  injured  by  coming  within  reach  of  other  horses, 
which  may  kick,  bite  or  trample  it.  With  other  domestic  ani- 
mals, especially  with  the  cow,  this  danger  is  not  so  great,  although 
present  in  a  minor  degree. 

It  is  not  always  desirable  to  remove  pregnant  females  too  far 
from  their  usual  place  and  surroundings  at  the  time  when  they 
are  to  give  birth  to  young,  because  in  many  of  them  it  tends  to 
induce  a  nervousness  and  unrest  which  may  lead  to  more  or  less 
serious  difficulty.  Some  animals,  especially  mares,  become  very 
nervoiK  and  even  frantic  when  removed  from  their  companions 
and  placed  in  a  strange  stall.     This  should  be  avoided. 

The  stall  in  which  an  animal  is  to  give  birth  to  young  should  be 
ample  in  size  and  scrupulously  clean.  It  should  be  well-bedded 
with  as  clean  bedding  as  it  is  practicable  to  obtain.  It  should  be 
kept  quite  free  from  feces  and  accumulations  of  urine  and  other 
decomposing  substances.  In  case  of  a  highly  valued  animal,  it 
may  even  be  desirable  and  economic  to  keep  the  stall  and  bedding 
disinfected  in  order  to  avoid  the  important  and  dangerous  infec- 
tions to  both  fetus  and  mother  which  may  follow  a  normal  case 
of  parturition. 

The  best  place  in  which  a  herbivorous  animal  may  give  birth 
to  young  is  the  open  j&eld  or  pasture,  if  the  weather  will  permit, 
there  being  no  place  so  safe  from  mechanical  accident  or  from 
infection.  In  some  cases  complications  arise  which  to  some  de- 
gree decrease  the  advantages  to  3'oung  of  birth  in  the  open  pas- 
ture. During  the  hot  summer  months  flies  offer  considerable 
annoyance  and  have  special  dangers  as  infection  bearers  for  the 
mother  and  young  when  the  act  of  birth  takes  place  in  the  open 
field. 

The  care  of  the  pregnant  animal  during  labor  should  not  be  of 
a  kind  which  will  in  any  way  annoy  or  disturb  her.  When  the 
animal  is  of  material  value,  it  is  well  that  the  course  of  labor 
should  be  sufficiently  watched  in  order  to  determine  whether  it 
is  proceeding  regularly  or  not,  since  it  is  always  important  that, 
if  help  must  be  extended  to  an  animal,  it  should   be  early.     A 


540  Veterinary  Obstetrics 

great  many  pregnant  animals  resent  the  constant  presence  of 
persons  during  labor  and  become  very  nervous  when  too  much 
attention  is  paid  to  them.  Owners  of  mares  have  frequently  noted, 
especially  in  those  pregnant  for  the  first  time,  that  labor  seems  to 
set  in  when  the  watcher  is  away  and  not  during  his  presence. 
The  animal  sometimes  seems  to  await  a  favorable  moment  to 
begin  labor,  .so  that,  when  an  intended  constant  watch  is  set, 
labor  is  liable  to  not  begin  until  some  slight  intermission  in  the 
supervision  occurs,  when  it  at  once  takes  place.  When  the 
watch  is  resumed,  it  is  found  that  birth  has  taken  place  during 
the  interval.  The  watch  upon  an  animal  should  therefore  be 
barely  sufficient  to  guard  against  any  serious  accident. 

In  the  care  or  watching  of  an  animal  during  parturition,  the 
breeder  or  his  employees  should  be  instructed  as  far  as  may  be 
nece.s.sary,  by  the  veterinarian,  in  reference  to  what  constitutes 
the  normal  progress  of  parturition  and  when  it  is  necessary  to 
interfere  in  a  case.  Should  the  veterinarian  be  called  to  attend  a 
case  of  what  is  suspected  as  irregular  or  abnormal  parturition,  he 
should  determine  by  a  careful  examination  the  exact  state  of 
affairs  and  interfere  only  in  those  cases  where  there  is  some  devia- 
tion from  the  normal  which,  in  his  judgment,  it  is  best  to  correct, 
or  which  would  not  be  ultimately  and  .safely  overcome  by  the 
mother  alone. 

He  should  determine  if  the  labor  pains  are  normal  and  whether 
the  general  condition  of  the  mother  is  good.  He  should  deter- 
mine whether  the  genital  passages  of  the  mother  are  in  normal 
condition  and  are  dilating  in  a  natural  manner.  The  position  of 
the  fetus  should  be  learned  and  the  veterinarian  should  know  if 
it  will  probably  be  expelled  without  assistance. 

The  veterinarian  should  determine  if  birth  may  properly  take 
place  at  once  or  if  in  the  natural  course  of  events  it  should  be  de- 
layed for  a  period  of  time.  For  this  purpose  it  is  es.sential  to 
differentiate  between  fal.se,  or  preparatory,  labor  pains  and  real 
expulsive  efforts  designed  to  bring  about  the  immediate  expul- 
sion of  the  fetus.  As  we  have  suggested  in  preceding  chapters, 
there  may  be  premonitory  pains  indicated  by  some  degree  of  un- 
easiness or  slight  colic  symptoms,  especiall}'  in  the  mare,  .some 
days  prior  to  parturition.  The.se  should  not  be  mistaken  for  par- 
turition itself  and  the  expulsion  of  the  fetus  hastened  by  artifi- 
cial means,  but  the  veterinarian  should  advi.se  patient  watching 


Mavagement  of  Normal  Parturition  541 

until  labor  sets  in  normally.  In  such  cases,  however,  it  would 
be  still  more  unfortunate  to  overlook  some  essential  and  funda- 
mental diflBculty  which  is  preventing  normal  labor  and  which 
must  eventually  be  overcome  in  order  to  save  the  life  of  the 
mother  or  fetus,  or  both.  For  example,  in  cases  of  torsion  of 
the  uterus,  eflfective  or  vigorous  labor  pains  do  not  occur 
because  the  conditions  of  the  uterus  are  such  as  to  prevent 
them.  It  would  be  exceedingly  unfortunate  and  perilous  to  the 
lives  of  both  mother  and  fetus  to  pass  over  this  displacement  of 
the  uterus  without  recognition  of  its  character,  because  a  few 
days  or  even  hours  of  wait  may  lead  to  difficulties  which  are 
insurmountable  and  which  could  readily  have  been  remedied  at 
the  right  time.  In  cases  of  the  bi-cornual  development  of  the 
fetus  in  the  uterus  of  the  mare,  we  are  not  likely  to  observe  very 
pronounced  and  vigorous  labor  pains,  and  yet  each  hour  that  is 
permitted  to  pass  makes  the  obstacle  which  is  to  be  overcome 
more  and  more  difficult  and  renders  the  death  of  both  mother 
and  fetus  all  the  more  certain  to  occur. 

In  other  cases,  as  in  the  cow,  where  the  cervix  of  the  uterus  is 
very  long  and  dense  and  where  its  canal  dilates  very  slowly,  it 
is  unwise  to  be  hasty  when  it  is  possible  or  probable  that,  with  a 
little  patience  and  watching,  the  dilation  wdll  occur  normally  and 
the  fetus  be  born  alive  without  assistance.  On  the  other  hand, 
it  is  equally  unwise  to  delay  the  dilation  of  the  os  and  the  ex- 
traction of  the  fetus  if  the  conditions  which  are  present  clearly 
indicate  that  a  natural  dilation  will  not  occur.  Take,  as  an 
example,  a  case  of  rigidity  or  constriction  of  the  cervix  uteri 
observed  by  us,  where  a  cow  was  allowed  to  go  for  some  10 
weeks  after  the  normal  end  of  gestation  with  a  fetus  imprisoned 
within  the  uterus  and  undergoing  putrefaction  ;  here  it  is  evi- 
dent that  surgical  interference  should  have  occurred  at  the  end 
of  gestation,  when  it  was  noted  that  portions  of  the  afterbirth 
had  protruded  beyond  the  vulva. 

So  long  as  the  act  of  parturition  seems  to  be  progressing 
favorably,  the  caretaker  of  the  animal  should  not  in  any  waj^  in- 
terfere. Owners  of  breeding  animals  should  be  carefully  in- 
structed by  the  veterinarian  as  to  the  dangers  of  unnecessary 
interference  in  cases  of  normal  parturition.  If  the  presence  of 
the  owner  causes  the  animal  to  be  nervous  or  irritable,  he  should 
remain  at  a  safe  distance  until  his  services  are  required.     On  the 


542  Veterinary  Obstetrics 

other  hand,  it  must  be  constantly  borne  in  mind  that  the  well- 
being,  or  even  life,  of  the  mother  and  fetus  may  depend  upon 
prompt  aid  from  the  owner  or  the  attendant,  of  a  kind  which  is 
too  pressing  to  await  the  arrival  of  the  veterinarian. 

This  applies  with  special  force  to  the  mare,  where  timely  aid 
may  preserve  the  life  or  value  of  the  mother  or  the  fetus,  when 
the  veterinarian  could  not  possibly  accomplish  the  same  end  later. 
It  is  a  general  rule,  which  we  might  almost  .say  is  merely  em- 
phasized by  the  few  exceptions,  that  a  veterinarian  never  saves 
the  life  of  a  foal  in  a  ca.se  of  dy.stokia,  so  abrupt  is  labor  in  the 
mare  and  .so  quickly  does  the  foal  perish  because  of  the  early 
.separation  between  the  fetal  and  maternal  placentae.  It  is,  there- 
fore, highly  important  that  the  owner  or  caretaker  of  breeding 
mares  should  be  competent  to  give  first  aid  in  cases  of  parturition 
and  it  is  a  part  of  the  duty  of  the  veterinary  obstetrist  to  instruct 
the  owners  of  such  animals,  .so  far  as  it  may  be  practicable,  in 
these  matters. 

We  might  illustrate  this  l)y  citing  some  of  the  common  acci- 
dents of  parturition  in  the  mare.  In  some  cases  an  extremity  be- 
comes pushed  up  against  the  roof  of  the  vagina  and  into  the 
rectum,  so  that  a  portion  of  the  fetus  may  begin  to  protrude 
through  the  anus,  still  covered  by  the  tissues  between  the  two 
organs.  If  the  owner  promptly  pushes  these  parts  back  and 
directs  them  properly  in  the  genital  passage,  birth  occurs  safely 
and  perhaps  a  living  foal  is  produced,  but  a  few  minutes' 
delay  leads  to  the  rupture  of  the  perineum  and  the  virtual  de- 
struction of  the  value  of  the  mare.  In  another  case  a  fetus  pre- 
sents in  an  almost  normal  position  and  the  no.se  or  a  foot  becomes 
impacted  against  or  caught  upon  the  pelvic  inlet.  If  the  owner 
intelligently  releases  the  part  and  gives  it  proper  direction,  the 
foal  is  born  alive  without  further  difficulty,  but  if  it  is  allowed  to 
go  without  this  slight  aid  until  a  veterinarian  has  been  called, 
the  deviation  of  the  part  has  then  become  much  magnified,  the 
life  of  the  foal  has  been  .sacrificed  and  that  of  the  mare  more  or 
less  .seriously  endangered. 

The  genital  tract,  at  this  time,  is  in  an  exceedingly  receptive 
state  for  infection,  and  consequently  the  veterinarian,  owner  or 
other  person  attempting  any  examination  or  manipulation  .should 
be  exceedingly  careful  regarding  cleanliness  and  the  prevention  of 
infection,  and  no  examination  should  ever  be  undertaken  except 


Managemeyit  of  Normal  Parturition  543 

it  is  first  warranted  b)'  the  apparent  course  of  labor,  which,  after 
proper  watching,  seems  to  indicate  the  possibility  of  the  presence 
of  some  obstacle  to  normal  parturition. 

The  character  of  the  labor  pains  should  be  observed  and  it 
should  be  determined  if  they  are  normal  or  otherwise.  The 
labor  pains  may  show  a  somewhat  violent  and  clonic  character, 
accompanied  by  inefficiency  instead  of  that  deliberate  vigor 
which  should  accompany  the  act.  This  is  claimed  to  occur 
chiefly  in  young  and  nervous  animals,  especially  in  primipara, 
and  is  due  in  all  probability  to  the  rather  excessive  pain  accom 
panying  the  first  uterine  contractions  and  the  very  slow  dilation 
of  the  OS  uteri  and  the  genital  passages.  Under  such  conditions, 
any  precipitate  expulsive  effort  causes  unusual  pain  to  the 
mother  and  leads  her  to  desist  early  in  the  effort,  so  that  the 
labor  is  not  marked  by  the  expected  efficiency.  There  is  usually 
little  need  for  interference.  If  the  patient  is  kept  quiet  and  al- 
lowed a  little  time,  the  labor  pains  soon  acquire  their  normal 
vigor  and  accomplish  the  end  without  assistance. 

It  has  been  claimed  that,  in  some  cases,  the  cervix  uteri  is  in  a 
state  of  spasm,  and  that  this  may  be  quickly  overcome  by  apply- 
ing a  little  extract  of  belladonna  to  the  parts.  Other  remedies 
of  various  kinds  have  been  suggested,  but  clinically  it  cannot  be 
demonstrated  that  any  of  them  possess  material  value,  and  thej' 
probably  in  reality  retard  parturition,  rather  than  help  it,  by 
simply  serving  as  a  source  of  annoyance  to  the  animal.  It  is 
extremely  doubtful  if  the  application  of  belladonna  to  the  cervix 
will  cause  it  to  relax.  Fleming  states  that  contractions  of  the 
uterus,  in  some  of  these  cases,  are  reversed  and  that  they  begin 
at  the  cervix  of  the  organ  and  pass  toward  its  fundus,  a  sort  of 
anti-peristalsis,  thus  tending  to  force  the  fetus  toward  the  apex 
of  the  horn  rather  than  toward  the  vagina.  Upon  what  clinical 
or  experimental  evidence  such  a  theory  depends,  he  is  wholly 
silent. 

Some  authors  have  emphasized  the  common  clinical  fact  that 
easy  parturition  in  the  cow  is  more  liable  to  be  followed  by  par- 
turient paresis  than  is  a  protracted  birth.  The  connection  be- 
tween easy  birth  and  parturient  paresis  is  not  fundamental  nor 
essential,  but  simply  coincident.  Parturient  paresis  occurs  be- 
fore birth  and  during  labor,  so  that  the  easy  accomplishment  of 
the  act  cannot  serve  as  a  cause.     Clinically,  difficult  labor  serves 


544  Veterinary  Obstetrics 

as  a  bar  to  subsequent  parturient  paresis,  but  it  does  so  indirectly, 
in  a  manner  which  we  do  not  comprehend  because  we  have  not 
yet  succeeded  in  fully  defining  the  disease  itself. 

Prolonged  labor  of  every  degree  may  occur  in  a  way  which  pre- 
vents us  from  drawing  any  fixed  line  of  demarcation  between 
normal  and  abnormal  birth.  What  may  be  an  abnormal  duration 
of  labor  in  one  species  of  animal  may  be  wholly  natural  in  an- 
other ;  what  may  constitute  abnormal  birth  in  one  animal  of  the 
same  .species  may  be  wholly  normal  in  another  animal  ;•  or  that 
which  may  be  normal  in  a  given  individual  at  one  birth  may  be 
wholly  abnormal  at  another  birth.  We  have  already  suggested 
that  in  the  mare  the  duration  of  labor  is  usually  but  a  few  min- 
utes, while  in  the  cow  it  is  from  two  to  ten  times  as  long,  and 
may  endure  from  two  to  four  hours  or  even  longer  and  yet  run 
an  apparently  normal  course  without  material  danger  or  incon- 
venience for  either  the  mother  or  the  calf.  It  is  constantly' to  be 
borne  in  mind  that  in  primipara,  where  the  genital  passages  have 
not  previously  been  dilated  by  a  birth,  the  dilation  is  slow  as 
compared  with  animals  which  have  previously  given  birth  to 
)^oung.  If  a  heifer  has  been  in  labor  for  several  hours  and  the 
cervix  of  the  uterus  is  not  fully  relaxed,  but  the  position  of  the 
fetus,  its  size  and  condition,  and  the  character  of  the  birth  canal 
itself,  all  .seem  to  be  normal,  there  is  no  reason  for  great  anxiety 
and  we  had  best  await  the  efficiency  of  nature  to  accomplish  the 
desired  result. 

If  animals  are  debilitated,  whether  from  old  age  or  inefficient 
feeding  or  care,  they  may  be  unable  to  normally  give  birth  to 
young,  although  the  fetus  is  in  ev^ery  way  properly  presented 
and  the  general  condition  of  the  genital  organs  is  apparently  nor- 
mal. Heifers  which  are  bred  very  young  are  liable  to  become 
weak  and  emaciated  on  account  of  the  extra  burden  placed  upon 
their  nutritive  .systems  by  the  pregnant  condition,  and  thus  arrive 
at  the  period  of  parturition  in  an  enfeebled  state.  In  addition 
there  may  be  a  relatively  large  fetus. 

In  such  animals  labor  pains  may  be  wanting  in  vigor  and  effi- 
ciency and  after  a  time  may  more  or  less  disappear  and  eventu- 
ally wholly  cea.se.  The  uterine  walls  are  so  lacking  in  vigor,  in 
harmony  with  the  general  debility  of  the  system,  that  they  be- 
come exhausted  and  their  force  diminishes  or  ceases.  The  feeble 
pains  may  rupture  the  fetal  membranes  and  permit  the  gradual 
discharge  of  the  fetal  fluids. 


Management  of  Normal  Pa7-turition  545 

When  it  has  been  determined  that  there  is  a  want  of  contractile 
power,  although  not  dependent  upon  some  mechanical  obstacle  to 
parturition,  we  have  passed  the  border  line  between  normal  birth 
and  dystokia.  Without  materially  invading  the  latter  field  we 
may  here  suggest  that  the  difficulty  should  be  overcome  by  admin- 
istering such  stimulants  or  tonics  as  will  tend  to  arouse  the  con- 
tractile power  of  the  uterus  and  the  general  strength  of  the  ani- 
mal. Some  have  advised  the  use  of  ecbolics,  such  as  ergot,  rue  and 
other  drugs  of  this  class,  but  their  power  to  induce  contractions 
of  the  uterus  in  domestic  animals  is  very  questionable,  and 
they  certainly  do  not  tend  to  strengthen  the  system  of  the  animal 
as  a  whole.  It  is  probably  better  to  employ  such  reliable  stimu- 
lants to  the  nervous  system  as  strychnine,  or  diffusible  stimulants 
like  alcohol  and  its  derivatives,  or  coffee  and  other  drugs. 

Traction  upon  the  fetus  is  evidently  unnecessary  in  normal 
parturition  and  is  only  called  for  in  those  cases  where  there  is 
some  deviation  from  the  normal  course.  It  is  well  here  merely 
to  point  out  that,  in  some  of  those  cases  which  mark  the  border- 
line between  normal  birth  and  dystokia,  it  may  be  desirable  to 
apply  more  or  less  traction  in  order  to  aid  the  pregnant  animal 
in  her  efforts  to  expel  the  fetus.  Such  aid  should  be  intelli- 
gently applied  in  those  cases  where  the  pregnant  animal  is  some- 
what weak  or  debilitated,  where  for  any  reason  the  parturition 
has  been  more  or  less  delayed  and  the  animal  is  becoming  ex- 
hausted, or  where  the  life  of  the  fetus  may  be  imperiled  by  a 
tardy  delivery.  In  primipara,  especially  in  young  heifers,  gen- 
tle and  judicious  traction  upon  the  fetus  is  frequently  desirable 
in  order  to  aid  them  in  overcoming  the  obstacles  presented,  but 
it  should  always  be  borne  in  mind  that  any  undue  or  unnecessary 
traction  may  prove  exceedingly  harmful  by  forcing  the  fetus 
through  the  birth  canal  before  the  latter  has  had  time  to  become 
fully  and  effectively  dilated.  In  this  way  the  tissues  become 
more  or  less  seriously  b^-uised  or  ruptured,  which  might  well  be 
avoided  by  allowing  abundance  of  time  and  a  natural  dilation  of 
the  passages. 

When  a  fetus  presents  posteriorly,  especially  in  the  mare  and 
cow,  it  is  essential  to  hasten  its  expulsion  as  soon  as  the  body 
has  advanced  far  enough  into  the  canal  that  the  umbilic  cord 
is  engaged  and  compressed  between  the  fetal  body  and  the  pubic 
brim  of  the  mother.  In  managing  such  a  case,  the  advancement 
35 


546  Veterinary  Obstetrics 

of  the  fetus  should  be  very  deliberate  and  not  hurried  until  the 
buttocks  of  the  young  animal  have  appeared  at  the  vulva  and 
have  passed  through  it,  thus  dilating  normally  the  entire  length 
of  the  passage.  Then,  when  the  critical  moment  has  arrived, 
the  fetus  should  be  promptly  and  carefully  withdrawn  in  order 
that  it  may  not  be  suffocated . 

;■;  ;•:  ;1:  *  *  % 

It  may  be  highly  important  to  determine  in  a  given  case  if  the 
fetus  is  alive  or  dead,  because  in  a  case  of  dystokia  the  question 
of  embryotomy  may  arise  and,  if  one  is  so  unfortunate  as  to 
badly  mutilate  a  fetus  and  then  extract  it  from  the  mother  in  a 
living  condition,  especially  if  it  is  highh'  valued  by  the  owner, 
the  error  maj'  become  very  embarrassing. 

It  is  frequently  very  difficult  during  labor  to  determine  whether 
the  young  animal  is  alive  or  dead,  especially  when  it  is  firmly  im- 
pacted in  the  pelvis,  where  it  has  no  power  to  move  and  no  op- 
portunity to  breathe  or  to  show  other  definite  signs  of  life.  Flem- 
ing has  asserted  that  fetor  of  the  liquor  amnii  may  not  neces- 
sarily show  that  the  fetus  has  perished.  Upon  what  grounds 
such  a  statement  is  based  we  cannot  comprehend,  unless  it  be 
that,  because  there  is  an  odor  present,  it  is  called  fetid.  The 
fetal  fluids  have  a  very  marked  and  distinctive  odor,  which  to  the 
experienced  obstetrist  has  no  suggestion  of  fetor,  but  is  simply 
the  normal  odor  of  a  healthy  liquid.  In  our  experience,  when 
the  fetal  fluids  are  fetid  there  is  no  longer  reason  for  doubt  that 
the  fetus  is  dead,  though  admittedly  the  line  of  demarcation  be- 
tween a  non-fetid  and  a  fetid  state  of  the  fetal  fluids  is  not  always' 
easily  drawn.  Any  active  movements  of  the  fetus  establish 
clearly  that  it  is  living. 

When  the  fetus  presents  anteriorly,  with  the  head  protruded 
through  the  vulva,  and  remains  incarcerated  for  some  time,  the 
head  becomes  engorged  and  swollen,  the  tongue  swollen,  blue- 
black  and  protruding  from  the  mouth,  and  the  eyes  glassy  and 
insensible.  However,  the  conclusion  is  not  to  be  hastily  drawn 
that  it  is  dead  ;  on  the  other  hand,  it  may  be  very  much  alive 
and  recover  immediately  and  begin  to  move  as  soon  as  it  is  re- 
leased from  its  perilous  position.  In  fact,  such  engorgement  of 
the  head  and  cyanosis  of  the  visible  mucosa  show  that  the  fetus 
was  alive  when  the  head  appeared.  Had  it  been  dead  at  the 
beginning  of  labor,  the  engorgement  could  not  have  occurred. 


Manageine7it  of  Norjnal  Parturition  547 

In  the  mare,  however,  it  maj-  generalh'  be  considered  that,  if 
vigorous  expulsive  efforts  have  continued  for  two  or  three  hours, 
or  if  the  fetus  has  been  engaged  in  the  pelvis  for  even  a  half 
hour,  unless  we  can  observe  some  definite  sign  of  life,  the  foal 
has  already  perished. 

The  death  of  the  fetus,  some  claim,  retards  parturition,  and 
the  claim  is  apparenth'  justified  by  clinical  experience. 

The  contractions  of  the  uterus  upon  the  living  young  tend  to 
cause  the  latter  to  make  spontaneous  movements  and,  in  doing  so, 
to  extend  its  extremities  in  the  most  favorable  position  for  their 
passage  through  the  birth  canal.  If  dead,  this  extension  of  the 
limbs  is  not  likely  to  occur,  because  of  the  absence  of  reflex 
movements  and  of  the  rigidity  of  the  foal.  Some  authors  state 
that  the  death  of  the  fetus  tends  to  eliminate  a  certain  stimula- 
tion to  the  uterine  walls,  which  causes  their  contraction,  but  this 
is  not  verified  clinically  because,  as  a  general  rule,  we  see  just  as 
vigorous  expulsive  efforts  in  case  of  a  dead  fetus  as  in  a  living 
one.  Others  contend  that  the  contractions  of  the  uterus  are  not 
effective  upon  the  dead  fetus,  because  of  the  flaccid  condition  of 
its  tissues. 

As  previously  stated,  the  position  of  the  fetus  prior  to  birth  is 
essentially  different  from  that  which  it  is  expected  to  assume 
during  its  expulsion.  Saint-Cyr  is  correct  in  holding  that,  if  the 
dead  fetus  presents  in  a  proper  position,  the  expulsion  is  as  easy 
as  though  the  young  were  alive.  Of  course,  if  the  fetus  has 
undergone  partial  decomposition  and  is  emphysematous,  its  ex- 
pulsion is  ver}'  much  more  difficult. 

■if.  -if.  ^,  %  'J(.  % 

The  causes  of  the  death  of  the  fetus  during  the  period  of  labor 
may  be  exceedingly  varied.  The  umbilic  cord  of  the  human 
fetus  sometimes  becomes  knotted,  or  it  may  twist  about  the  neck, 
body  or  limbs  of  the  child,  and  thus  interrupt  the  circulation  and 
cause  its  death.  This  does  not  occur  in  domestic  animals  with 
sufficient  frequency  to  become  of  clinical  importance.  The  um- 
bilic cord  is  too  short  to  favor  such  an  accident. 

Fleming  claims  that  the  death  of  the  fetus  may  be  due  to  the 
premature  rupture  of  the  membranes,  the  escape  of  the  fetal 
liquids,  and  the  consequent  immediate  pressure  of  the  uterus  upon 
the  fetus.     We  do  not  understand  how  the  pressure  of  the  uterus 


548  Veterinary  Obstetrics 

upon  the  fetus  can  be  any  greater  after  the  expulsion  of  the  fetal 
liquids  than  before,  although  we  admit  that  it  does  closely  in- 
vest the  fetal  body  and  may  thus  be  prevented  from  expelling 
the  fetus  from  its  cavity.  The  escape  of  the  fetal  fluids  indi- 
cates rather  a  delayed  expulsion  of  the  fetus  than  a  premature 
rupture  of  the  membranes  ;  that  is,  the  membranes  normally 
rupture,  but  after  their  rupture  some  mechanical  obstacle  or 
some  weakness  of  the  uterus  has  served  to  prevent  the  expulsion 
of  the  fetus,  and  consequently  has  led  to  its  death. 

Indirectly  the  rupture  of  the  fetal  membranes  and  escape  of 
the  fluids  is  probably  the  most  common  cause  of  the  death  of  the 
fetus  during  labor.  The  fact  that  a  foal  does  not  usually  live  more 
than  one  to  three  hours  after  the  first  expulsive  efforts,  while 
the  calf  may  continue  to  live  much  longer,  is  explained  by  the 
differences  in  the  character  of  the  placentae.  The  attachments  in 
the  mare  are  less  intimate  and  become  detached  very  shortly  after 
labor  sets  in.  The  calf  lives  longer  largely  because  the  os  uteri 
of  the  cow  dilates  more  slowly  and  hence  the  fetal  waters  do  not 
so  completely  escape,  or  they  may  be  entirely  retained  and  the 
membranes  remain  unruptured  for  a  considerable  period  of  time. 
In  the  cow  also  the  allantoic  sac  may  not  rupture  at  first,  but 
only  the  amnion,  whereas  in  the  mare  the  allantoic  sac  must 
necessarily  rupture  before  the  amniotic  sac  appears  at  the  vulva 
and,  consequently,  when  this  latter  ruptures  both  .sacs  are  freely 
open  and  all  the  fluids  may  escape.  The  escape  of  these  fluids 
permits  a  contraction  of  the  uterus  which  certainly  exerts  an 
important  influence  upon  the  dehi.scence  of  the  placenta  and 
leads  to  the  death  of  the  fetus. 


The  rupture  of  the  water-bag  in  an  approximately  normal  par- 
turition may  well  be  left  wholly  to  nature,  as  it  ordinarily  requires 
no  interference,  but,  on  the  other  hand,  is  usually  better  accom- 
plished without  it  and  will  naturally  occur  at  the  most  appropri- 
ate time.  The  water-bag  cannot  protrude  far  beyond  the  vulva 
in  the  cow  or  other  ruminant,  without  rupturing,  because  the 
amnion  is  adherent  to  the  chorion  over  a  large  part  of  its  area,  so 
that  it  cannot  pass  out  with  the  fetus,  but  must  rupture,  and  the 
fetus  be  born  naked. 

Some  writers  claim  that  it  is  at  times  necessary  for  an  attendant 
to  rupture,  or  even  to  cut   the  chorion  of  the  new-born.     We 


Ma7iageme7it  of  Normal  Parturition  549 

have  not  had  occasion  to  observe  any  such  necessity.  A  living 
foal  cannot  be  born  in  the  chorion, because  it  would  necessarily 
die  from  asphyxia  before  it  could  possibly  be  expelled.  It  would 
then  be  useless  to  open  the  chorion. 

The  expulsion  of  an  aborted  fetus  in  all  its  membranes  is  not 
rare,  but  the  expulsion  of  a  full-sized  dead  fetus  enclosed  within 
the  chorion  is  improbable,  if  not  impossible.  Should  such  ex- 
pulsion be  threatened,  and  the  chorion  protrude  into  the  vulva, 
it  should  be  opened  to  allow  the  fluids  to  escape  and  render  the 
expulsion  of  the  fetus  easier. 

Occasionally  the  foal  is  born  more  or  less  enveloped  in  the 
amnion,  but  this  is  so  delicate  that  a  very  slight  struggle  upon 
its  part  will  free  it  from  any  adherent  portions.  It  has  also  been 
stated  that  the  mother  gnaws  through  this  membrane  and  releases 
the  young  animal,  but  she  always  rests  for  a  time  after  the  ex- 
pulsion of  the  fetus,  and  consequently,  if  its  life  were  jeopardized 
by  being  expelled  included  in  its  membranes,  it  would  become 
asphyxiated  long  before  the  mother  would  give  it  any  attention. 
We  have  not  known  a  fetus  to  perish  because  of  inclusion  within 
the  membranes. 

It  is  needless  to  remark  that,  in  cases  where  a  living  fetus  is 
expelled  more  or  less  enclosed  in  the  amnion  in  such  a  way  as 
to  interfere  with  respiration,  the  attendant  should  remove  the 
obstruction  as  promptly  as  possible,  preferabh'  before  the  fetus  is 
completely  expelled. 


THE  CARE  OF  THE  PARTURIENT  ANIMAL 
AND  OF  THE  NEW-BORN. 

After  the  completion  of  labor,  the  mother  should  not  be  an- 
noyed by  the  presence  of  other  animals  of  her  own  or  other  spe- 
cies, or  by  the  unnecessary  presence  of  persons.  She  should  have 
clean  and  comfortable  quarters,  whether  in  the  stable  or  in  the 
field,  and  her  body  should  be  kept  as  clean  as  circumstances  per- 
mit ;  if  present,  any  blood  or  discharges  should  be  washed  or 
wiped  away  from  her  tail  and  thighs  or  other  parts  of  her  body 
which  have  become  soiled.  In  case  of  the  large  domestic  ani- 
mals, the  afterbirth,  if  it  has  come  away,  should  be  removed  and 
destroyed,  although,  as  a  general  rule,  no  material  harm  comes 
to  the  mother  from  eating  it.  If  the  animal  is  stabled,  allowing 
the  expelled  afterbirth  to  remain  in  the  stall  permits  it  to  un- 
dergo rapid  decomposition,  entices  flies,  and  tends  to  render  in- 
fection of  the  mother  or  fetus  more  probable  because  of  its  pres- 
ence. 

An  abundance  of  good  drinking  water  and  suitable  food  should 
be  allowed.  For  herbivorous  animals,  which  have  given  birth 
to  young  during  the  warm  season  of  the  year,  grass  constitutes 
the  most  favorable  diet.  Mares  w'hich  are  used  for  work 
purposes  should  be  rested  for  a  few  days  after  parturition,  as  a 
safeguard  against  disease.  As  a  general  rule  the  mare  may 
safely  return  to  work  in  the  course  of  three  or  four  days,  if 
parturition  has  been  easy  and  without  accident,  but  the  labor  must 
be  of  a  gentle  character. 

If  the  genital  organs  have  suffered  any  material  injury  during 
the  act  of  birth,  proper  precautions  should  be  taken  against  in- 
fection. For  this  purpose  some  mild  disinfecting  solution  should 
be  used  to  flush  out  the  vulva  and  vagina.  Unless  these  inter- 
ferences are  necessitated  by  conditions,  the  animal  should  be  left 
quite  alone. 

:\i  ;i;  ^i  -^  -Jfi  ^ 

Immediately  following  parturition  there  occurs  a  series  of  rapid 
changes  by  which  the  genital  organs  resume  the  form  and  func- 
tions of  the  non-pregnant  animal.  In  domestic  animals  this 
interval  is  brief,  usually  extending  over  but  three  to  five  days, 
and  is  marked  by  little  exterior  change.  It  is  a  period  in  which 
the  maternal  body  is  highly  susceptible  to  insults  of  various 
550 


Care  of  th  e  Pa  rtii  rien  t  A  n  im  a  I  551 

kinds  and  in  which  pathologic  changes  are  very  readily  aroused 
in  case  of  accident  or  undue  exposure. 

Normally  this  interval  of  time  passes  almost  unnoticed  in  our 
domestic  animals,  and  it  is  only  when  we  give  close  attention 
that  the  changes  which  are  taking  place  are  observed. 

After-pains  in  the  domestic  animals  are  unobserved  as  a  natu- 
ral condition,  beyond  some  expulsive  pains,  which  are  noticed 
in  some  cases  while  the  "afterbirth  is  being  detached  and  ex- 
pelled. When  this  act  is  accomplished,  we  usually  observe  no 
pains,  although  Saint-Cyr  claims  that  in  some  cases  there  is  a 
whisking  of  the  tail  and  an  increa.sed  tension  of  the  abdomen 
which  indicates  that  the  uterus  is  contracting  in  a  manner  to 
cause  some  pain  to  the  animal. 

As  a  general  rule,  when  evidences  of  abdominal  pain  follow 
shortly  after  parturition,  they  suggest  some  pathologic  condition, 
which  may  be  more  or  less  important,  such  as  the  retention  of 
a  portion  of  the  fetal  membranes  or  some  displacement,  such  as  a 
beginning  inversion  of  the  uterus.  Consequently,  whenever 
such  pains  are  observed  following  parturition,  a  careful  manual 
exploration  of  the  uterus  should  be  made  to  determine  the  cause, 
followed  by  the  application  of  the  necessary  remedies. 

After  the  expulsion  of  the  fetus  and  its  membranes,  there  in- 
evitably occurs  in  all  animals  a  more  or  less  recognizable  dis- 
charge from  the  uterus,  consisting  of  blood  and  fragments  of  the 
uterine  mucosa  or  of  the  villi  of  the  placenta,  which  substances 
need  be  cast  off  before  the  uterus  can  resume  its  normal  .state. 
This  discharge  is  known  as  the  lochia.  Though  prominent  in 
woman,  on  account  of  the  very  complex  discoid  placenta,  it  is 
inconspicuous  in  animals,  where  the  placentae  are  more  extensive 
in  area  and  less  complex  in  their  structure,  so  that  one  needs  ob- 
serve an  animal  quite  closely  in  order  to  recognize  the  presence  of 
the  lochial  discharge  following  an  easy  birth.  It  becomes  least 
conspicuous  when  the  placenta  is  distributed  over  a  wide  area  and 
has  a  feeble  attachment  to  the  uterus.  It  follows  that,  in  the 
mare,  where  a  diffu-sed  placenta  is  found,  in  which  the  villi  are 
not  very  extensive,  the  lochia  can  scarcely  be  recognized  at  all, 
while  in  the  cow  with  the  multiple  or  cotyledonous  placenta  it  is 
more  evident,  but  even  here,  under  normal  conditions,  quickly 
disappears.  In  the  mare  the  lochial  discharge  should  not  be 
recognizable  except  after  a  few  hours,  nor  should  it  be  conspicu- 


552  Veterinary  Obstetrics 

ous  in  the  cow  for  more  than  a  day  or  two.  At  first  it  is  a  red- 
dish or  grayish-red  discharge,  owing  to  the  admixture  of  blood, 
but  this  quickly  changes  to  mucus,  which  may  persist  for  a  longer 
period  of  time. 

Fleming  considers  this  lochial  discharge  far  more  important 
than  we  have  observed.  He  states  that  it  may  continue  for 
days  or  weeks  and  that  7  to  8  quarts  of  lochial  discharge  have 
been  removed  from  the  uterine  cavity'  of  the  mare  three  days 
after  parturition.  Apparently  he  and  others  have  failed  to 
recognize  the  proper  line  of  demarcation  between  the  physiology 
of  the  puerperal  state  and  the  pathology  of  this  period.  In  our 
judgment,  when  these  discharges  become  very  apparent  and 
acquire  marked  characters  they  are  no  longer  physiologic,  but 
are  pathologic,  and  should  be  regarded  as  such. 

The  discharge  of  the  lochia  is  of  physiologic  importance  to 
the  animal,  since  it  rids  the  maternal  system  of  an  amount  of 
tissue  which  has  ceased  to  live  and  which  must  con.sequently  be 
excreted  either  directly  through  the  vagina  or  indirectly  by  be- 
ing absorbed  by  the  maternal  system  and  later  excreted  through 
other  channels.  If  it  is  not  promptly  discharged,  it  forms  a 
dangerous  culture  medium  in  which  bacteria  may  multiply  and 
cau.se  more  or  less  serious  di.sease. 

Some  believe  that  the  suspension  of  the  lochial  discharge 
causes  .serious  disease.  This  is  difficult  of  proof.  Admittedly 
we  observe  serious  disease  in  animals  when  the  lochia  become 
infected  and  the  products  of  infection  enter  the  maternal  system. 
This  is  not  the  result  of  lochial  su.spension,  but  of  infection. 

;1;  ;1;  ;1;  ;!;  ;i;  -^ 

Often  the  mother  more  or  less  resents  the  approach  of  other 
animals  or  of  persons  and  is  very  liable  to  injure  her  young  by 
treading  upon  them  in  an  effort  to  protect  them.  Such  danger 
is  often  observed  with  nervous  mares.  The  same  is  especiallj^ 
noted  if  a  sow  is  disturbed.  She  then  shows  great  liability  to 
trample  her  young,  or,  failing  in  this,  she  lies  upon  .some  of  the 
pigs  as  a  consequence  of  her  excitement. 

It  .should  not  be  forgotten  that  many  of  our  domestic  animals 
are  prepared  to  strenuously  defend  their  young  and  will  vigor- 
ously attack  other  animals,  or  man,  when  they  approach.  Such 
an  attitude  is  not  confined  to  any  one  species,  but  is  a  maternal 
instinct  which  is  shown  to  some  extent   by  all   animals   which 


Care  of  the  Parturient  Animal  553 

naturall}^  fight  in  self-defense.  It  is  verj'  common  in  the  mare, 
and  in  man}-  cases  it  is  more  or  less  dangerous  to  approach  her 
when  she  is  giving  her  first  attention  to  a  new-born  foal.  Not 
only  maj'  she  trample  the  foal,  but  may  bite,  strike  or  kick  an}- 
person  who  approaches  her.  A  mare  resented  strongly  the 
actions  of  an  attendant,  who  had  placed  his  arms  about  her 
foal  in  order  to  move  it  from  one  enclosure  to  another.  In 
an  effort  to  defend  the  foal  she  kicked  so  vigorously  at  the 
attendant  that,  striking  instead  the  head  of  the  foal,  she  killed 
it  instantly  in  the  attendant's  arms.  It  is  consequently  discreet, 
when  one  wishes  to  handle  a  new-born  foal,  to  have  a  second 
part}'  present  to  control  the  mare  and  thus  avoid  accident,  until 
her  attitude  has  been  fully  determined.  We  note  a  similar  de- 
gree of  danger  in  approaching  cows  with  new-born  calves,  espe- 
cially those  which  have  been  allowed  to  run  at  large  during  most 
of  their  lives  and  have  acquired  a  rather  strong  sense  of  self- 
defense.  The  danger  of  approaching  a  bitch  with  new-born 
puppies  is  very  well  known  and  should  alwa\-s  be  recognized. 
The  sow  habitually  and  vigorously  defends  her  young  and  some- 
times imperils  the  life  or  limb  of  any  attendant  who  may  injudi- 
cioush-  approach  her. 

In  some  instances  the  mother  fails  to  show  any  maternal  affec- 
tion for  her  young,  will  repel  it,  not  allow  it  to  suck,  nor  take 
any  care  of  it,  and  may  instead  destroy  it  because  of  its  attempts 
to  approach  her.  In  such  instances  some  writers  suggest  various 
expedients  to  induce  the  mother  to  permit  the  young  to  suckle 
or  to  cause  her  to  care  for  it,  but  as  a  rule  these  eflforts  are  not 
highly  successful  if  the  repulsion  is  well  marked  and  strong. 
In  some  cases  it  may  be  that  attendants  can  quiet  the  mother, 
and,  by  carefully  bringing  the  young  animal  in  contact  with  her 
for  a  time,  overcome  her  repulsion.  Frequently  such  refusal  of 
the  mother  to  own  and  care  for  her  young  is  referable  to  interfer- 
ence and  annoyance  by  attendants. 

Muciparous  animals  sometimes  give  birth  to  more  young  than 
the  mother  has  teats,  in  which  case  the  supernumerary  ones  usu- 
ally perish.  In  the  sow  and  other  multiparious  animals  each 
young  has  its  own  particular  teat,  to  which  it  regularly  goes  at 
feeding  time.  The  sternal  teats  of  the  sow  are  generally  better 
developed  and  supply  more  milk,  and  the  most  vigorous  young 
usually  take  to  these  teats  and  crowd  the  weaker  ones  to  those 


554  Veterinary  Obstetrics 

glands  which  supply  the  lesser  amount.  In  this  way  it  fre- 
quently occurs  that  one  or  more  of  the  pigs  is  very  poorly  nour- 
ished. It  has  been  suggested  that  these  weaker  individuals  be 
put  upon  the  larger  teats,  but  this  is  not  a  very  easy  process  to 
carry  out,  since  the  selection  of  the  teats  is  generally  made  by 
the  pigs  themselves  and  adhered  to  quite  vigorously.  When 
there  are  more  young  than  there  are  teats  present,  the  excess 
should  be  destroyed,  reared  by  hand  or  placed  upon  another  ani- 
mal. The  latter  plan  is  most  convenient,  but  does  not  always 
succeed,  because  the  foster  mother  will  not  always  allow  the 
young  animal  to  suck. 

Sometimes,  when  several  animals  of  the  same  species,  with 
young,  are  kept  in  the  same  enclosure,  the  older  or  stronger  young 
animals  may  rob  the  younger  ones  of  food  by  sucking  not  only 
their  own  mother  but  also  that  of  their  younger  neighbors,  and 
being  stronger  can  readily  push  them  away  from  the  teat.  Such 
an  occurrence  should  be  watched  for  and  the  needed  measures 
taken  to  insure  the  younger  animal  its  normal  food  supply. 

The  identification  of  the  new-born  young  of  a  given  parent 
sometimes  offers  serious  difficulty,  and  the  veterinarian  should  be 
in  as  good  a  position  as  possible  to  aid  owners  in  escaping  from  such 
a  dilemma.  When  females  of  the  same  species  give  birth  to  young 
at  about  the  same  time  and  in  the  same  enclosure,  their  offspring 
may  become  interchanged.  The  young  of  one  may  be  stolen  by 
another  mother,  and  considerable  confusion  thus  brought  about. 
Sometimes  an  animal  which  has  not  yet  given  birth  to  young 
may  take  the  young  of  another  animal  and  suckle  it  and  drive 
away  the  actual  mother.  One  case,  which  we  observed,  raised  a 
serious  question  as  to  pedigree.  A  client  owned  a  valuable  herd 
of  pedigreed  draft  mares,  among  which  there  was  a  grade  draft 
mare  of  very  low  value.  Our  client,  upon  going  to  the  pasture 
one  morning,  found  a  very  excellent  foal  being  cared  for  by  the 
cheap  grade  mare.  The  disparity  between  the  form  and  quality 
of  the  foal  and  what  he  would  expect  from  the  inferior  mare  was 
so  great  that  his  suspicions  were  at  once  arou.sed.  In  the  same 
enclosure  was  one  of  his  best  pedigreed  mares,  which  looked  as 
though  she  had  foaled,  although  there  was^  no  great  evidence 
and  there  were  .scarcely  any  traces  of  blood  or  fetal  fluids  upon 
the  tail  or  thighs.  On  the  other  hand,  the  grade  mare  had  her 
tail  and  thighs  badly  .soiled  and  portions  of  the  afterbirth  were 


Care  of  the  Parhirient  Animal  555 

hanging  from  her  vulva.  Under  the  circumstances,  I  was  asked 
to  aid  in  solving  the  problem.  Upon  examination,  it  was  found 
that  the  valuable  mare  had  indeed  given  birth  to  a  foal  and  that 
her  uterus  was  vacant,  while,  upon  examining  the  grade  mare, 
it  was  found  that  her  foal  was  lying  dead  in  her  uterus.  It  thus 
became  clearl)-  established  that  she  had  stolen  the  foal  of  the  ped- 
igreed mare. 

;!;  ;•;  ^  ;!;  H=  ;i; 

In  Other  cases  the  mother,  owing  to  some  abnormal  appetite, 
proceeds  to  destroy  her  j'oung  and  eat  them.  This  is  especially 
notable  in  the  sow,  which  will  not  infrequently  eat  her 
entire  litter  of  pigs  shortly  after  they  are  born.  In  some  in- 
stances this  abnormal  appetite  or  cannibalism  does  not  confine 
itself  to  one  mother,  but  seems  to  involve  an  entire  herd  of  sows 
during  a  given  season,  so  that  the  pig  crop  on  a  given  farm  may 
be  utterly  destroyed  by  this  perversion  of  the  maternal  instinct. 
The  causes  of  this  perversity  are  not  well  understood.  It  occurs 
most  frequently  in  those  sows  which  are  kept  in  styes,  but  some- 
times also  in  those  which  run  at  large.  In  individual  cases  it 
would  seem  to  be  due  sometimes  to  the  accidental  death  of  one 
or  more  of  the  young,  followed  by  the  eating  of  it  by  the  mother, 
in  conformity  with  her  general  omnivorous  character.  Once 
having  tasted  this  flesh,  she  may  proceed  to  kill  and  devour  the 
others,  but  this  does  not  account  for  the  wholesale  perversion 
which  is  sometimes  observed. 

In  one  instance  coming  to  our  knowledge  a  herd  of  ewes  de- 
voured their  new-born  lambs  with  great  uniformit}^  so  that  the 
entire  lamb  crop  of  a  given  year  was  virtually  destroyed.  We 
have  also  observed  the  cat  devour  her  new-born  kittens. 

In  these  more  rare  cases  we  can  only  attribute  it,  in  the  pres- 
ent state  of  our  knowledge,  to  some  general  defect  in  the  care  of 
the  pregnant  animals  at  the  time  of  their  giving  birth  to  young 
or  shortly  preceding.  It  might  be  well  to  try,  in  such  instances, 
the  changing  of  the  animal's  food  and  the  allowance  of  some  al- 
terative, such  as  an  increased  ration  of  salt  or  the  administration, 
in  the  food,  of  alkalies,  like  bicarbonate  of  soda. 

Harms  recommends,  as  a  remedy  for  sows  which  devour  their 
young,  that  they  be  watched  during  parturition  and  the  fetal 
membranes  be  removed  so  that  they  cannot  eat  them  and  thereby 


556  Veterinary  Obstetrics 

arouse  their  appetite  for  eating  their  young.  He  suggests,  in 
addition,  that  she  be  given  veratri  radix,  and  cites  Vogel  as  recom- 
mending 0.3  to  0.5  grammes  given  internally,  while  Harms  pre- 
fers to  take  a  small  piece  of  the  root  cut  in  the  form  of  a  wedge 
and  insert  it  beneath  the  skin  of  the  animal.  Others  suggest 
that  vomition  be  induced  by  administering  tartar  emetic,  or  that 
opium  or  camphor  be  given.  Harms  also  cites  Professor  Landois, 
who  mentions  an  instance  of  a  sow  which  showed  a  tendency  to 
devour  her  young  and  was  cured  of  the  habit  by  sorcery.  In 
this  instance  a  local  expert  repeated  a  series  of  words  for  100 
consecutive  times,  stroking  the  sow  over  the  head,  and  thereafter 
she  showed  no  further  tendency  to  eat  her  young.  As  Harms 
very  well  remarks,  however,  the  best  known  remedy  for  these 
animals,  in  which  the  vice  has  once  occurred,  is  to  fatten,  and 
send  them  to  the  butcher. 

The  new-born  usually  gets  the  best  care  from  its  mother,  when 
she  has  been  given  natural  and  proper  environment  in  \vhich  to 
bring  forth  her  young  and  the  birth  has  been  normal.  So  far  as 
is  practicable,  the  care  of  the  young  should  be  left  to  the  instinct 
of  the  mother,  but  the  conditions  of  domestication  impose  cer- 
tain dangers  and  ri.sks  to  the  new-born  which  intelligent  care 
upon  the  part  of  the  owner  may  minimize  or  obviate. 

It  is  essential  to  an  intelligent  consideration  of  the  question  to 
bear  in  mind  the  changes  in  environment  and  function  which 
must  occur  when  the  fetus  is  expelled  from  the  uterus  and  must 
begin  its  extra-uterine  life.  Certain  functions  which  have  pre- 
viously been  carried  on  through  the  medium  of  the  placenta  of 
the  mother  must  now  be  taken  up  by  the  young  animal  itself  in 
a  semi-independent  manner.  It  is  the  safe  establishment  of  these 
functions  which  constitutes  the  chief  concern  to  the  owner. 

I.  Prior  to  birth,  the  supply  of  oxygen  for  the  fetus  has  been 
carried  from  the  lungs  of  the  mother  to  the  maternal  placenta  and 
thence  to  the  fetus,  while  the  carbon  dioxide  and  other  waste  or 
injurious  substances  have  been  carried  from  the  fetal  circulation 
through  the  fetal  placenta,  and  thence  through  the  circulation  of 
the  mother,  to  be  excreted  from  her  lungs  or  oth^r  organs.  This 
relationship  has  become  suddenly  interrupted  by  the  act  of  birth 
and  must  quickly  be  replaced  by  direct  respiration  through  the 
lungs  of  the  new-born  animal.  The  urgency  for  the  establi.sh- 
ment  of  this  respiration  is  such  that  it   permits   no  delay.     The 


Care  of  the  New-Born  Animal  557 

first  object,  therefore,  of  a  care-taker  or  watcher  of  new-born  ani- 
mals is  to  see  that  thej^  begin  breathing  pronipth'  and  that  any 
impediments  to  this  act  are  removed  as  quickly  as  possible  or  that 
any  other  necessary  means  which  might  insure  the  prompt  estab- 
lishment of  respiration  are  employed. 

It  should  be  immediately  seen  that  the  nostrils  of  the  fetus  are 
free,  so  that  air  may  readily  enter  the  lungs  ;  if  portions  of  the 
fetal  membranes  cover  the  nose  they  should  be  removed  ;  if  mu- 
cus has  collected  in  the  nostrils,  it  should  be  taken  away  prompt- 
ly. In  a  litter  of  new-born  pigs  we  noted  that  there  was  difficult 
respiration,  although  the  nostrils  were  not  blocked.  Upon  post- 
mortem examination  of  some  of  these,  we  found  that  a  clot  of 
firm  mucus  was  lodged  in  the  larynx.  It  is  quite  possible  that 
such  a  condition  sometimes  exists  in  other  young  animals,  and 
should  have  the  attention  of  the  care-taker.  In  nianj-  cases,  per- 
haps, this  mucus  could  be  dislodged  by  manipulating  the  tongue — 
by  alternately  drawing  it  forward  and  then  allowing  it  to  retract. 

In  .some  cases  the  fetus  has  apparently  been  strangled  to  some 
extent  during  birth,  owing  to  the  inhalation  of  fluids  because  of 
interruption  of  the  umbilic  circulation,  in  which  instance  it  may  be 
advisable  to  drain  out  some  of  the  fluid  by  suspending  the  young 
animal  for  a  few  moments  by  the  hind  legs  or  b\'  placing  it  in  a 
position  with  its  head  declined.  If,  however,  the  fetal  circula- 
tion is  good,  any  fetal  fluids  which  may  have  been  inhaled  are 
promptly  absorbed  and  cease  to  have  danger  for  the  young  animal. 

In  tardy  birth  there  may  occur  suspended  animation  because 
of  a  too  long  delayed  respiration.  According  to  some  writers, 
the  principal  .stimulus  in  establishing  respiration  is  the  shock 
which  the  new-born  receives  from  being  expelled  from  the  uterus, 
where  the  temperature  has  been  105  to  108  F.,  to  the  exterior,  in 
the  cold,  dry  air.  The  importance  of  this  in  the  arousing  of 
respiration  is  not  very  clear  clinically,  and  there  seems  to  belittle 
difference  in  this  respect  whether  a  fetus  be  born  where  the 
temperature  is  at  zero  F,  or  90  to  100°  F.  It  seems,  how- 
ever, that  the  dashing  of  cold  water  upon  the  fetus  or  vigorous 
stroking  of  the  chest  will  arouse  the  act  of  respiration  in  some 
cases.  Generally,  we  should  probably  attribute  the  induction  of 
respiration  to  the  reflex  influence  of  the  venous  blood  upon  the 
central  nervous  system.  In  order  to  arouse  this  reflex,  it  may  be 
of   advantage  to  place  the  animal  with  its  head   in  a  declining 


558  Veterinary  Obstetrics 

position  or  to   pick   the  fetus  up  by  the  hind    feet    for    a    few 
moments. 

Artificial  respiration  may  also  be  induced  by  the  usual  com- 
pression and  relaxation  of  the  chest  walls,  or  by  inffating 
the  lungs  by  forcing  air  through  the  nostrils  with  a  small  bel- 
lows, should  such  an  apparatus  be  at  hand.  So  long  as  the 
heart  continues  to  beat,  there  is  a  possibility  of  inducing  respira- 
tion, and  efforts  should  consequently  be  continued,  so  long  as  the 
cardiac  action  persists.  As  a  general  rule,  respiration  cannot  be 
established  at  all  unless  it  succeeds  very  promptly,  so  that  in 
those  cases  where  the  animal  does  not  breathe  within  two  or 
three  minutes  it  will  probably  die  in  spite  of  the  fact  that  the 
heart  may  continue  to  act  for  lo  or  15  minutes. 

2.  The  umbilic  cord  must  be  divided  and  the  la.st  direct  rela- 
tion between  the  mother  and  young  severed.  This  division  re- 
sults in  a  wound  which  involves  the  arteries,  veins  and  urachus, 
each  of  which  communicates  with  internal  parts  of  the  system  of 
the  young  animal.  Different  writers  assume  different  attitudes 
toward  the  care  of  the  navel  of  the  new-born.  Naturally,  the 
umbilic  cord  becomes  ruptured  in  a  variety  of  ways.  In  the 
foal  the  cord  is  so  long  (3  feet)  that  it  is  usually  not  ruptured 
when  the  fetus  is  expelled,  if  the  mare  is  recumbent,  but  gives 
way  only  when  she  rises  to  her  feet,  and  even  then  in  some  cases 
not  until  she  turns  her  head  toward  the  fetus  in  order  to  care  for 
it,  and  in  so  doing  pulls  the  cord  in  two  near  the  umbilicus.  In 
other  cases,  in  the  mare,  the  chorion  becomes  detached  from  the 
uterus  almost  immediately  after  the  expulsion  of  the  fetus  and 
comes  away  with  the  cord  still  intact.  It  is  then  ruptured  later 
by  the  struggles  of  the  fetus  itself.  The  mare  may  step  upon 
some  portion  of  the  membranes  when  the  foal  is  attempting  to 
get  up,  and  the  foal,  in  falling,  throws  its  weight  upon  the  cord 
in  such  a  way  as  to  rupture  it. 

In  the  cow  the  umbilic  cord  is  very  short  (about  12  to  15 
inches)  and  is  almost  always  ruptured  just  as  the  fetus  emerges 
from  the  birth  canal,  or  even  slightly  before.  In  carnivora  and 
the  .sow  the  umbilic  cord  is  frequently  not  ruptured  in  a  spon- 
taneous way,  but  is  torn  in  two  by  the  teeth  of  the  mother. 

The  point  at  which  the  navel  cord  naturally  ruptures  or  is 
divided  by  the  mother  corresponds  quite  closely  in  all  our  do- 
mestic animals.     In  examining  the  navel  cord  of  the  foal,  we 


Care  of  the  Neiv-Born  Animal 


i59 


find  that  immediately  against  the  umbilicus  there  is  a  dense  area 
extending  for  a  distance  of  about  i  V2  inches,  which  ends  some- 
what abruptly  by  a  marked  ring  in  the  soft  umbilic  cord.  This 
projection,  A,  Fig.  90  B,  consists  of  a  hairless  skin,  which,  in  the 
healing  of  the  navel,  atrophies  and  disappears.  In  the  calf,  the 
corresponding  cutaneous  navel  is  haired  and  persists  for  some 
months  as  a  conical  projection  of  skin,  thickly  covered  with  long 
hairs.  Just  beyond  this  point,  one  or  two  inches  from  it  in  the 
foal,  is  the  weakest  point  in  the  cord,  and  it  is  at  this  point  that 
it  ruptures  or  is  torn  in  two. 


Fig.  90  B.     Umbilic  Cord  of  Foal. 
A.  Cutaneous  portion  of  cord.     B,  Amniotic  portion  of  cord. 

After  it  ruptures,  the  behavior  of  the  parts  when  left  undis- 
turbed is  interesting  and  highly  suggestive  of  the  degree  and 
character  of  interference  demanded  upon  the  part  of  the  attend- 
ant. One  of  the  most  prominent  effects  of  the  rupture  of  the 
cord  by  linear  tension  or  by  laceration  by  the  teeth  of  the  mother, 
is  the  promptness  with  which  hemostasis  is  brought  about,  so 
that  as  a  rule  there  is  but  little  hemorrhage,  appearing  usually 
to  not  exceed  the  amount  of  blood  h'ing  in  the  umbilic  veins 
outside  the  umbilic  ring. 


560  Veterinary  Obstetrics 

The  two  fetal  ends  of  the  umbilic  arteries  retract  very 
promptly  toward  and  into  the  abdominal  cavity,  and  in  doing  so 
their  cavities  become  decreased  by  the  shortening  and  consequent 
thickening  of  their  walls,  which  tend  to  close  them  completely 
and  prevent  hemorrhage.  Additional  security  against  bleeding 
arises  from  the  fact  that,  in  retracting,  they  must  draw  back  with 
them  the  loose  areolar  tissue,  which  produces  an  impermeable 
net- work  of  fibers  just  beyond  their  broken  ends.  The  result  is 
well  delineated  at  UA  in  Fig.  56,  page  337.  The  ruptured  um- 
bilic veins,  after  some  of  their  contained  blood  has  escaped,  col- 
lapse and  remain  almost  empty  in  the  region  of  the  umbilicus, 
although  still  partially  filled  with  blood  in  their  course  through 
the  abdominal  cavity  to  the  liver. 

The  urachus  is  so  intimately  as.sociated  with,  and  attached  to, 
the  two  umbilic  arteries  that  it  recedes  into  the  abdominal  cavity 
to  some  extent,  along  with  the  latter.  The  Whartonian  gelatine 
surrounding  the  vessels  in  the  cord  loses  almost  its  entire  sub- 
stance by  its  liquid  portions  slowly  oozing  out  from  the  broken 
surface  of  the  cord,  a  process  which  is  usually  favored  and  accel- 
erated by  the  licking  of  the  stump  of  the  cord  by  the  mother, 
which  presses  the  fluid  out  by  a  sort  of  massage. 

Occa.sionally  w^e  meet  with  variations  as  to  the  promptness  and 
exact  position  of  the  rupture  of  the  umbilic  cord.  Ca.ses  have 
been  recorded  where  it  has  given  way  immediately  against  the 
umbilicus,  although  these  accidents  are  very  rare  and  apparently 
accompanied  by  little,  if  any,  danger.  A  more  common  devia- 
tion from  the  normal  rupture  of  the  cord  is  its  giving  way  at  a 
point  too  remote  from  the  abdomen,  so  that  in  some  cases  we  find 
the  navel  stump  of  the  foal  or  calf  5  or  6  inches  in  length.  This 
leads  to  two  dangers.  The  extra  length  of  the  cord  prevents  the 
rapid  escape  of  the  Whartonian  gelatine  and  also  prevents  the 
retraction  of  the  umbilic  arteries  from  the  exterior ;  infection 
and  putrefaction  occur  in  the  cord,  which  may  lead  to  an  in- 
flammation of  the  veins,  arteries  or  urachus,  and  thereby  greatly 
imperil  the  life  of  the  fetus.  In  other  cases,  when  the  cord  is 
too  long,  it  may  be  trampled  upon  or  become  otherwise  caught, 
and  the  fetus,  in  struggling,  may  tear  it  away  too  clo.se  to  the 
umbilicus  and  make  a  fresh  wound,  inviting  infection. 

Two  apparently  conflicting  courses  are  advised  by  different 
veterinary  obstetrists  in  reference  to  interference  with  the  um- 
bilic cord  ;  without  and  with  ligation. 


Care  of  the  Netif-Boni  Animal  561 

We  very  greatly  prefer  either  to  allow  the  cord  to  be  ruptured 
naturally  and  go  wholly  without  mechanical  interference,  or,  in 
case  of  valuable  animals  where  interference  will  not  harmfully 
annoy  the  mother  and  young,  to  imitate  and  supplement  nature 
with  antisepsis  and  artificial  dessication.  If  the  cord  has  not 
ruptured  spontaneously,  or  if  the  stump  is  too  long,  it  is  to  be 
ruptured  at  the  proper  point  by  linear  tension.  The  cord  is 
grasped  at  the  point  where  we  desire  it  to  be  severed,  with  the 
thumb  and  index  finger  of  each  hand  and,  by  drawing  the  hands 
apart,  it  is  torn  asunder  between  them.  If  the  cord  is  too  strong, 
we  may  facilitate  the  rupture  with  the  thumb  nail,  or  by  scraping 
the  cord  in  two  with  a  dull  scalpel. 

After  the  cord  has  been  divided,  the  Whartonian  gelatine  and 
all  fluids  should  be  pressed  out  of  the  remaining  stump  as  com- 
letelj-  as  possible,  by  grasping  it  close  against  the  umbilicus,  be- 
tween the  thumb  and  finger,  and  then  drawing  downward,  forc- 
ing the  fluids  out  from  the  broken  end.  This  operation  is  to  be 
carried  out  under  strict  antiseptic  precautions,  and  as  soon  as 
completed  there  should  be  applied  a  dessicating  antiseptic  powder 
which  may  consist  of  almost  any  reliable  antiseptic  of  a  character 
which  will  not  prove  caustic  to  the  surrounding  parts.  We  would 
suggest,  as  such  an  antiseptic,  a  powder  composed  of  equal  parts 
of  alum,  tannin  and  oxide  of  zinc,  or  of  equal  parts  of  tannin  and 
iodoform. 

A  variety  of  antiseptics  may  be  selected,  according  to  the 
custom  and  habit  of  the  practitioner.  The  essential  point  is 
thorough  antisepsis  and  prompt  dessication  of  the  stump.  When 
the  navel  heals  under  natural  conditions,  it  dessicates  and  dries 
as  a  hard,  black  eschar  in  24  to  48  hours  after  birth,  which  brings 
about  a  hermetic  sealing  of  the  wound  and  the  vessels  of  the  cord, 
and  renders  infection  thereafter  impossible.  We  simply  aim  to 
second  the  efforts  of  nature  to  bring  about  a.septic  or  antiseptic 
dessication  of  the  stump.  We  advise  the  application  of  the  dessi- 
cant  antiseptic  powder  as  soon  as  pos.sible  after  birth,  to  be  re- 
peated every  hour  or  two  until  the  dessication  of  the  stump  has 
become  complete. 

Many  veterinary  obstetrists  advise  that  the  cord  be  ligated  and 
then  divided  beyond  the  ligature  ;  others  advise  that  two  liga- 
tures be  applied  and  the  division  be  made  between  the  two. 
Some  suggest  that  the  ligated  fetal  stump  should  be  frequently 
36 


562  Veterinary  Obstetrics 

washed  with  a  liquid  antiseptic  and  thus  guarded  against  serious 
nfection.  It  is  evident  that,  if  these  antiseptic  solutions  are 
applied  with  sufficient  frequency  and  thoroughness,  thej-  must 
accomplish  their  purpose  of  preventing  putrefaction  of  the  cord, 
with  its  accompanying  dangers. 

This  is  neither  so  efficacious  nor  so  convenient  as  the  preced- 
ing plan.  The  presence  of  the  ligature  tends  to  prevent  the  re- 
traction of  the  stumps  of  the  umbilic  arteries,  and  keeps  them  in 
a  position  where  they  are  far  more  exposed  to  the  po.ssibilities 
of  infection.  There  is  probably  also  an  increased  liability  to 
hemorrhage,  as  viewed  from  the  standpoint  of  clinical  experi- 
ence. We  have  known  but  one  fatality'  from  umbilic  hemor- 
rhage in  the  foal,  and  this  was  caused  by,  or  at  least  occurred 
with,  ligation  and  excision  of  the  cord.  We  all  recognize 
clearly  the-  far  greater  tendency  toward  hemorrhage  from  an 
artery  when  it  has  been  divided  by  cutting  instead  of  by  linear 
tension,  scraping,  or  other  kind  of  mutilation.  If,  in  addition 
to  this,  the  artery  is  not  allowed  to  retract  or  its  proper  retraction 
is  interfered  with,  the  tendency  to  bleeding  is  greatl}^  increased. 

Ligation  of  the  umbilic  cord  by  an  ignorant  layman  or  careless 
veterinarian  is  one  of  the  most  dangerous  interferences  with  a 
wound  known  to  surgery.  Frequently  the  work  is  done  with 
dirty  hands,  and  a  common  cord  is  used  without  sterilization. 
Often  the  cord  used  is  repulsively  dirty.  The  Whartonian 
gelatin  is  imprisoned  on  the  one  hand  by  the  ligature,  on  the 
other  by  the  almost  impervious  amniotic  sheath  of  the  cord. 
The  imprisoned  fluid  furnishes  an  excellent  culture  medium  for 
decomposition  bacteria  ;  the  dirty  hands  of  the  operator,  the 
dirty  ligature,  or  flies  attracted  by  the  moist  cord,  furnish  the 
infection  and  cause  putrid  decomposition  of  the  cord,  which 
should  dessicate  instead. 

The  ligature  detains  the  arteries,  veins  and  urachus  in  the 
infected  area,  and  eventually  a  more  or  less  extensive  infection 
occurs  and  there  results  a  series  of  highly  fatal  maladies  which 
we  shall  consider  under  "  Infections  of  the  New-Born." 

3.  The  urethra,  anus  and  other  external  openings  should  be 
observed  to  see  that  they  are  normal.  In  case  of  abnormality 
it  should  be  determined  whether  or  not  they  require  attention. 

4.  It  should  be  determined  that  the  various  excretions  of  the 
body  are  taking  place  normally.      It   must   be   learned   that   tlie 


Care  of  the  New-Born  Animal  563 

intestinal  contents  are  being  normally  expelled.  We  are  chiefly 
concerned  with  the  discharge  of  the  accumulated  excretion  in 
the  intestines,  known  as  meconium.  Normally,  this  should  be 
expelled  very  shortly  after  birth,  which  in  some  cases  does  not 
occur,  especially  in  the  foal,  and  as  a  result  there  soon  appear 
symptoms  of  rentention  of  the  meconium,  which  we  shall  consider 
later,  among  the  diseases  of  the  new-born.  It  is  highly  important 
that  the  care-taker  should  see  that  the  meconium  is  promptly 
expelled,  and  if  necessary  its  expulsion  should  be  favored  by 
means  of  enemas  of  warm  water,  warm  normal  salt  solution,  or 
soda  bicarborate  solution.  The  enemas  should  be  continued 
until  all  hard  pellets  of  meconium  have  come  away  and  there 
follows  instead  a  soft,  pasty  meconic  mass. 

5.  The  young  animal  should  be  promptly  supplied  with  nour- 
ishment. In  the  larger  domestic  animals,  the  need  for  early 
nourishment  is  important,  and  it  is  best  that  the  young  animal 
should  receive  a  liberal  supply  of  milk  within  an  hour  or  two 
after  its  birth,  since  otherwise  it  suffers  more  or  less  from  hunger. 
It  is  essential  that  the  young  animal  is  enabled  to  reach  the  teat 
and  suck,  or  that  milk  be  administered  to  it  artificially.  In 
herbivorous  animals  the  mother  always  stands  for  the  young  to 
suck,  and  consequently  it  is  necessary  that  the  latter  be  able  to 
stand  or  be  assisted  in  standing,  in  order  that  it  may  reach  the 
teat  and  procure  nourishment.  If  for  any  reason  the  young 
animal  cannot  stand,  milk  should  be  drawn  from  the  udder  of 
the  mother  and  given  to  it  in  sufficient  quantity  and  at  proper 
intervals. 

The  young  animal  should  not  be  allowed  too  much  milk,  how- 
ever, since  it  will  frequently  overfeed.  This  is  especially  true 
of  the  foal,  which  sometimes  shows  an  inordinate  appetite  and 
seems  to  consider  it  incumbent  upon  it  to  take  all  the  milk  which 
the  udder  of  the  mother  contains,  and  thereby  serioush'  overfeeds, 
which  may  end  in  more  or  less  severe  indigestion.  It  is  conse- 
quently advisable,  in  many  instances,  to  withdraw  a  portion  of 
the  milk  for  the  first  few  days  in  order  to  prevent  the  overfeed- 
ing of  the  young  foal,  a  danger  which  does  not  seem  to  exist  to 
the  same  degree  in  other  young  animals. 

Some  writers  insist  that  it  is  highly  essential  for  the  young 
animal  to  receive  from  the  mother  the  first  milk,  or  colostrum, 
because,  they  say,  this  acts  as  a  laxative  and   brings  away   the 


564  Veterinary  Obstetrics 

meconium  which  has  become  accumulated  in  the  intestinal  tract. 
Clinically  this  theorj^  is  apparenth-  not  so  important  as  some  per- 
sons would  have  us  believe.  The  udder  of  the  mare  frequently 
becomes  so  distended  that  the  milk  flows  out  in  large  quantities 
for  hours,  days  or  even  weeks  before  the  birth  of  the  foal.  Yet 
this  does  not  seem  to  have  any  very  definite  relation  to  the  reten- 
tion of  the  meconium,  although  we  would  assume  that  the  colos- 
trum has  wholly  disappeared  before  the  birth  of  the  foal.  As 
the  foal  is  born  with  the  rectum  impacted  with  hard  masses  of 
meconium,  the  condition  is  not  acquired  after  birth  through  the 
absence  of  the  colostrum,  and  we  are  unable  to  see  clinically  that 
the  retention  is  any  more  probable  or  serious  in  the  foal  of  a 
mare  from  which  the  colostrum  has  escaped  than  in  those  in- 
stances where  the  reverse  is  true. 

•^  -^  -j(.  -^  %  •)(. 

The  artificial  feeding  of  the  new-born  has  until  recently 
been  considered  a  difficult  and  uncertain  task.  The  chief  diffi- 
culty has  been  in  reference  to  the  question  of  intestinal  infection 
because  of  contaminated  food.  The  comparative  composition  of 
the  milk  from  various  species  of  animals  has  been  well  studied  and 
understood,  and  attempts  have  been  made  in  artificial  feeding  to 
modify  the  milk  by  the  addition  of  sugar,  water  or  other  normal 
constituents  in  amounts  which  would  cause  it  to  approach  ap- 
proximately the  composition  of  that  of  the  species  to  which 
the  young  animal  belongs.  Thus,  in  case  of  the  artificial  feed- 
ing of  a  foal  upon  cow's  milk,  the  milk  is  diluted  with  10  to  20  % 
of  water,  and  sugar  is  added,  in  order  to  have  it  approach  the 
composition  of  the  milk  of  the  mare.  This  is  attempted  under 
the  assumption  that  the  young  of  a  given  species  thrives  best 
upon  the  milk  derived  from  that  species,  and  next  best  upon  a 
milk  which  has  been  artificially  modified  to  closely  resemble  that 
of  the  mother  of  the  new-born  animal.  This  artificial  change  in 
the  composition  of  milk  has  not  produced  the  satisfactory  results 
which,  for  a  time,  were  expected  and,  although  important,  is 
not  of  the  same  value  as  the  control  of  the  bacterial  contents  of 
the  milk. 

At  present  we  place  the  chief  emphasis  in  artificial  feeding 
upon  the  question  of  having  the  milk,  as  far  as  possible,  free  from 
the  presence  of  pathogenic  bacteria.  Hence  it  is  aimed  to  keep 
the  milk,  and  the  vessels  from  which  it  is  fed,  scrupuously  clean, 


Car-e  of  the  New-Bor7i  Ayiimal  565 

and  to  take  every  measure  known  to  prevent  its  contamination 
with  dangerous  bacteria.  Some  advise  the  sterilization  of  the 
milk,  while  others  are  opposed  to  it.  If  the  milk  is  clean  and 
free  from  injurious  bacteria,  it  is  better  for  the  3'oung  that  it  be 
given  in  the  raw  state  ;  but,  if  it  is  contaminated  or  if  it  comes 
from  an  animal  which  is  suffering  from  an  infectious  disease,  like 
tuberculosis,  it  is  essential  that  the  milk  be  sterilized  before  be- 
ing fed  to  the  young,  if  we  are  to  prevent  disease. 

The  amount  of  food  to  be  given  at  a  meal  and  the  frequency  of 
the  feeding  will  depend  largely  upon  the  size,  species  and  indi- 
vidual. The  new-born  young  need  to  feed  at  frequent  intervals 
and  in  small  quantities ;  but,  as  they  increase  in  age  and  the  ali- 
mentary tract  becomes  more  and  more  developed,  the  amount  of 
food  ma}'  be  increased,  while  the  frequency  of  feeding  may  be 
constanth'  decreased  until  it  is  reduced  to  two  or  three  times  per 
day. 

During  the  puerperal  state  there  occur  well-marked  modifi- 
cations in  the  function  of  lactation,  varying  in  the  different 
species  of  animals  and  in  individuals  of  the  same  species.  The 
cow  maj^  milk  continuously.  If  the  cow  is  milked  through  the 
entire  period  of  gestation  and  is  not  dried  up  prior  to  parturi- 
tion, there  is  little  if  any  change  noted  in  the  milk  except  that 
it  is  increased  somewhat  in  amount  just  before  calving.  In  all 
domestic  animals  there  is  a  tendency  for  lactation  to  be  well 
established  when  the  young  is  born,  especially  in  the  larger 
herbivora,  where  the  young  are  very  active  immediately  after 
"birth.  These  must,  in  the  wild  state,  at  once  possess  strength 
and  endurance  to  escape  from  predatory  animals,  and  this 
necessitates  the  securing  of  abundant  nutrition  in  the  form  of 
milk.  Consequently,  in  the  cow,  mare  and  ewe,  the  milk  secre- 
tion has  become  well  established  before  the  birth  of  the  young, 
and  the  amount  is  frequently  so  great  that  it  escapes  from  the 
udder  in  streams  for  days  or  weeks  before  parturition. 

From  the  3d  to  the  5th  or  6th  day  after  parturition,  the  colos- 
trum disappears  and  ordinary  milk  is  present,  so  that  in  dairy 
animals  the  milk  is  generally  considered  to  be  normal  in  from  3 
to  5  daj's  after  parturition  and  is  sold  as  human  food.  The  milk 
has  a  density  of  1032  to  1041  and  is  composed  essentially  of  water, 
fat,  casein,  albumen,  milk-sugar  and  salts.  The  principal  con- 
stituents of  milk  are  somewhat  easily  separated  by  various  means. 


566 


Veterinary  Obstetrics 


The  composition  of  milk  varies  widely  according  to  species  and 
individuality,  the  methods  of  feeding,  the  period  of  lactation, 
and  numerous  other  conditions.  The  following  table  by  Vernois 
and  Becquerel  gives  a  comparative  idea  of  the  composition  of  the 
milk  of  various  animals,  the  figures  representing  the  amounts  of 
each  constituent  in  looo  parts  of  milk  : 


Specific  Gravity 1032.67 

Weight  of  Water 889.08 


Woman     Cow       Goat 


Weight  of  Solid  Parts 

Fat 

Casein  and  Extractive  Matters 
Milk-sugar 

Salts  (by  incineration) 


110.92 
26.66 
39-24 

43-64 
1.38 


1033-38 

S64.06 

135-94 

36.12 

55-15 

3''^-03 

6.64 


[033-53 
844.90 
155-10 
56.87 
55-14 
36.91 
6.18 


Sheep    Camel 


1040.98, 
832.32 
167.68 

51.31 
69.78 

39-43 
7.16 


134-00 
36.00 
40.00 
58.00 


Mare 


Ass 


Specific  Gravity 1033.74 

Weight  of  Water 904.30 

Weight  of  Solid  Parts 95,70 

Fat 24.36 

Casein  and  Extractive  Matters  33-35 

Milk-sugar 32.76 

Salts  (by  incineration) 5.23 


Sow    1  Bitch 


1034-57 

890. 1 2 

109.88 

18.53 

35-65 

,  50.46 

5-24, 


1041.62 


854.90 

772.0S 

145-10 

227.92 

19-50 

87.95 

84.50 

116.88 

30.30 

15-29 

10.90 

7.80 

Cows  which  give  a  large  volume  of  milk  may  do  so  at  the  ex- 
pen.se  of  the  solid  constituents,  and  especially  of  the  butter  fat. 
Thus  one  cow,  which  yields  a  very  large  amount  of  milk,  may 
show  only  2  or  3  %  of  butter  fat,  while  another,  which  yields  a 
much  less  amount  of  milk,  may  show  6  to  7  %  of  butter  fat. 

Generally  speaking,  the  milk  of  the  smaller  domestic  animals 
is  richer  in  ca.sein  and  fat  than  that  of  the  larger  species.  The 
milk  of  the  mare,  compared  with  the  milk  of  other  animals,  is 
very  rich  in  sugar. 

The  milk  of  carnivora  is  exceedingly  rich  in  casein  and  fat,  so 
that,  while  it  is  not  abtindant,  it  nevertheless  has  a  very  high 
nutritive  value,  as  is  well  shown  by  the  exceedingly  rapid  growth 
of  their  new-born  young.  On  the  other  hand,  the  milk  of 
carnivora  is  said  to  contain  almost  no  sugar,  which  is  in  marked 
contrast  to  that  of  other  animals. 


Care  of  the  Nezv-Born  Ajihnal  567 

Milk  contains  all  the  elements  necessary  for  nutrition,  consti- 
tutes the  natural  food  for  new-born  animals  and  induces  in  them, 
when  supplied  in  due  quantity  and  of  proper  quality,  very  rapid 
growth. 

6.  The  young  animal  should  be  placed  and  kept  under  com- 
fortable and  favorable  conditions,  free  from  extremes  of  tem- 
perature. Although  it  may  withstand  quite  high  and  low 
temperatures  without  .serious  injury,  if  the  temperature  be 
extremely  low  the  extremities  of  the  new-born,  especially  the 
ears  and  tail,  very  readily  freeze,  or  its  life  may  be  quickl}'  im- 
periled under  such  extreme  conditions.  In  very  hot  weather  flies 
may  be  exceedingly  troublesome  and  annoying  to  the  young,  or 
even  very  dangerous.  For  example,  they  may  carry  putrid 
infection  to  the  navel  of  the  young  animal  and  cause  thereby 
serious  and  fatal  disease,  so  that  we  should,  as  far  as  possible, 
protect  it  against  these  dangers. 

7.  Exercise  is  as  essential  to  the  new-born  animal  as  to  the 
adult,  and  possibly  even  more  so.  With  some  species,  like  the 
carnivora  and  rabbit,  the  young  are  born  in  .so  immature  a  state 
that  no  marked  degree  of  exercise  is  possible,  but  with  the 
larger  herbivora  the  young  animal  is  ready  for  a  considerable 
degree  of  exercise  within  a  few  hours  after  birth,  and  this  should 
be  promptly  provided  in  all  cases.  When  the  mare  is  allowed 
the  run  of  a  pasture,  exercise  is  fully  secured  to  the  foal.  In 
case  of  other  animals  a  similar  freedom  accomplishes  the  neces- 
sary ends  in  the  safest  and  best  manner.  Otherwise,  some  provis- 
ions should  be  made  for  the  daily  exercise  of  the  young  animal 
as  soon  as  it  is  capable  of  taking  it.  With  work  animals  it  is 
not  injurious,  but  rather  beneficial,  for  the  foal  to  follow  the 
mother  if  engaged  in  .slow,  light  work. 


DYSTOKIA. 

In  the  preceding  pages  we  have  dealt  with  birth  as  it  occurs 
normally.  While  it  is  accompanied  by  pain  and  violent  efforts 
on  the  part  of  the  mother,  the  act  is  natural  and  comparatively 
safe  for  both  the  mother  and  the  young.  There  is  constant 
danger  that  birth  may  become  difficult  or  impossible,  without 
artificial  aid,  and  when  these  difficulties  arise  we  know  the  con- 
dition as  dystokia  or  difficult  labor. 

Normally  the  obstacles  to  be  overcome  in  expelling  the  fetus  are 
exceeded  by  the  expelling  powers  of  the  female.  The  obstacles 
to  normal  birth  consist  chiefly  in  the  narrowness  and  undilated  con- 
dition of  the  birth  canal  as  related  to  the  size,  form  and  presenta- 
tion or  position  of  the  fetus.  When  any  one  of  these  impediments 
becomes  exaggerated  in  any  way,  the  obstacles  to  birth  become 
accentuated.  Constriction  of  the  cervix  uteri,  displacement  of 
the  uterus  by  revolving  upon  its  long  axis,  narrowness  of  the 
vulvo-vaginal  pa.ssage  or  other  impediments  may  be  met,  which 
render  parturition  difficult  or  impossible  except  by  surgical  aid. 
If  the  fetus  should  be  of  abnormal  size  as  related  to  the  dimen- 
sions of  the  birth  canal,  if  it  should  be  deformed  or  distorted 
from  disease  or  aberration  in  development,  if  its  presentation  or 
position  .should  be  unnatural,  or  there  should  be  present  some 
deviation  of  an  extremity  or  other  part  of  the  body  from  a 
natural  attitude,  the  impediment  to  birth  may  be  so  great  as  to 
render  artificial  aid  essential. 

Accordingly  dystokia  may  be  divided  into  two  fundamental 
classes. 

1.  Maternal  dystokia  dependent  upon  some  defect,  disease 
or  displacement  of  the  maternal  organs. 

2.  Fetal  dystokia  due  to  some  disea.se  of,  or  to  abnormality  in 
the  size,  form,  presentation  or  position  of  the  fetus. 

The  occurrence  of  dystokia  in  our  domestic  animals  depends 
very  largely  upon  species,  being  comparatively  common  in  some 
and  comparatively  rare  in  others.  The  cow  readily  takes  the 
first  place  in  the  frequency  of  dystokia,  both  of  the  maternal  and 
fetal  types.  Dystokia  in  the  mare  is  not  uncommon  and  takes 
first  place  in  gravity.  The  bitch,  sow  and  ewe  also  suffer  fre- 
quently from  dystokia. 
568 


Dystokia  569 

It  is  diflficult  to  state  whether  the  comparative  frequency  of 
dystokia  is  dependent  directly  upon  species  or  if  it  is  due  to  the 
prevailing  environments  or  care  of  the  species  of  animal  under 
consideration.  The  comparative  frequency  of  dystokia  in  the 
cow  and  mare  varies  greatly  in  different  regions  of  the  country, 
according  to  the  character  of  the  breeding  industry.  Veteri- 
nary obstetrists,  as  a  whole,  agree  that  the  cow  is  far  more  sub- 
ject to  dystokia  than  the  mare.  For  example,  Fleming  cites 
two  Danish  veterinarians,  who  have  had  r6  to  19  cases  of  dys- 
tokia in  the  cow  to  one  in  the  mare,  even  though  there  were 
more  horses  than  cows  reared  in  their  districts.  Our  own  ex- 
perience does  not  verify  this  view,  and  is  probably  due  to  the 
difference  in  the  character  of  our  practice  as  compared  with  that 
of  most  writers  upon  veterinary  obstetrics. 

We  constantly  met  in  our  private  practice  with  more  cases  of 
dystokia  in  the  mare  than  in  the  cow,  although  in  our  judgment 
there  were  annually  more  cows  than  mares  giving  birth  to  j'oung 
in  our  territory.  It  should  be  explained,  however,  that  the  calves 
which  were  bred  in  our  territory  were  raised  for  beef  purposes 
and  that  the  pregnant  cows  were  habitually  out  of  doors  through- 
out the  entire  year,  were  well-fed  and  strong,  were  not  bred  until 
they  had  attained  sufficient  size  that  they  would  not  be  likely  to 
suffer  from  dj-stokia  because  of  immaturity,  and  were  usually 
sent  to  the  butcher  before  they  had  attained  extreme  old  age.  In 
these  animals  dystokia  was  exceedingly  rare,  and  it  was  only  in 
exceptional  cases  that  there  was  any  great  difficulty  in  parturition. 

One  other  element  probably  served  largely  to  make  an  apparent 
difference  in  the  frequency  of  dystokia  in  the  two  animals  in  our 
practice.  Owners  very  generally  did  not  hesitate  to  attempt 
assistance  to  the  cow  and  very  frequently  succeeded  fairly  well, 
so  that  our  attention  was  not  called  to  the  cases.  In  mares, 
which,  in  our  territory,  were  of  high  value,  the  owners  usually 
desisted  from  any  attempts  at  bringing  about  delivery  themselves 
and  we  were  more  or  less  promptly  called.  These  considerations 
may  have  served  to  make  the  difference  in  our  experience  as 
compared  with  that  of  other  obstetrists. 

It  is  constantly  to  be  noted  that  dystokia  runs  parallel  in  fre- 
quency to  the  confinement  of  the  animal.  Consequently  we  find 
that  those  females  which  are  most  closely  housed  and  least  exer- 
cised are  the  ones  which  suffer  most   frequently  and   seriously 


57©  Veterbiary  Obstetrics 

from  dystokia.  Hence  among  all  domestic  animals  the  dairy  cow, 
which  is  frequently  kept  closely  confined  in  a  stanchion  year  in 
and  year  out,  easily  takes  the  first  place  of  importance  in  refer- 
ence to  difficult  labor.  Cows  of  the  same  or  similar  breeds,  when 
not  so  closely  confined  nor  so  intensely  used  for  dairy  purposes,  are 
not  so  subject  to  these  accidents,  while  in  beef  cows,  which  are 
habitually  permitted  to  run  at  large  throughout  the  year,  dys- 
tokia is  apparently  almost,  if  not  quite  as  rare  as  in  any  domestic 
animal. 

The  frequency  of  dystokia  as  related  to  environment  is  greatly 
emphasized  by  observations  upon  the  bitch  and  cat.  In  agri- 
cultural communities,  where  these  animals  are  habitually  out  of 
doors  daily  and  lead  an  active  life,  dystokia  is  almost  unknown  ; 
whereas,  in  pet  females  which  are  kept  closely  confined  in  the 
city  houses,  dystokia  is  frequent.  In  Illinois,  though  we  were 
in  an  extensive  swine  breeding  district,  dystokia  in  the  sow 
was  almost  unknown  to  us.  In  New  York  State,  where  swine 
breeding  is  very  limited,  but  the  sows  are  kept  closely  confined 
in  styes,  dystokia  is  comparatively  common. 

We  are  not  prepared  to  state  exactly  the  reasons  for  these 
differences  in  the  frequency  of  dystokia  as  modified  by  environ- 
ment. Fundamentally,  it  seems  that  the  proper  development  of 
the  young  is  largely  dependent  upon  the  freedom  of  the  mother 
during  gestation,  as  is  shown  by  the  fact  that  aberration  in  de- 
velopment, such  as  double  monsters,  and  other  teratologic  con- 
ditions, are  most  frequently  observed  in  those  animals  which  are 
closely  confined.  The  general  system,  as  well  as  the  generative 
organs  of  the  pregnant  female,  does  not  preserve  its  normal  vigor 
whenever  the  animal  is  closely  confined  by  housing,  and  so  when 
parturition  arrives  the  mother  does  not  possess  the  needed  vigor 
for  the  expulsion  of  the  young. 

The  influence  of  the  number  of  young  at  a  given  birth  upon 
the  occurrence  of  dystokia  does  not  seem  to  be  of  very  great  im- 
portance. In  the  cow,  ewe  and  goat,  twins  may  simultaneously 
approach  the  pelvic  inlet  and,  by  one  or  more  of  the  extremities 
of  each  entering  the  pelvis,  may  bring  about  dystokia,  but  this 
is  not  very  common.  In  multiparous  animals,  the  simultaneous 
entrance  of  two  fetu.ses  into  the  pelvis  does  not  readily  occur,  and 
dystokia  is  dependent  upon  the  individual  fetus,  so  that  the 
possibility  of  difficult  birth  is  .simply  multiplied  by  the  number 


Dystokia  571 

of  fetuses  in  the  uterus,  any  one  of  which,  except  the  first, 
which  is  the  most  dangerous,  is  almost  equally  liable  to  cause 
difficulty  in  birth.  Should  dystokia  occur  from  one  of  the  first 
fetuses  to  be  expelled,  it  inevitably  blocks  the  passage  of  the  fol- 
lowing fetuses,  either  from  both  horns,  if  lodged  in  the  uterine 
body  or  in  the  vagina,  or  from  the  involved  horn  in  case  it  be- 
comes arrested  in  its  passage  before  leaving  the  cornu.  In  spite 
of  this  fact,  however,  dystokia  in  these  small  animals,  as  we  have 
already  stated,  is  very  rare,  with  the  exception  of  those  which 
are  closely  housed. 

The  importance  of  dystokia,  as  related  to  the  possibility  or 
probability  of  delivery,  as  well  as  to  the  recovery  of  the  mother 
and  the  life  of  the  fetus,  varies  greatly  according  to  species. 
Among  our  domestic  animals  dystokia  in  the  mare  easily  takes 
first  place  in  its  seriousness  as  affecting  the  life  and  well-being 
of  the  dam  and  still  more  in  relation  to  the  life  of  the  fetus.  The 
great  seriousness  of  dystokia  in  the  mare  is  largely  dependent 
upon  the  tumultuous  character  of  labor  and  her  susceptibility  to 
infection,  as  well  as  upon  the  differences  in  the  conformation  of 
the  fetus,  which  renders  an  adjustment  more  difficult  and  injuries 
to  the  uterus  or  other  parts  more  liable  to  occur. 

Parturition  is  so  tumultuous  in  the  mare  that  serious  and  fatal 
injuries  may  occur  to  her  in  a  very  short  time,  frequently  long 
before  the  obstetrist  can  arrive,  even  if  called  by  the  owner  with- 
out delay.  This  is  in  sharp  contrast  to  the  cow,  in  which  serious 
injury  from  labor  is  not  liable  to  occur  until  a  number  of  hours 
have  passed. 

The  exceedingly  rapid  birth  in  the  mare  tends  constantly  to 
produce  ruptures  of  the  uterus,  in  which  the  wounds  penetrate 
the  peritoneal  cavity  and,  as  a  general  rule,  end  fatally  for  the 
mother.  In  the  cow  these  penetrant  wounds  of  the  peritoneal 
cavity  rarely  occur  directly  from  the  labor,  and  even  when  they 
do  they  are  not  nearly  so  fatal  as  in  the  mare. 

The  tendency  to  infection  in  the  mare  is  very  much  greater 
than  that  noted  in  the  cow  and  constantly  assumes  a  more  serious 
aspect  for  the  life  of  the  animal. 

The  length  of  the  extremities  of  the  young  foal  tends  con- 
stantly to  increase  the  difficulty  of  labor  in  all  cases  of  vicious 
position,  because  the}-  are  far  more  difficult  of  adjustment,  so 
that  embr^'Otomy  is  more  frequently  required.     Not  only  are  the 


572  Veterinary  Obstetrics 

extremities  longer,  but  they  are  comparatively  more  rigid.  In 
addition  to  all  these,  the  fetus  of  the  mare  is  usually  larger  and 
consequently  not  so  readily  adjusted  as  that  of  the  cow. 

Dystokia  is  not  only  more  serious  for  the  mare  than  the  cow, 
but  it  is  also  far  more  serious  for  the  foal  than  for  the  calf. 
During  an  extensive  experience  with  obstetrics  in  mares,  it  has 
not  been  our  fortune  to  deliver  a  living  foal  where  there  was 
actual  dystokia.  Our  experience  is  in  accord  with  that  of  most 
practitioners,  and  it  is  only  very  rarely  that  the  veterinary  ob- 
stetrist  succeeds  in  delivering  a  live  foal  in  cases  of  dystokia. 
We  have  attended  mares  when  living  foals  were  born,  but  in 
those  instances  we  were  hurriedly  called  by  owners  of  mares 
under  the  impression  that  there  was  something  abnormal,  which, 
upon  our  arrival,  proved  to  be  normal,  and  the  fetus  was  very 
quickly  born  in  a  natural  manner.  On  the  other  hand,  in  the 
cow  the  common  experience  is  that,  if  the  fetus  is  alive  when 
labor  sets  in  and  the  veterinarian  is  called  promptly,  a  living 
calf  is  secured.  This  dissimilaritv  in  the  two  animals  has  its 
basis  largely  in  the  differences  in  the  placentae.  The  foal  quickly 
perishes  because  of  the  detachment  of  the  fetal  from  the  maternal 
placenta,  whereas  the  calf  continues  to  live  because  the  placental 
circulation  is  not  interrupted  for  a  long  period  of  time  after  the 
advent  of  labor  pains. 

From  the  standpoint  of  the  veterinary  obstetrist,  dystokia  in  the 
mare  is  usually  far  more  formidable  than  in  the  cow.  The 
tumultuous  labor  in  the  mare  usually  very  quickly  expels  the 
fetal  fluids  and  leaves  the  passage  dry,  while  it  also  tends  to  con- 
stantly accentuate  any  deviation  of  fetal  parts  and  otherwise  to 
rapidly  increase  the  obtacles  to  delivery.  When  the  veterinarian 
reaches  the  case,  the  violent  expulsive  efforts  of  the  mare  inter- 
fere very  seriously  with  his  operations  and  try  his  patience  and 
endurance  to  the  utmost  degree,  while  the  cow  is  more  deliberate 
and  the  labor  pains  are  much  less  violent. 

The  size  of  the  foal  and  its  very  long  and  rigid  limbs  and  the 
excessively  long  neck  all  conspire  to  render  the  obstetrist's  task 
more  difficult  and  laborious.  The  tumultuous  character  of  labor 
in  the  mare  calls  for  greater  promptness  in  bringing  about  the 
delivery  of  the  fetus,  from  the  standpoint  of  itsown  life  and  that 
of  the  mare.  The  mare  also  is  liable  to  annoy  and  endanger  the 
operator  by  vicious  kicking. 


Dystokia  573 

The  cow,  on  the  other  hand,  shows  one  marked  disadvantage 
in  manipulation,  because  she  is  less  amenable  to  command  in 
reference  to  her  position.  While  the  obstetrist  usually  prefers 
to  carry  out  his  examinations  and  operations  with  the  animal 
in  the  standing  position,  the  cow  is  frequently  very  obstinate 
and  will  persistently  maintain  the  recumbent  position,  whereas 
the  mare  will  habitually  stand  throughout  the  operation  or  will 
promptly  rise,  if  able,  after  she  has  once  gone  down.  It  is 
worthy  of  note  also  that  inability  to  rise  in  the  case  of  the  mare  is 
very  rare,  while  in  the  cow  it  is  not  uncommon. 

The  difficulties  of  dystokia  in  all  animals  bear  an  almost  con- 
stant relation  to  the  promptness  of  veterinary  attendance.  If 
the  case  has  been  neglected  for  a  long  period  of  time,  the  fetal 
fluids  escape  and  permit  the  fetus  to  become  closel)^  invested  by 
the  uterus  and  its  membranes,  so  that  any  changes  in  the  posi- 
tion of  the  young  become  much  more  difficult  than  when  the 
fetal  fluids  are  still  present.  During  the  period  of  delay  any 
vicious  position  of  the  fetus  tends  to  be  constantly  accentuated. 
An  extremity,  which  in  the  beginning  was  only  slightly  deviated 
from  the  normal  and  could  have  been  corrected  in  a  moment, 
may  have  become  very  greatly  displaced,  and  its  adjustment 
rendered  exceedingly  difficult  or  even  impossible,  so  that  it  may 
call  for  embryotomy. 

If  the  veterinarian  is  not  called  promptly,  the  fetus  perishes 
and  rigor  mortis  sets  in,  which  renders  any  adjustment  of  its  posi- 
tion exceedingly  laborious.  After  the  death  of  the  fetus,  it  un- 
dergoes very  rapid  decomposition,  accompanied  by  emphysema, 
which  increases  its  size  by  50  to  100%  or  even  more,  thus  greatly 
increasing  the  difficulties  in  delivery  and  the  dangers  to  both  the 
animal  and  the  operator  from  the  standpoint  of  infection.  In 
the  meantime  the  mother  becomes  more  and  more  exhausted  and 
less  capable  of  enduring  the  ordeal  through  which  she  must  pass. 

A  very  important  element  of  delay  in  veterinary  attendance 
upon  cases  of  dystokia  is  the  meddling  of  inexperienced,  if  not 
ignorant  laymen,  or  still  worse,  of  charlatans,  with  their  crude 
instruments  and  dirty  hands  and  arms,  which  have  perhaps  been 
befouled  in  attending  other  cases  of  a  septic  character.  They 
frequently  carry  out  operations  which  very  greatly  increase  the 
difficulty  for  the  obstetrist  and  enormously  increase  the  risk  to 
the  animal.     Perhaps  they  have  already,  by  some  awkwardness, 


574  Veterinary  Obstetrics 

placed  the  life  of  the  mother  beyond  the  possibility  of  being 
preserved  by  the  veterinarian. 

It  is  consequently  of  great  importance  that  the  veterinarian 
should  use  every  opportunity  to  instruct  his  clients  in  reference 
to  the  great  importance  of  calling  him  early  and  of  leaving  the 
case  entirely  alone  until  his  arrival,  except  in  those  instances 
where  a  little  intelligent  manipulation  may  bring  about  a  prompt 
and  easy  delivery. 

The  subject  of  veterinary  obstetrics  has  not  been  well  studied 
or  taught,  and  the  work  of  many  American  veterinary  obstet- 
rists  has  been  entirely  too  inefficient  to  command  that  con- 
fidence and  respect  of  the  stock-owner  which  it  should.  If  the 
practitioner  desires  to  be  called  early  he  must  first  be  able  to 
impress  upon  his  clients,  by  means  of  efficient  work,  the  eco- 
nomic advantage  of  an  early  call.  In  order  to  do  this,  the  vet- 
erinary obstetrist  needs  prepare  himself  in  an  intelligent  manner, 
by  study,  experience  and  equipment,  to  render  the  highest  pos- 
sible service  in  promptness  and  efficiency. 

Some  writers  upon  obstetrics  would  well-nigh  exclude  many 
veterinarians  from  obstetric  practice  because  of  their  physique. 
But  some  of  the  conditions  which  they  regard  as  essential  to 
success  are  not  really  of  such  great  importance  as  they  would 
have  us  believe.  Any  man  of  nioderate  size,  strength  and  power 
of  endurance  can  succeed  as  an  obstetrist,  if  he  will  but  give  his 
subject  that  amount  of  study  and  research  which  its  importance 
demands.  Some  say  that  long  and  powerful  arms  are  absolutely 
neces.sary,  and  we  will  admit  that  they  possess  certain  advan- 
tages. But  a  ' '  long  head  "  is  worth  more  than  an  extra  one  or 
two  inches  in  length  of  arm. 

As  in  other  surgical  operations,  the  veterinary  obstetrist  re- 
quires, above  all,  intelligence,  education,  experience,  and  de- 
termination. 

He  must  husband  his  strength,  must  possess  the  ability  to 
have  others  carry  out  any  manipulations  or  work  which  they 
can  properly  do  under  his  directions,  and  must  reserve  his  own 
force  and  strength  for  the  proper  direction  of  the  work  of  others 
and  for  those  manipulations  which  he  alone  is  competent  to 
properly  perform.  It  is  not  his  office  to  exert  traction  upon  a 
fetus  when  a   bystander  can  do  it  equally  well.     Such  labor  is 


Dystokia  575 

directly  opposed   to   the  interests  of  the  animal,  the  owner  and 
himself. 

The  veterinarian  is  called  upon  to  carry  out  no  work  in  his 
profession  which  is  more  exacting  than  the  overcoming  of  dys- 
tokia in  our  larger  domestic  animals.  It  calls  for  the  highest 
possible  training  and  the  most  read}'  mental  resources  at  every 
turn.  No  two  cases  are  alike,  and  each  demands  effective  judg- 
ment rather  than  conformity  to  a  fixed  rule  of  procedure.  The 
veterinarian  must  be  ready  to  judiciously  meet  each  obstacle  as 
it  presents  itself,  must  meet  it  promptly,  sometimes  in  a  moment, 
and  yet  throughout  the  entire  procedure,  from  the  beginning  of 
the  examination  to  the  extraction  of  the  fetus,  must  preserve  his 
patience  and  equanimity,  and  in  order  to  do  this  must  conserve 
his  physical  powers  as  far  as  is  possible. 


EQUIPMENT  FOR  OBSTETRIC  WORK. 

In  order  to  succeed  in  obstetric  work,  the  veterinarian  must 
be  judiciously  equipped  for  it,  not  only  from  the  standpoint  of 
quantity  and  quality,  but  also  in  reference  to  the  readiness  of  his 
equipment  for  immediate  use.  The  obstetric  equipment  of  the 
veterinarian  should  be  carefully  selected  and  arranged,  should 
include  every  article  which  is  likely  to  be  needed  during  any 
obstetric  operation,  and  should  be  carefullj'  packed  in  one  or  more 
containers  ready  for  immediate  transportation,  so  that  no  article 
of  importance  will  be  left  behind  or  forgotten. 

The  instruments  of  the  veterinary  obstetrist  should  be  ample 
in  number,  simple  in  character,  and  efficient  for  any  operation 
or  manipulation  which  he  may  possibly  be  called  upon  to  per- 
form. Obstetric  instruments  are  of  the  greatest  possible  design 
and  variety,  and  it  is  not  practicable  for  us  to  enter  into  detail  in 
relation  to  the  multitudinous  varieties  which  have  been  proposed 
by  various  operators  and  writers. 

Obstetrical  instruments  are  intended  to  aid  in,  or  to  accomplish 
three  distinct  offices  :  traction,  repulsion  and  incision  or  exci.sion. 

For  the  production  of  traction,  the  appliances  most  frequently 
used  are  cords,  bands,  halters,  hooks,  forceps  and  nooses. 

Cords  and  bands  are  of  every  possible  description  and  variety 
and  may  be  either  very  simple  or  quite  complex.  Usually  speak- 
ing the  simplest  are  the  best  for  two  important  reasons.  One 
may  accomplish  with  simply  a  looped  cord  any  operation  which 
is  possible  with  the  most  complex.  When  one  operation  with  a 
cord,  band  or  halter  has  been  carried  out,  the  apparatus  is  of 
no  further  value  for  obstetric  uses,  but  becomes  a  danger  in  suc- 
ceeding cases,  which  is  to  be  constantly  avoided  by  the  destruc- 
tion of  the  apparatus  after  a  single  use,  and  this  means  an  im- 
portant expense  in  case  of  complex  appliances. 

We  prefer  the  simple,  cotton  cord.  Fig.  91a,  about  }i  inch  in 
diameter  and  4  feet  in  length,  one  end  to  be  wound  with  strong 
thread  to  prevent  ravelling,  while  at  the  other  a  spliced  loop  is 
formed  of  sufficient  size  to  permit  the  cord  to  play  through  it 
freely.  It  is  not  advantageous  to  have  all  these  of  uniform  size 
because,  in  some  instances  where  the  traction  is  not  to  be 
severe,  a  smaller  cord  than  ^  in.  may  be  more  easily  applied 
and  retain  its  hold  more  securely  upon  a  part.     In  some  cases  it 


Cords,  Bands  and  Halters  577 

is  advantageous  to  use  various  sized  cords  because  the}-  ma}- 
thus  be  more  readily  distinguishable  from  each  other.  When 
severe  traction  is  required,  a  Yt,  in,  rope  may  be  found  necessary. 

The  ropes  should  be  prepared  carefully  and  should  preferabl}' 
be  sterilized  or  disinfected  in  advance  and  carefully  wrapped  in 
impervious  paper  in  such  a  way  that  they  will  not  become  con- 
taminated before  ready  for  use.  They  should  be  made  in  suffi- 
cient numbers,  according  to  the  volume  of  the  practitioner's 
obstetric  work,  and  should  be  ready  when  wanted. 

Other  veterinarians  use  and  advise  bands  of  various  kinds, 
such  as  are  shown  in  Fig.  91,  c,  and  d,  instead  of  cords. 
These  are  more  difficult  to  obtain,  are  expensive,  and  have  no 
advantage  in  efficiency.  They  may  wound  or  abrade  the  genital 
passage  of  the  mother  somewhat  less,  but  the  difference  is  not 
important,  and  the  cotton  cord  which  is  twisted  only  moderately 
hard  meets  the  requirements  quite  fully  in  reference  to  this  dan- 
ger. Some  writers  claim  that  a  cord  with  a  running  noose  may 
injure  the  part  of  the  fetus  to  which  it  has  been  attached,  but 
this  we  have  never  observed.  Others  prefer  a  leather  band,  but, 
while  this  is  efficient  in  many  respects,  it  does  not  keep  its  hold 
upon  a  part  as  well  as  a  cord  and  it  is  highly  expensive  and 
cannot  be  readily  sterilized. 

Halters,  h.  Fig.  91,  are  recommended  by  many  obstetrists, 
where  the  traction  is  to  be  applied  to  the  head,  but  these  are  ex- 
ceedingly difficult  of  adjustment  and  are  but  little,  if  any,  supe- 
rior in  efficiency  to  the  simple  cord  or  to  the  hook.  They  are 
expensive,  and  the  difficulty  of  rendering  them  sterile  constitutes 
a  formidable  objection  to  their  repeated  use.  Numerous  head 
collars  or  halters  are  described  by  various  veterinary  obstetrists, 
such  as  those  of  Binz,  Rueflf,  and  others,  while  for  the  smaller 
animals  Binz  recommends  what  is  termed  a  forceps-band. 

When  the  halter  has  been  applied  to  the  head  of  the  fetus  it 
possesses  an  advantage  over  the  simple  noose- around  the  neck 
because,  if  the  halter  stale  pulls  upon  the  chin  of  the  fetus,  it 
tends  to  keep  the  head  in  a  direct  line,  which  favors  its  passage 
through  the  canal.  Even  with  the  halter  adjusted  in  the  best 
possible  way,  the  simple  cord  can  be  so  applied  that  it  fully 
answers  the  same  purpose.  If  we  take  a  long  cord  and  apply  it 
as  a  noose  about  the  neck  of  the  fetus  with  the  loop  in  the  region 
of  the  larynx,  we  can  then  place  a  half-hitch  around  the  nose  in 
37 


578 


Veterinary  Obstetrics 


such  a  way  that  we  can  draw  directly  upon  the  median  line  of 
the  ventral  surface  of  the  head  with  the  same  accuracy  and 
efficiency  as  with  the  best  adjusted  halter.  The  application  of 
the  cord  in  this  way  is  simpler  and  easier  than  the  halter.  The 
objection   may  be  raised  that  the  running  noose  about  the  neck 


Fig.  91.     Cords  and  Traction  Appliances. 


a,  Ordinary  noose  with  spliced  loop. 

b,  Ring  noose. 

c,  Braided  obstetric  noose. 

d,  Loweg's  obstetric  strap. 

e,  Darreau's  long  noose  carrier. 


f,  Breulet's  obstetric  noose  for  dogs. 

g,  g,  Defay's  ol)stetric  noose  for  dogs, 

closed  and  open  respectively, 
h,  Rueff's  obstetric  halter, 
i,    Obstetric  noose  of  annealed  copper 

wire.  (  Hauptner. ) 


may  strangle  or  otherwise  injure  the  fetus.  This  is  sentimental 
rather  than  scientific,  because  while  traction  is  being  exerted  up- 
on the  head  of  the  fetus  it  is  not  breathing,  and  consequently 
there  is  no  interference  with  respiration,  and  evidently  no  other 
serious  harm  is  probable.  Evidently  traction  should  not  be 
exerted  by  means  of  a  running  noo.se  upon  the  neck  of  a  live  fetus 


Cords,  Bands  and  Halters  579 

after  its  chest  has  emerged  from  the  vulva  and  the  establishment 
of  respiration  has  become  necessary.  Neither  is  traction  by  the 
neck  demanded  at  such  stages,  since  this  may  be  preferably 
applied  to  the  fore-legs. 

Cords  are  applied  to  the  limbs  and  head  by  two  distinct  plans. 
The  running  noose  of  the  cord,  alreadj'  formed,  is  introduced  into 
the  genital  passages  and  slipped  over  the  foot  of  the  fetus  up  to 
the  pastern,  above  the  fetlock,  or  even  higher,  according  to  con- 
ditions. The  distal  end  of  the  cord  is  then  drawn  taut  by  the 
operator  or  an  assistant,  and  thus  made  fast  upon  the  part  in  a 
manner  which  permits  any  degree  of  traction  desired. 

A  second  method  of  applying  the  cord  to  the  limb  is  used  in 
those  cases  where  the  foot  is  not  available  to  slip  the  ready- formed 
noose  over  it,  and  it  must  instead  be  passed  around  the  limb  to  be 
later  made  fast.  For  this  purpose  the  looped  end  of  the  cord 
may  be  carried  in  the  hollow  of  the  hand  to  the  limb  which  it  is 
desired  to  .secure,  the  end  carried  around  the  limb  as  far  as  pos- 
sible, and  then  grasped  from  the  opposite  side  of  the  limb  and 
drawn  out  through  the  vulva.  By  passing  tlie  distal  end  of  the 
cord  through  the  loop  and  drawing  upon  it  with  one  hand  while 
pressing  upon  the  loop  with  the  other,  the  noose  is  guided  back 
to  that  part  of  the  limb  to  which  it  is  desirable  or  possible  to 
secure  it,  and  drawn  tight. 

In  order  to  accomplish  this  operation,  the  fetal  membranes  must 
be  removed  from  the  limb  at  the  point  to  be  secured  with  the 
cord.  This  sometimes  offers  considerable  difficulty.  When  the 
cord  is  passed  partly  around  the  limb  and  dropped,  before  the 
membranes  have  been  well  ruptured,  and  the  hand  passed  around 
to  the  other  side  to  grasp  the  cord,  the  end  of  the  cord  is,  by  the 
elasticity  of  the  membranes,  thrown  away  from  the  position  in 
which  it  was  deposited,  and  consequently  cannot  be  secured  from 
the  other  side.  Even  when  the  membranes  are  fairly  well  ruptured, 
there  is  sometimes  difficulty  because  of  the  cord  following  the 
hand  backward  as  it  is  withdrawn,  and  thus  becoming  displaced. 
We  find  it  a  great  advantage,  in  overcoming  this  difficulty,  to 
fold  the  looped  end  of  the  rope  in  a  comparatively  large  mass, 
which  is  carried  in  the  hollow  of  the  hand.  When  this  folded  cord 
is  delivered  as  far  around  the  limb  as  is  practicable,  we  find  that 
while  the  hand  is  being  withdrawn  the  rope  may  partly  uncoil  and 
follow  it,  but  most  of  the  rope,  including  the  loop,  will  remain  in 


580  Veterinary  Obstetrics 

position  and  may  be  grasped  from  the  other  side  and  drawn  out. 

Some  practitioners  use  what  is  known  as  a  porte-cord  or  cord- 
carrier,  Fig.  106  f ,  in  order  to  aid  in  securing  the  limb  under  the 
conditions  we  have  just  named.  vSuch  an  instrument  may  be 
made  to  serve  the  double  purpose  of  a  cord-carrier  and  a  blunt 
hook.  There  are  numerous  patterns  of  these,  but  they  do  not 
seem  to  possess  a  very  high  value  in  actual  practice  and  are  not 
largely  used.  In  some  cases,  where  there  is  great  difficulty  in 
passing  a  cord  around  a  limb  because  of  the  presence  of  fetal 
membranes,  the  instrument  may  be  of  great  advantage.  With  it 
the  operator  can  hold  the  cord  in  place  by  means  of  the  instru- 
ment, while  the  hand  is  passed  around  the  other  side  of  the  limb 
and  the  cord  grasped.  Once  the  cord  is  grasped  the  instrument 
is  usually  withdrawn,  while  the  operator  holds  the  looped  end  of 
the  cord  and  guards  the  end  of  the  instrument  to  prevent  its 
catching  in  any  of  the  soft  parts.  When  the  porte-cord  has  been 
withdrawn,  the  fastening  of  the  cord  about  the  limb  is  carried 
out  in  the  same  way  as  without  the  use  of  the  instrument.  Per- 
sonally we  have  found  little  use  for  the  porte-cord  and  have  not 
seen  a  case  where  we  might  have  applied  a  cord  with  the  aid  of 
this  instrument  in  which  we  could  not  also  accomplish  this  with- 
out it..  In  some  instances  the  application  of  the  cord  is  easier 
with  the  instrument. 

When  cords  are  to  be  applied  to  the  neck,  and  the  head  is  in  a 
direct  line,  the  nose  presenting,  the  cord  may  be  applied  to  the 
neck,  as  an  open  noo.se,  by  slipping  it  back  over  the  nose  and  later 
the  ears,  until  it  rests  upon  the  poll  above  and  in  the  pharyngeal 
region  below.  Then  drawing  upon  the  cord  we  may  exert  what- 
ever traction  is  desired.  With  a  simple  loop  about  the  neck 
there  will  be  a  constant  tendency  for  the  head  to  deviate  from  a 
direct  line,  which  may  be  overcome  by  taking  a  half  hitch  around 
the  nose  or  around  the  lower  jaw,  so  that  any  traction  which  may 
be  exerted  will  keep  the  no.se  and  head  in  a  direct  line  with  the 
genital  canal. 

When  the  head  and  neck  are  so  deviated  that  it  is  impossible 
to  slip  the  completed  noose  over  the  head,  and  back  upon  the 
neck,  the  looped  end  of  the  cord  may  be  carried  as  far  as  possible 
over  one  .side  of  the  neck,  deposited  at  that  point  and  then, 
by  reaching  around  the  neck  from  the  other  direction, grasped  from 
the  opposite  side.     When  the  looped  end   has  been   .secured,  it 


Cords.  Bands  and  Halters  581 

should  be  drawn  out  through  the  vulva,  the  free  end  of  the  cord 
passed  through  the  loop  and,  by  drawing  upon  it,  the  neck 
secured  in  the  running  noose.  In  order  to  aid  in  passing  the  cord 
around  the  neck  in  this  way,  various  devices  have  been  proposed 
in  the  form  of  curved  sounds  or  curved  porte-cords,  but  the}' 
have  apparently  acquired  no  permanent  place  in  obstetric  prac- 
tice. In  some  instances  thej-  may  prove  quite  useful,  especially 
if  the  head  cannot  be  reached  in  such  a  way  as  to  cord  the  lower 
jaw  or  to  engage  the  head  with  a  hook  in  the  orbit.  In  those 
cases  of  extreme  deviation,  however,  where  the  head  is  out  of 
reach,  it  is  often  desirable  to  not  try  to  secure  the  head,  but 
rather  to  perform  embryotomy  and  to  decrease  the  size  of  the 
fetus  to  such  an  extent  that  the  deviation  of  the  head  may  be 
easily  corrected  or  the  fetus  may  be  extracted  without  correcting 
the  deviation. 

One  of  the  most  useful  places  for  the  attachment  of  cords  is 
the  inferior  maxilla  of  the  fetus.  In  the  various  deviations  of 
the  head  there  are  few  methods  which  are  more  advantageous  to 
the  practitioner  than  traction  upon  the  lower  jaw.  When  prop- 
erly applied,  it  affords  a  very  secure  attachment,  which  permits 
an  almost  unlimited  amount  of  traction  and  in  a  very  advanta- 
geous direction.  Some  obstetrists  have  said  that  they  could  not 
securely  apply  a  cord  to  the  lower  jaw  of  the  fetus,  and  especially 
to  that  of  the  foal,  because  it  very  readily  slips  off  and  so  does 
not  offer  a  secure  hold.  Our  experience  has  been  wholly  differ- 
ent, and  we  have  constantly  found  that  a  cord  can  be  very 
securely  fastened  to  this  part,  as  shown  in  Fig.  108.  We  pro- 
ceed as  follo.ws  :  First,  with  the  ring-knife  or  other  cutting  in- 
strument we  make  an  incision  3  or  4  cm.  long,  between  the  rami 
of  the  lower  jaw,  through  the  skin  and  superposed  tissues,  into 
the  oral  cavity.  Next,  we  pass  the  prepared  noose  of  the  cord  over 
the  jaw  and  push  it  back  beyond  the  incision  with  the  loop  rest- 
ing in  the  mouth  of  the  fetus.  We  then  pass  the  free  end  of  the 
cord  through  the  incision  from  the  oral  cavity  outward,  and  draw 
firmly  upon  the  cord  so  as  to  tighten  it,  after  which  any  amount 
of  traction  desired  may  be  employed  without  any  danger  of 
slipping  or  of  tearing  out.  By  this  method  the  two  rami  of  the 
jaw  are  held  together,  instead  of  being  split  apart  as  when  a  hook 
is  used.  The  objection  may  be  raised  that,  in  case  of  a  living 
fetus,  mutilation  is  caused,  but  the  wound  is  so  insignificant  in 


582  Veterinary  Obstetrics 

character  that  there  is  no  reason  why  it  should  not  heal  very 
promptly  and  without  blemish. 

A  few  practitioners  also  pass  cords  around  the  loins  of  the  fetus, 
in  case  of  posterior  presentation,  with  the  hind  limbs  completely 
retained,  but,  so  far  as  we  know,  this  plan  of  procedure  has  not 
been  generally  adopted.  Personally,  we  .see  no  need  for  this  very 
tedious  plan,  which,  if  completed,  still  offers  very  great  danger 
for  the  mother  and  virtuall}'  no  hope  for  the  life  of  the  fetus. 
In  our  experience  there  are  other  plans  of  procedure  which  are 
simpler  and  more  effective. 

In  addition  to  cords  and  bands  there  are  other  methods  for  ap- 
plying traction,  among  which  may  be  mentioned  the  annealed 
wire-loop.  Fig.  gi  i,  for  the  larger  animals.  Similar  devices  for 
small  animals  may  consist  of  a  small  tube  of  metal  or  other  suit- 
able material,  through  which  is  pa.ssed  a  wire  loop,  as  shown  in 
Fig.  91  f,  or  a  more  complex  device  such  as  that  of  Defaj^  g.  g., 
Fig.  91. 

Hooks.  Few  obstetric  instruments  have  been  so  much  u.sed  and 
made  of  so  many  patterns  as  hooks.  They  may  be  divided  into 
long  and  short.  Those  which,  when  attached  to  a  por- 
tion of  the  fetus  within  the  birth  canal,  will  be  completely 
hidden,  are  called  short  hooks,  j  and  k.  Fig,  92  and  b,  Fig.  106. 
Those  which  are  of  such  a  length  that,  w^hen  applied  to  a  given 
part  of  the  fetus,  their  distal  ends  project  beyond  the  vulva  like 
a  to  e.  Fig.  92,  and  g.  Fig.  106,  we  denominate  long  hooks.  Hooks 
may  be  either  sharp  or  blunt. 

Some  hooks  are  used  singly  and  others  doubly  or  in  pairs.  In 
case  of  the  short  hooks,  especially  the  finger  hook,  the  traction 
must  be  applied  through  the  medium  of  a  cord  passsed  through  an 
eye  in  the  hook  or  through  the  medium  of  the  operator's  hand. 
The  long  hooks  are  applied  to  the  desired  point  accompanied  by 
the  hand  of  the  operator,  and  traction  is  exerted  from  the  outside 
through  the  aid  of  an  assistant. 

The  advantages  and  disadvantages  of  long  and  short  hooks  are 
largely  matters  of  personal  experience.  One  practitioner  becomes 
accustomed  to  the  short  hook,  another  to  the  long,  and  each  be- 
lieves that  his  kind  is  the  better.  As  a  matter  of  fact  there  are 
few  things  which  can  be  accomplished  with  one  of  these  hookg 
which  cannot  be  done  with  almost  the  same  facility  with  the 
other.     There  are  few,  if  any,  places   that  a  short  hook  can  be 


Obstetric  Hooks 


applied  where  a  long  hook  could  not  also  be  inserted  with  equal 
facilit)^  or  vice  versa. 

There  is  one  difference  which  is  of  importance.  With  the  long 
hook  the  operator  may,  by  pushing  upon  the  instrument  from 
the  outside,  aid  the  hand  in  reaching  a  trifle  further  and  implant- 
ing the  hook  in  a  part  not  practicable  with  the  short  instrument. 
Al-so,  the  point  of  the  long  hook  may  be  turned  in  any  direction 


^ 


n 


6 


(J 


Fic.  92 
1,  Long  embryotoiny  hook  (39  in) 


OnsTETRic  Hooks. 

g,  Rieraer's  double  obstetric  hooks. 


b,  Jointed  obstetric  hook  . 

c,  Rectal  hook  of  Harms. 

d,  Single  hook  for  small  animals. 

e,  Double  hook  for  small  animals. 

f,  Harms'  eye  hooks. 


h,  Rrogniez'  obstetric  hooks, 
i,   Harms'  flank  hooks. 
j.   Sharp  hinged  hook  of  Scharnier. 
k,  Blunt  hinged  hook  of  Scharnier. 
-(Hauptner). 


through  the  agenty  of  the  outside  hand,  when  such  control  might 
not  be  possible  with  the  short  hook  dependent  for  guidance 
wholly  upon  the  inserted  hand. 

In  comparing  the.  sharp  and  blunt  hooks,  most  practitioners 
favor  the  latter  for  most  excellent  reasons.  It  is  exceedingly 
difficult  to  apply  a  sharp  hook  with  safety  for  either  the  mother 


584  Veteri?iary  Obstetrics 

or  the  operator.  It  is  an  ugly  instrument  to  handle  unless  we 
first  place  our  patient  under  complete  anaesthesia,  because,  while 
carrying  a  sharp  hook  in  the  hand  for  insertion  at  a  given  point, 
we  are  almost  certain  to  have  our  progress  interrupted  by  violent 
expulsive  efforts  on  the  part  of  our  patient,  and  it  is  only  by  the 
very  greatest  caution  and  dexterity  that  we  avoid  at  such  times 
serious  wounds  to  our  hands  or  to  the  genital  organs  of  the 
mother.  After  repeated  trials  with  the  sharp  hooks,  without 
having  been  benefitted  by  them  in  a  single  case,  we  finally  aban- 
doned all  attempts  to  use  them.  Even  should  we  desire  to  fix  a 
hook  in  a  part  where  the  blunt  point  would  not  enter  on  account 
of  the  skin,  we  may,  as  a  rule,  incise  the  integument  and  thus 
prepare  an  opening  for  the  blunt  instrument. 

The  form  of  the  hook  is  highly  important.  They  are  made  in 
every  conceivable  form,  and  many  makers  apparently  ignore  all 
mechanical  principles  and  construct  an  instrument  which  does 
not  serve  the  purpose  with  that  security  and  safety  desired. 
Aside  from  the  question  of  strength  and  finish,  it  is  essential  that 
a  hook  be  so  constructed  that,  when  once  inserted  into  the 
tissues  and  traction  is  exerted  upon  it,  its  form  shall  cause  it 
to  sink  deeper  and  deeper  into  the  parts  and  acquire  a  hold  with 
constantly  increasing  security.  The  hook  should  leave  the  shaft 
at  an  angle  of  about  45°  and  need  continue  in  a  straight  line,  or 
nearly  so,  to  the  end.  The  right  and  wrong  forms  of  hooks  are 
illustrated  by  Figs.  92  a,  d,  and  106  g.  A  study  of  tlie.se  instru- 
ments will  show  that  92  a  w^ould  have  scarcely  any  tendency 
to  sink  deeper  and  deeper  into  the  tissue,  while  Fig.  106  g  would 
constantly  press  deeper  into  the  parts  to  which  it  is  applied. 
The  width  of  the  opening  of  the  hook  should  not  exceed  2.5  to 
3  in.  .so  that  the  operator  may  readily  conceal  it  in  his  hand  dur- 
ing insertion  or  withdraw^al. 

Double  hooks  have  been  proposed  by  many  obstetrists,  and  some 
of  them  have  been  u.sed  extensively.  Harms  especially  rec- 
ommends his  flank  hooks.  Fig.  92  i,  which  are  about  17  cm. 
long  and  are  intended  to  be  inserted  one  in  each  flank,  when  the 
fetus  presents  by  its  croup  and  it  is  wished  to  bring  about  forci- 
ble extraction.  We  constantly  prefer  embryotomy  to  forcible 
extraction,  which  Harms  and  others  recommend,  and  conse- 
quently find  no  need  for  the.se  appliances.  Others  use  hooks  of 
a  somewhat  .similar  character  for  correction  of  the  deviation  of 
the  head  by  applying  one  hook  in  each  orbit. 


Obstetric  Hooks 


585 


When  a  hook  is  used  for  the  development  of  traction,  when- 
ever force  is  applied,  the  instrument  must  be  constantly  guarded 
by  the  operator's  hand  lest  it  slip  or  tear  out  and  lacerate  the 
uterus.     This  applies  with  special  force  to  the  sharp  hook. 

In  the  application  of  hooks,  the  operator  shoujd  always  aim  to 
select  a  point  where  the  instrument  will  be  secure  against  tear- 
ing out,  and  in  order  to  do  this  he  needs  have  well  in  mind  the 
anatomical  structure  of  the  fetus  and  the  resistance  of  various 
parts. 


Fio.  93. 
Roeder's   obstetric   forceps 


Obstetric  FoRcicrs. 
for 


swine. 

b.  Pig  forceps.     Walcli's. 

c.  Obstetric  forceps  for  swine  and 

goats.     Witt's. 


d,  Moeller's  bitch  forceps. 

e,  EUinger's  pig  forceps. 

f ,  deBruin's  forceps  for  sheep. 

g,  deBruin's  bitch  forceps. 

( Hauptner). 


Anteriorly  the  hooks  may  be  inserted  with  comparative  safety 
in  the  orbits.  The  point  of  the  hook  should  be  sunk  deeply  into 
the  orbit  and  should  force  its  way  through  the  bony  walls  of  that 
cavity  into  the  sinuses  of  the  face.  For  this  purpose  the  hook 
should  be  about  3  inches  in  length.  In  correcting  a  slight  devi- 
ation of  the  head,  it  may  be  allowable  at  times  to  insert  the  hook 
into  the  lower  jaw  between  its  two  branches,  but  this  constitutes 
a  very  in.secure  hold,  which  will  give  way  under  very  moderate 
traction  and  consequently  does  not  permit  of  great  force.  When 
it  is  wished  to  applj^  severe  traction  to  the  lower  jaw,  the  cord 
should  be  used  as  already  described. 


586  Veterinary  Obstetrics 

When  the  fetus  presents  posteriorly,  the  points  which  offer  the 
most  secure  insertion  for  hooks  are  the  borders  of  the  bones  of  the 
pelvis.  The  hooks  may  be  implanted  in  front  of  the  pubic  brim 
or  of  the  ilium,  or  in  the  oval  foramen,  either  from  without  or 
within.  It  is  much  safer  to  insert  the  hook  in  the  pelvis  from 
without,  inwards.  If  inserted  from  within,  the  point  of  the 
hook  must  be  constantly  guarded,  lest  it  push  through  the  soft 
tissues  of  the  fetus  and  lacerate  the  genital  canal  of  the  mother. 

Obstetric  forceps  of  great  variety  have  been  proposed  by 
various  writers,  but  they  have  not  come  into  general  use  and  ap- 
parently cannot  serve  any  important  purpose  in  the  larger  ani- 
mals. The  immense  forceps  of  Jorg  are  too  voluminous  and 
heavy  to  be  applied  to  the  head  of  the  fetus  in  the  genital  canal 
and,  were  they  once  applied,  no  power  of  anj'  efficiency  could  be 
exerted  thereon.  Various  types  of  these  forceps  have  been  in- 
vented, but  each  alike  has  failed  to  serve  any  purpose. 

In  smaller  animals  obstetric  forceps  have  proven  highly  u.seful 
and  practical.  They  constitute  one  of  the  safest  and  most  effi- 
cient methods  for  applying  traction  to  the  fetus  of  the  cat,  bitch, 
sow  and,  to  a  lesser  degree,  the  ewe  and  goat.  Some  of  the  most 
useful  of  these  are  illustrated  in  Fig.  93. 

Among  the  various  means  for  the  application  of  traction,  the 
safest  is  the  cord.  It  constitutes  the  only  appliance  which  the 
operator  can  leave  unguarded. 

The  application  of  traction  to  the  fetus  in  cases  of  dys- 
tokia  will  vary  largely  in  the  intensity  allowable,  the  direction  in 
which  it  is  best  to  exert  it  and  the  means  which  may  most  use- 
fully be  employed  in  developing  the  necessary  force. 

The  direction  in  which  traction  is  to  be  applied  will  de- 
pend very  largely  upon  the  attitude  of  the  fetus  and  the  point 
which  it  has  reached  in  the  birth  channel.  As  we  have  alreadj^ 
suggested  in  a  preceding  chapter,  the  fetus  of  our  domestic  ani- 
mals, and  especially  of  the  larger  ones,  normally  assumes  a  some- 
what curved  position.  The  ventral  surface  of  the  fetus  is  con- 
cave and  the  dorsal  is  convex,  which  curvature  may  be  increased 
very  greatly  by  artificial  means,  but  the  normal  curve  in  the  fetal 
body  does  not  readily  undergo  obliteration  or  reversal  by  the  fetal 
body  being  bent  dor.salwards. 

As  the  fetus  approaches  the  pelvic  inlet,  in  our  larger  domestic 
animals,  and  especially  in  those  cases  where  the  animal  is  stand- 


Application  of  Traction  587 

ing,  it  is  located  below  the  pubic  brim  and  must  mount  that 
obstacle  in  order  to  gain  the  pelvic  canal.  Presenting  thus, 
if  traction  should  be  necessary  or  desired,  it  should  be  applied  to 
the  fetus  somewhat  obliquely  upward,  so  as  to  lift  the  fetus  up- 
ward and  backward  over  the  pubic  brim. 

During  the  progress  of  the  fetal  head  through  the  pelvis,  the 
traction  should  be  directly  backward  or  slightly  upward  and 
backward,  but,  when  the  fetal  head  arrives  at  the  vulva,  if  the 
traction  is  continued  upward  it  tends  to  force  the  poll  of  the  head 
too  powerfully  against  the  superior  vulvar  commissure,  and  not 
only  tends  thereby  to  cause  an  obstruction  to  delivery  by  jam- 
ming the  fetal  head  against  this  part,  but  also  endangers  the  in- 
tegrity of  the  superior  commissure  of  the  vulva  it.self  and  tends 
to  cause  more  or  less  laceration  of  it.  Consequently  the  direc- 
tion at  this  point  should  be  somewhat  downward  in  order  to 
avoid,  as  far  as  possible,  any  injury  to  the  soft  parts. 

After  the  head  has  passed  through  the  vulva,  the  traction 
should  be  continued  more  and  more  downward  as  the  body  of  the 
fetus  advances,  until  finally,  when  the  withers  have  passed  the 
vulva,  the  line  of  traction  should  be  almost  perpendicular  to  the 
long  axis  of  the  spinal  column  of  the  mother  or  parallel  to  the 
long  axis  of  the  posterior  limbs  of  the  mother. 

If  the  animal  is  standing,  the  direction  of  traction,  when  the 
fetus  is  well  advanced,  should  be  immediately  downward  toward 
the  floor,  or  if  she  is  lying  down  it  should  be  directed  toward 
her  hind  feet.  Such  a  direction  in  traction  permits  the  ventral 
wall  of  the  fetal  body  to  become  .somewhat  relaxed,  and  in  this  way 
the  fetal  viscera  may  pass  backward  or  forward  in  the  body  cav- 
ity and  thus  escape  from  that  part  of  the  cavity  which  is  being 
most  compressed  in  the  birth  pas.sage,  thereby  decreasing  the 
diameter  of  the  fetal  body  at  the  most  critical  point. 

The  downward  direction  of  the  traction  pulls  the  tuberosities 
of  the  fetal  ilia  downward  from  the  uppermost  part  of  the 
maternal  pelvis,  and  prevents  their  becoming  interlocked  with 
those  of  the  mother. 

Unless  care  is  exercised  at  this  time,  the  fetal  and  maternal 
pelves  become  immov-ably  locked.  We  have  repeatedly  seen  this 
occur  where  one  or  two  honses  have  been  hitched  to  the  head  of 
a  calf  and   violent  traction  employed   in   a  direct   line  without 


588  I'^eten'nary  Obstetrics 

moving  the  fetus,  although  the  presentation,  position,  fetus  and 
maternal  pelvis  were  each  apparently  normal. 

The  amount  of  traction.  In  passing  through  the  birth 
canal  the  fetus  and  the  maternal  parts  in  contact  with  the  fetus 
undergo  an  enormous  pressure  because  of  the  comparative  nar- 
rowness of  the  canal.  This  pressure  is  to  a  great  extent  inevit- 
able, and  it  is  only  when  it  becomes  excessively  high  that  it 
has  any  danger  for  the  fetus  or  mother. 

In  veterinary  practice  we  scarcely  recognize  the  presence  of 
any  danger  whatever  to  the  fetus  from  the  pressure  during  its 
passage  through  the  birth  canal,  nor  as  a  rule  do  we  observe  any 
injury  to  the  fetus  because  of  traction  applied  to  any  of  its  ex- 
tremeties.  The  amount  of  traction  which  will  be  boine  by  the 
head  or  the  limbs  of  a  fetus  during  its  passage  through  the  canal 
is  astonishing.  It  far  surpasses  any  point  which  an  average  per- 
son would  believe  possible  for  the  fetus  to  endure  without  more 
or  less  serious  injury,  and  yet,  as  a  rule,  strain  or  other  in- 
jury to  the  fetus  from  such  traction  is  virtually  unknown  in 
practice. 

The  mother,  however,  not  infrequently  suffers  seriou.sly  from 
severe,  or  rather  we  might  say,  from  injudicious  traction.  How 
much  pressure  the  pelvis  of  our  domestic  animals  will  withstand, 
when  applied  through  the  medium  of  a  fetus  impacted  within  its 
canal,  we  do  not  know.  Experimentally,  it  has  required  from 
375  to  635  pounds  pressure  upon  a  round  ball  representing  the 
head  of  the  fetus,  to  produce  a  fracture  of  the  bones  or  disunion 
of  the  pelvis  of  woman. 

The  great  danger  to  the  organs  of  the  domestic  animal  is  not 
to  the  bony,  but  to  the  soft  parts,  and  it  is  these  which  are  first 
injured  by  an  excessive  pressure. 

The  amount  of  traction  which  may  be  applied  to  the  fetus 
varies  with  its  position.  When  the  fetus  is  presenting  normally 
and  the  traction  is  exerted  in  the  direction  which  we  have  sug- 
gested, there  is  no  point  where  the  soft  tissues  of  the  fetus  may 
not  move  to  some  extent  upon  each  other  and  thus  relieve  the 
pressure  upon  a  given  point,  so  that  in  normal  cases  the  pressure 
of  the  fetus  against  the  walls  of  the  birth  canal  is  well  nigh  equal 
over  the  entire  surface. 

When  the  fetus  presents  improperly,  when  an  extremity  is  re- 
tained in  such  a  way  that  a  greatly  increased  pressure  is  brought 


Applicatio7i  of  Traction  589 

to  bear  upon  one  small  area  of  the  genital  passages  of  the  mother, 
the  question  of  the  amount  of  admissible  traction  changes  greatly. 
For  example,  if  a  fetus  is  presenting  with  its  head  deviated  to 
the  side,  one  man  b}'  drawing  upon  it  may  cause  far  more  injury 
than  five  men  might  do  if  the  fetus  were  presenting  normally. 

Different  practitioners,  working  under  varying  conditions,  have 
obtained  apparently  contradictory  results  in  reference  to  the 
amount  of  traction  which  it  is  desirable  to  employ.  Some  claim 
that  only  moderate  traction  should  be  employed,  and  define  their 
term  "  moderate  "  as  the  force  of  from  2  to  4  men  pulling  simul- 
taneously. Others  have  unhesitatingly  employed  the  combined 
strength  of  from  6  to  10  men  and  have  claimed  that  their  success 
has  fully  warranted  the  amount  of  force  employed.  Personally 
we  have,  when  hard  pressed,  applied  a  force  which  would  equal 
that  of  6  to  10  ordinary  men,  in  those  cases  in  the  cow  and  mare 
where  the  fetus  lay  in  a  wholly  natural  position,  and  when  the 
force  of  the  traction  fell  alike  over  the  entire  birth  canal. 
Usually,  when  it  reaches  the  point  where  so  great  force  has  be- 
come necessary,  we  have  not  used  this  number  of  men,  but  have 
substituted  .some  mechanical  appliance  for  their  power,  such  as 
the  lever  or  puUe}-. 

Donnareix  claims  that  three  assistants  are  usually  sufficient 
for  handling  d^-stokia  in  the  cow.  Of  these,  he  places  one  at  the 
head,  another  at  the  tail  and  a  third  to  aid  the  operator.  In 
contrast  with  this  he  finds  10  men  necessary  for  the  mare  and 
distributes  them  somewhat  similarly,  except  that  an  extra  man 
is  needed  to  confine  the  limbs  of  the  animal,  while  5  or  6  are 
needed  to  pull  at  the  fetus.  While  the  amount  of  assistance 
required  in  a  given  case  constantly  varies  in  either  the  mare  or 
the  cow,  we  have  never  found  the  great  number  either  neccessary 
or  desirable,  and  have  always  considered  that  we  could  better 
manage  from  3  to  5  men  than  a  larger  number  and  that  we  could 
always  develop  mechanical  force  of  sufficient  degree  to  get  the 
power  desired. 

When  traction  is  applied  to  a  fetus  which  is  not  in  a  proper 
position  and  in  which  the  fetal  pressure  is  not  alike  upon  the  en- 
tire area  of  the  maternal  passages,  great  and  even  fatal  injuries 
to  the  mother  are  constantly  threatened.  If  a  limb  is  retained 
or  misdirected  it  is  liable  at  any  time  to  be  forced  through  the 
uterine  wall  into  the    peritoneal    cavity  and  produce  a  rupture, 


590  Veterinary  Obstetrics 

from  which  the  animal  usually  dies  as  a  result  of  shock,  hemor- 
rhage, or  infection. 

In  other  cases,  when  a  portion  of  the  fetus  is  deviated,  the 
walls  of  the  uterus,  which  are  closeh'  investing  the  fetal  bod}', 
may  be  caught  during  severe  traction  and  dragged  along  until  a 
small  rupture  is  caused,  or  the  uterine  walls  so  seriously  crushed 
and  maimed  that  they  later  become  necrotic  and  a  secondary  per- 
foration of  the  uterus  occurs.  When  the  fetus  is  further  ad- 
vanced in  the  pelvic  canal  and  approaches  the  outlet,  any  great 
deviation  o  the  presenting  parts  of  the  fetus  may  cause  a  very 
.serious  rupture  of  the  perineum.  Therefore,  the  application 
of  great  force  to  a  fetus  in  an  improper  position  is  con- 
stantly to  be  condemned. 

In  the  selection  of  as.sistants,  when  there  is  a  sufficient  num- 
ber present  to  permit  of  selection,  one  should  take  by  preference 
tho.se  persons  who  are  somewhat  experienced  in  the  handling  of 
animals  and  who  are  strong  and  of  equable  temperament.  One 
needs  to  have  these  men  thoroughly  at  his  command  and  to  know 
that  they  will  obey  his  orders  promptly  and  without  question.  It 
has  been  a  common  experience  of  the  writer,  when  he  has  asked 
that  two  or  three  men  shall  take  hold  of  a  rope  to  exert  traction, 
that  upon  turning  his  head  he  finds  that  the  number  has  doubled 
or  trebled.  This  must  be  constantly  watched  in  ca.se  of  a  crowd 
of  bystanders. 

When  traction  is  being  applied  the  operator  should  take  his 
place  immediately  behind  the  patient,  constantly  watch  and 
examine  the  progress  of  the  fetus,  command  the  direction  and 
amount  of  force  to  be  applied  at  this  or  that  time,  and  determine 
when  the  traction  should  cease.  Various  conditions  may  arise  de- 
manding that  the  traction  shall  be  more  to  the  right  or  the  left, 
upward  or  downward,  or  otherwi.se  modified. 

When  there  seems  to  be  any  great  impediment  which  appar- 
ently bars  the  progress  of  the  fetus  at  a  given  point,  the  traction 
should  cease  and  the  operator  should  determine  the  nature  of  the 
obstacle  to  its  progress  and  devise  the  necessary  means  for  over- 
coming it.  The  operator  should  not  join  in  the  traction  unless 
circumstances  should  arise  making  it  necessary,  but  should  de- 
vote his  attention  to  the  direction  of  the  force  to  be  applied  by 
others. 


Application  of  Traction  591 

Haste  in  traction  upon  a  fetus  is  onh"  ver}'  rarely  justifiable, 
and  the  maternal  parts  should  be  allowed  to  dilate  gradually  as 
the  fetus  slowly  advances  in  the  form  of  a  wedge.  In  posterior 
presentation,  \yhen  a  supposedly  live  fetus  is  well  advanced  in 
the  pelvis  so  that  the  umbilic  cord  is  impinged  between  the  fetal 
body  and  the  maternal  pelvis,  hasty  extraction  of  the  fetus  may 
be  warranted  in  order  to  save  its  life.  Very  rarely,  possibly,  other 
conditions  arise  to  warrant  hasty  extraction  of  the  fetus. 

Traction  should,  if  possible,  only  be  applied  during  the  expul- 
sive efforts  of  the  mother,  since  at  these  times  it  is  very  much 
safer,  and  more  efficient.  Traction  applied  in  the  absence  of  ex- 
pulsive efforts  constantly  tends  to  drag  the  uterus  along  with  the 
fetus,  with  danger  of  uterine  rupture. 

Expulsive  efforts  of  the  mother  may  usually  be  artificially 
aroused  by  slight  traction  upon  the  fetus  or  by  the  operator 
passing  his  hand  between  the  fetus  and  the  vaginal  walls.  When 
these  efforts  have  been  aroused  they  should  promptly  be  seconded 
by  firm  traction,  to  be  regulated  in  amount  according  to  the  cir- 
cumstances in  each  case.  Before  traction  is  applied,  and  as  far 
as  po.ssible  during  its  continuance,  the  birth  canal  should  be  kept 
moist  and  well  lubricated  by  means  of  oil,  fat,  or  warm  lysol  so- 
lution. 

While  traction  should  be  applied,  as  a  rule,  only  during  expul- 
sive efforts,  in  some  cases,  when  the  animal  is  exhausted  or  under 
the  influence  of  an  anaesthetic,  the  expulsive  powers  ma}^  be 
partly  or  wholly  wanting  and  forcible  extraction  made  necessary. 

The  general  rules  for  the  application  of  traction — the  direction, 
amount  and  method — are  essentially  the  same  whether  the  fetus 
presents  anteriorly  or  posteriorly. 

The  development  of  the  required  amount  offeree,  when 
applying  traction  to  the  fetus,  may  be  brought  about  in  a  variety 
of  ways. 

We  have  already  suggested  that  the  difficulties  increa.se  as  the 
number  of  men  increases,  because  a  large  number  of  men  is  diffi- 
cult to  control.  They  are  almost  always  excited  and  tend  to  exert 
their  force  in  an  irrational  manner.  Since  they  neces.sarily  work 
behind  the  operator's  back,  he  has  little  opportunity  to  watch 
them,  while  giving  proper  attention  to  the  progress  of  the  fetus. 
In  some  cases  the  men  who  are  at   the  command  of  the  operator 


592  Vefennarj'  Obstetrics 

are  not  very  intelligent,  and  such  persons  at  once  render  his  task 
more  difficult  in  controlling  the  application  of  force. 

The  barbarous  method,  which  is  more  or  less  in  vogue,  of  de- 
veloping force  by  hitching  one  or  more  horses  to  the  foal  or  calf, 
requires  no  condemnation.  Such  a  force  is  quite  beyond  control. 
The  horses  become  excited  and  jump  or  jerk  in  such  a  way  as 
to  be  exceedingly  dangerous  for  the  mother  and  fetus,  if  the  latter 
is  yet  alive.  After  one  or  two  ineffectual  efforts  to  overcome 
the  resistance,  the  horse  behaves  so  badly  that  his  starting  and 
stopping  cannot  be  depended  upon.  Besides  this  we  have  very 
poor  control,  under  these  circumstances,  of  the  direction  in  which 
the  force  is  to  be  exerted.  Any  sudden  movement  of  the  patient 
changes  the  direction  of  the  traction  quite  as  suddenly  and  may 
be  fraught  with  serious  results. 

When  power  must  be  developed,  requiring  the  force  of  more 
than  4  or  5  men,  it  is  preferable  according  to  our  experience  to 
supplant  the  men  with  mechanical  appliances,  of  which  we  have 
many.  The  two  to  which  we  have  usuall}^  resorted,  and  which 
have  given  us  highly  satisfactory  results,  have  been  the  lever  and 
the  pulley. 

The  lever  is  universally  available  and  can  be  applied  under 
almost  any  conditions  which  might  be  named,  except  possibly  in 
those  in.stances  where  the  stall  in  which  the  operation  is  under- 
taken is  too  small  to  permit  of  its  use.  In  such  instances, 
however,  it  is  almost  equally  difficult  to  apply  other  mechanical 
•force.  Our  method  has  been  to  procure  a  stout  beam  from  8  to  10 
feet  in  length  and  to  find  a  secure  resting  place  for  the  fixed  end 
of  the  lever,  which  is  to  act  as  a  fulcrum,  against  a  door,  post,  or 
other  solid  object.  If  the  animal  is  in  the  pasture,  or  otherwise  in 
the  open,  and  recumbent,  a  stout  stake  may  be  driven  in  the 
ground  to  serve  as  a  fulcrum  and  the  end  of  the  lever  placed 
against  this.  A  hole  may  be  made  in  the  ground  or  in  the  floor 
and  the  end  of  the  lever  inserted  into  this.  The  cord  or  rope 
which  is  attached  to  the  fetus  may  then  be  made  fast  to  the 
lever  at  a  distance  of  about  two  feet  from  the  fulcrum  and  the 
power  applied  to  the  long  arm  of  the  lever,  by  one,  two  or  more 
men,  as  conditions  may  warrant.  The  amount  of  power  which 
may  be  developed  in  this  way  is  virtually  unlimited,  its  direc- 
tion is  under  excellent  control,  and  it  is  free  from  irregularities 
in  its  application. 


Application  of  Traction  593 

Much  the  same  may  be  said  of  the  pulley,  by  which  we  can 
increase  the  force  at  will  and  can  quite  readily  control  the  di- 
rection of  the  traction  at  every  stage  of  progress.  The  pulley 
has  the  one  very  marked  advantage  that  it  may  be  carried  in  a 
very  compact  form  by  the  operator,  as  a  part  of  his  equipment, 
and  be  ready  for  application  whenever  occasion  arises. 

Others  have  used,  for  the  purpose  of  developing  mechanical 
force,  various  apparatuses  in  case  of  emergency,  such  as  the  wind- 
lass, capstan,  and  various  obstetric  machines,  which  have  been 
worked  by  means  of  a  screw  or  otherwise.  However,  the  two 
which  we  have  suggested  are  so  universally  available  and  so  effi- 
cient that  it  would  seem  scarcely  necessary  to  discuss  the  others 
beyond  admitting  that,  when  they  chance  to  be  at  hand,  they 
ma\' act  quite  as  well  as  those  which  we  have  habitually  used. 

While  these  mechanical  devices  for  the  development  of  force 
seem  in  some  respects  cruel,  they  are  not  so  at  all  when  com- 
pared with  other  means  for  which  they  are  substituted.  Veter- 
inarians in  general  condemn  the  practice  of  hitching  horses  or 
oxen  to  a  fetus  in  order  to  draw  it  away,  as  being  cruel  and  un- 
justified by  any  principles  of  surgery  or  of  humanity.  Unless  a 
number  of  men  can  be  well  controlled  in  their  efforts,  it  is  no 
more  humane,  nor  is  it  any  more  scientific,  to  place  8  or  10  men 
upon  a  cord  to  draw  upon  a  fetus  than  it  is  to  hitch  a  horse  to  it. 

Mechanical  means  for  the  application  of  force  are  far  more 
under  the  control  of  the  operator,  are  more  continuous  and  better 
directed.  In  our  judgment,  where  a  certain  force  is  necessary, 
which  cannot  be  accomplished  by  three  or  four  men,  the  mechan- 
ical appliance  is  safer  and  more  effective.  In  our  comparison  we 
are  dealing  with  the  question  of  the  application  of  a  given  amount 
of  force  with  like  supervision.  Admittedly,  with  mechanical 
means  we  can  apply  such  an  unlimited  force  as  to  tear  either  the 
fetus  or  mother  asunder,  but  so  we  may  by  manual  force  if  we 
but  sufficiently  multiply  the  number  of  men. 

The  amount  of  force  to  be  applied  in  a  given  case  constitutes  a 
severe  test  of  the  judgment  of  the  veterinarian.  It  is  a  practi- 
cal question  which  should  be  decided  upon  sound  principles.  In 
almost  any  case  of  dystokia  we  may  reduce  the  size  of  the  fetus, 
by  embryotomy,  to  such  dimension  that  but  little  force  will  be 
required  to  bring  about  its  extraction  from  the  uterus.  If  this 
can  be  readilv  accomplished,  and  the  fetus  is  dead,  it  follows  that 
38 


594  Veien'fiary  Obstetrics 

such  is  the  proper  action  to  take.  We  are  not  justified,  for  ex- 
ample, in  applj'ing  great  traction  to  a  fetus  presenting  posteriorly 
with  the  two  hind  feet  completely  retained,  when  by  intra-fetal 
embrytomy,  with  removal  of  the  two  hind  limbs,  we  may  so  re- 
duce the  size  of  the  fetus,  in  the  course  of  an  hour,  as  to  permit 
of  its  easy  extraction  by  the  traction  of  say  two  persons. 

On  the  other  hand,  we  recall  an  instance  in  our  personal  expe- 
rience where  a  foal  was  in  the  breech  presentation  with  both  hind 
limbs  completely  retained,  and,  as  it  had  been  dead  for  some 
time,  the  waters  had  all  escaped.  The  fetus  was  enormously 
enlarged  because  of  emphysema  as  a  result  of  decomposition. 
We  removed  the  two  hind  limbs,  the  pelvis  and  all  the  fetal 
viscera,  and  then  attached  a  cord  to  the  posterior  end  of  the 
.spinal  column  and  applied  traction.  The  fetus  was  in  the  dorso- 
sacral  position  and  there  was  no  impediment  to  its  extraction 
except  the  great  emphysema. 

We  might  have  further  reduced  the  size  of  the  fetal  body 
by  removing  the  ribs  and  then  withdrawing  one  of  the  shoulders, 
and  with  it  the  fore-leg.  We  might  have  repeated  the  process 
upon  the  other  fore-leg,  and  perhaps  this  would  have  been 
the  more  surgical  and  approved  method,  but,  before  we  realized 
the  seriousness  of  the  obstacle  to  extraction,  we  had  wedged 
the  fetus  quite  tightly  in  the  birth  canal  .so  that  further  opera- 
tion was  rendered  exceedingly  difficult.  Rather  than  go  through 
the  tedious  work  es.sential  for  the  desired  reduction  in  .size,  we 
applied  force  which  we  estimated  at  more  than  looo  pounds,  by 
means  of  a  lever,  and  drew  the  fetus  awa)-.  However  cruel 
some  operators  might  con.sider  the  operation,  the  animal  did  well. 

We  doubt  very  much  indeed  if  she  could  have  done  any  bet- 
ter, or  even  if  she  would  have  suffered  less  had  we  further  re- 
duced the  size  of  the  fetus  by  a  verj'  tedious  and  difficult 
operation. 

Other  .similar  experiences  might  be  cited,  but  what  we  wish  to 
in.sist  upon  most  strongly  is  that,  if  such  great  force  is  to  be  ap- 
plied for  the  extraction  of  a  fetus,  it  .should  first  be  brought  into 
a  natural  po.sition  .so  that  in  its  pa.s.sage  all  the  .soft  tissues  will 
be  prcs.sed  upon  alike  and  that  consequently  the  danger  of  pre- 
dominant pressure  upon  one  area  is  reduced  to  a  minimum. 

In  the  application  of  powerful  traction,  the  operator  should 
take  particular  care    to    properly    command    the   direction  and 


Repellers  and  Repulsion  595 

amotint  of  force  which  is  applied.  In  some  cases  it  is  essential  to 
fix  the  animal's  body  so  that  it  shall  not  be  drawn  from  its  posi- 
tion instead  of  the  fetus  being  extracted,  while  in  other  cases  it 
is  necessary  that  the  body  of  the  parent  be  fixed  in  order  to  per- 
mit of  the  traction  being  applied  in  the  desired  direction. 

As  a  general  rule,  when  severe  traction  is  applied  the  animal 
assumes  the  recumbent  position,  and,  when  the  fetus  is  well  ad- 
vanced in  the  pelvic  canal,  it  may  be  necessary  to  in  some  way 
fasten  the  posterior  part  of  the  body  of  the  mother  so  that,  when 
the  traction  is  directed  toward  her  feet,  she  is  not  constantly 
moved  from  her  position.  In  order  to  overcome  this  movement 
of  the  body  of  the  mother,  we  may  in  the  mare  fix  a  rope  to  the 
tail  and,  by  attaching  it  to  a  solid  object,  prevent  the  constant 
slipping  of  the  bodj^  in  a  ventral  direction.  In  either  the  cow  or 
the  mare,  a  long  rope  may  be  passed  between  the  hind  limbs  or 
around  the  buttocks  somewhat  below  the  vulva  and  then  attached 
to  some  solid  object  beyond  the  dorsum  of  the  mother  in  such  a 
way  as  to  prevent  her  gliding  in  a  ventral  direction. 

Repellers  and  Repulsion. 

In  obstetrical  operations  it  frequently  becomes  essential  that 
the  fetus  be  pushed  back  into  the  uterine  cavity  or  the  abdomen, 
in  order  that  room  may  be  obtained  in  which  to  make  certain 
changes  in  the  position  of  parts  or  to  carry  out  other  operations 
which  may  be  essential  to  the  extraction  of  the  fetus.  This  pro- 
cedure we  know  as  repulsion  or  retropulsion.  It  may  be  carried 
out  in  a  variety  of  ways,  and  naturally  the  most  primitive  method 
is  that  of  pushing  the  fetus  backward  by  means  of  the  operator's 
hand.  This  most  primitive  and  simple  of  all  methods  has  great 
advantages  over  the  others,  especially  because  the  force  can  be 
applied  with  intelligence  and  safet}-. 

It  is  the  most  effective  means  for  bringing  about  changes  in 
the  location  and  direction  of  the  fetus,  because  the  force  may  be 
constantly  applied  at  the  proper  angle  and  may  be  at  once  modi- 
fied according  to  an}-  changes  in  the  position  of  the  fetus  during 
the  progress  of  the  operation. 

Manual  repulsion  has  the  great  disadvantage  that  it  places  upon 
the  operator  the  full  burden  of  a  more  or  less  difficult  task  and 
makes  a  demand  upon  his  physical  resources,  which  may  later  be 
sorely  needed  for  the  accomplishment  of  other  important  opera- 


596  Veterinary  Obstetrics 

tions.  In  harmony  with  the  rule  which  we  have  already  sug- 
gested, that  the  operator  should  delegate  to  other  persons  what- 
ever they  may  safely  and  properly  do,  leaving  him  to  direct  the 
application  of  force,  various  appliances  have  been  introduced 
to  relieve  the  obstetrist  from  the  phj-sical  strain  involved  in  this 
operation. 

Some  obstetrists  have  an  assistant  push  against  the  operator's 
shoulder  or,  grasping  his  arm,  push  it  forward  so  as  to  increase 
his  power  in  that  way,  but,  however  great  additional  force  he 
may  secure  in  this  manner,  the  impact  still  falls  wholly  upon  the 
operator's  hand  and  tends  finally  to  produce  fatigue. 

Another  plan  is  to  have  an  assistant  insert  his  hand  and  arm 
alongside  that  of  the  operator  and  the  two  push  unitedly  against 
the  fetus,  but  this  does  not  give  the  very  best  results  because  the 
room  for  working  with  the  two  arms  in  the  passages  is  not  very 
ample  and  the  two  persons  are  somewhat  in  each  other's  way. 
In  attempting'this  method  of  repulsion,  the  assistant  stands  with 
his  back  to  the  back  of  the  operator,  and,  if  the  operator  is  using 
his  right  hand,  the  assistant  inserts  his  left  hand. 

More  commonly  and  preferably  the  extra  force  is  applied  by 
means  of  instruments,  usually  by  a  repeller  or  crutch,  Fig.  94. 
This  instrument  is  shaped  somewhat  like  a  crutch  and  is  made 
of  wood,  iron  or  steel,  of  variable  size  and  form,  usually  about  30 
to  36  inches  in  length.  Cleanliness  and  neatness  dictate  that 
this  instrument  should  be  made  of  steel,  which  is  to  be  well  pol- 
ished and  then  plated  with  nickel  so  that  it  will  not  rust. 

The  crutch,  or  repelling  end,  is  usually  made  solid  and  de- 
scribes the  segment  of  a  circle.  It  is  made  of  varying  width,  and 
most  of  the  instruments  are  very  much  larger  than  is  necessary 
or  desirable. 

Instruments  made  of  good  steel,  j^2  inch  in  diameter,  are  abun- 
dantly strong  for  all  the  force  which  one  will  have  occasion  to 
apply,  and  the  length  of  the  crutch  itself  should  not  exceed  4 
inches,  while  3  inches  is  quite  ample  for  all  purposes.  Some 
make  them  very  much  wider  than  this,  with  the  idea  that  they 
may  thereby  .secure  a  safer  hold  upon  the  fetus  and  thus  do  away 
with  the  liability  of  the  instrument  slipping  off  and  injuring  the 
mother. 

In  our  experience  there  is  no  occasion  for  a  repeller  to  slip  from 
its  point  of  fixation,  if  properly  made,  applied  and  guarded.     If 


Repellers  and  Repulsion 


597 


the  instrument  has  too  great  a  diameter,  it  is  exceedinglj^  diffi- 
cult to  introduce  and  may  cause  injury  to  the  soft  parts  of  the 
mother  while  being  applied.  After  it  has  been  located  at  the 
proper  point  and  force  applied  to  it,  if  the  transverse  diameter  of 
the  crutch  is  very  great,  the  ends  may  project  beyond  the  parts 
of  the  fetus  to  which  it  is  applied,  catch  in  the  walls  of  the  uterus 
or  vagina  and  more  or  less  seriously  injure  them.  We  therefore 
prefer  a  repeller  with  a  very  short  crutch,  or  transverse  piece, 
which  ma}'  be  readil}'  introduced  completely  covered  by  the  Land 
and  easily  applied  to  the  desired  part  of  the  fetus. 


^ 


r 


) 


Fig.  94.    Repellers. 

a,  Wither 's  repeller.  ( Sharp  &  Smith )    d,  Cup-shaped  repeller  of  Binz. 

b,  Hinged  repeller.  (Hauptner). 

c,  Reindr.s  repeller  wth  attachments     e,  Giinther's  repeller.   (Hauptner). 

(2  and  3  pronged  repellers,  Ijlunt     f.    Kaiser's  repeller  with  two  detach- 
and   sharp  hooks,    and    vaginal  able  repellers  and  one  cord  carry, 

dilator).      (Hauptner).  ing  hook. 

In  a  large  proportion  of  cases  where  repulsion  is  desired,  the 
fetus  is  dead.  In  such  we  use  a  repeller  having  a  sharp  spike  in 
its  center,  Figs.  94  a  and  106  e,  which  sinks  into  the  tissues  of 
the  fetus  and  gives  the  instrument  a  secure  hold. 

If  the  fetus  is  alive,  the  small  spike,  passing  into  the  soft  tis- 
sues, produces  an  aseptic  wound,  which  heals  without  inflam- 
mation and  without  requiring  material  attention,  so  that  it  is  not 


598  Veterinary  Obstetrics 

highly  objectionable.  In  order  to  overcome  any  such  objection, 
however,  the  spike  should  be  detachable  and,  in  case  the  fetus  is 
alive  and  the  spike  not  absolutely  necessary  to  secure  fixation  of 
the  instrument,  it  may  be  unscrewed  and  removed  and  the  instru- 
ment used  without  it. 

When  using  any  type  of  repeller,  the  hand  of  the  operator 
should  constantly  accompany  the  end  which  is  in  contact  with 
the  fetus  during  the  entire  operation  of  repulsion,  and  thereby 
guide  the  direction  and  amount  of  force  and  guard  constantly 
against  its  slipping  or  doing  injury  to  adjacent  parts.  When  the  re- 
pulsion has  been  accomplished  and  it  isdesired  to  hold  the  fetus  in 
its  position  while  the  operator  carries  out  some  change  in  the  po- 
sition of  an  extremity  or  brings  about  some  other  modification 
in  position,  it  is  allowable  to  take  the  hand  away  from  the  instru- 
ment and  instruct  the  assistant  to  press  steadily  upon  it.  The 
party  handling  the  repeller  must  be  prepared  to  immediately 
withdraw  his  force,  and  even  the  instrument,  in  case  there  is  any 
suspicious  change  in  position  of  the  fetal  body,  especially  if  it 
seems  to  yield  in  such  a  way  as  to  suggest  that  the  instrument 
may  become  displaced. 

Some  obstetrists  condemn  the  repeller  as  a  dangerous  instru- 
ment, but  we  have  not  found  it  so  in  any  case.  We  consider 
that  the  repeller  should  be  used  in  most  cases  where  repulsion  is 
desired  and  that  the  operator  must,  as  a  rule,  abstain  from  using 
his  own  power  for  bringing  about  this  movement  of  the  fetus 
when  others  may  do  it  quite  as  well  or  even  better  if  he  will  but 
place  the  instrument  securely  against  the  desired  portion  of  the 
fetus  and,  accompanying  it  constantly  with  his  hand,  direct  the 
force  of  the  assistant  or  assistants. 

In  the  repulsion  of  the  fetus  it  is  essential  that  th^  uterusshould 
be  extended  somewhat  in  order  for  its  contents  to  move  backward . 
Con.sequently,  whenever  force  is  applied  to  the  fetus  with  the 
idea  of  pushing  it  backward,  it  almost  inevitably  arouses  more  or 
less  vigorous  expulsive  eflForts,  which  tend  to  prevent  the  desired 
repulsion.  Whenever  these  expulsive  efforts  come  on,  little  pro- 
gress, if  any,  can  be  made  in  the  operation,  and  the  operator  must 
wait  until  the  expulsive  efforts  cease  and  then,  by  a  prompt 
thrust,  push  the  fetus  away  toward  the  anterior  end  of  the  uterus. 
During  the  expulsive  efforts,  however,  the  operator  should  at- 
tempt to  prevent  the  fetus  from  being  driven  toward  the  pelvis  or 


histruments  for  Section  599 

into  it,  by  maintaining  a  steady  pressure  in  the  opposite  direction 
and  then  being  ready,  as  soon  as  the  expulsive  efforts  relax,  to 
quickly  accomplish  the  results  which  are  desired. 

Instruments  for  Section. 

Traction  and  repulsion,  with  any  accompanying  changes  in 
the  position  of  the  fetus,  cannot  alwa5's  bring  about  a  sufficiently 
favorable  position  of  the  fetus  or  other  essential  conditions  to  al- 
low of  its  extraction  whole.  Consequently  the  operator  is  fre- 
quently compelled  to  diminish  the  size  of  the  fetus  by  removing 
one  or  more  parts  so  as  to  permit  of  its  easy  passage  through  the 
birth  canal.  For  the  carrying  out  of  embryotomy,  a  greater 
variety  of  instruments  has  been  devi.sed  than  for  any  other 
obstetric  purpose. 

Each  operator  has  his  own  preference  in  the  selection  of  his 
means  for  bringing  about  these  ends,  and  for  each  operator  those 
instruments  to  which  he  is  accustomed  may  be  the  best  because 
there  is  no  place  in  the  realm  of  surgery  where  familiarity  with 
an  instrument  constitutes  .so  great  a  part  of  its  value  to  the  oper- 
ator as  in  embryotomy. 

Knives.  First  and  most  important  in  this  group  of  in.stru- 
ments  are  the  knives,  of  which  we  have  an  infinite  variety  offered 
by  the  various  instrument  makers.  We  may  divide  these  into 
two  great  cla.sses  ;  the  finger-knife,  and  the  short-handled  knife  or 
scalpel. 

The  finger-knife,  Fig.  95,  which  is  attached  to  one  of  the 
fingers  by  means  of  one  or  two  rings,  is  one  of  the  simplest  and 
most  effective  of  all  embrj^otomy  section  instruments,  and  is  per- 
haps the  most  universally  used.  It  is  made  in  various  shapes, 
according  to  the  individual  preferences  of  the  operator.  Most  fre- 
quently it  consists  of  a  somewhat  narrow  blade  which  is  curved 
downw^ard.  The  blade  may  advantageously  be  hooked  for  all 
those  operations  where  it  is  desired  to  make  a  long,  drawing  cut, 
by  inserting  the  hand  to  the  point  where  we  wish  the  incision  to 
begin  and  then  making  the  cut  as  the  hand  is  drawn  outward. 
In  such  a  case  the  hooked  knife  sinks  into  the  tissues  automa- 
tically and  the  operator  .simply  keeps  his  hand  again.st  the  surface 
which  he  wishes  to  cut  and  draws  it  outw^ard. 

Finger  knives,  as  made  by  most  instrument  dealers,  are  too 
long  for  the  average  operator  and  cannot  be  easily  handled.     The 


6oo 


Veterinary  Obstetrics 


operator  with  a  small  hand  cannot  guard  the  ordinary  finger- 
knife  in  such  a  way  that  he  can  readily  introduce  it  to  the  point 
where  he  desires  to  work.  We  have  been  compelled  to  have 
finger-knives  constructed  to  order,  because  of  this  difficulty. 
The  blade  of  the  finger-knife  should  be  of  such  a  length  that, 
when  it  is  placed  upon  the  finger,  the  hand  can  close  about  it  in 
such  a  wa\'  as  to  protect  the  point  completely,  with  safetv  alike 
to  the  operator  and  to  the  patient. 


a,  Full-curved  obstetric  knife. 

b,  Half- curved  obstetric  knife. 

c,  Karl's  embryotomy  knife. 

d,  Giinther's  embryotomy  knife. 


FiNCKR  Knives. 


e,  Vienna  embryotomy  knife. 

f,  Danish  embryotomy  knife,  with 

detachable   blades   of    various 


patterns. 


The  types  of  these  finger-knives.  Fig.  95,  are  exceedingly  vari- 
able, but  the  simpler  ones  a  and  b,  are  perhaps  as  efficient  as  any 
after  the  operator  once  becomes  accustomed  to  them,  though  we 
would  not  say  they  are  superior  to  the  many  other  types.  These 
instruments  admit  chiefly  of  incisions  in  a  line  parallel  to  the  long 
axis  of  the  operator's  hand  and  arm,  and  cannot  very  well  be  used 
for  section  in  a  transverse  direction.  If  we  take  one  of  the  finger- 
knives  with  but  a  single  ring,  which  is  larger  than  the  finger,  it 
may  be  turned  more  or  less  obliquely  across  the  hand  and,  by 
bending  the  hand  .somewhat  akso,  we  may  be  enabled  to  make  a 
transverse  incision. 

Scalpels.  We  also  find  a  very  extensive  list  of  scalpels  or 
bistouries  with    straight    handles,  the    blades  of   which  may  be 


Inst7-2iments  for  Section 


60 1 


either  naked  or  concealed.  In  some  cases  the  blade  is  concealed 
within  the  handle,  and  in  others  by  a  moveable  guard  alongside 
the  blade. 

The  concealed  types  have  a  tendency  to  become  swollen  and 
refuse  to  work  after  they  have  been  imniensed  in  liquids 
for  a  time,  especially  those  with  wooden  or  bone  handles. 
This  criticism  does  not  apply  when  the  instrument  is  constructed 
entirely  of  metal.  A  very  good  type  of  the  concealed  knife  is 
that  of  Kauflfman,  Fig.  96  e,  f.  An  equally  convenient  type  of 
knife,  which  to  us  seems  even  superior,  perhaps  because  we  are 
more  familiar  with  it,  is  the  Colin  scalpel,  Fig.  106  b,  and  as  in 
other  cases  we  greatly  prefer  that  the  instrument  be  constructed 
wholly  of  metal  so  that  the  guard  will  not  become  caught  because 
of  swelling  of  the  handle. 


^J 

fl* 

il'l 

■3 

' 

...       ^L_ 

si 

sii* 

Fig.  96.     Concealed  and  Guarded  Knives. 
a,  b,  c,  Concealed  knife  of  Giinther,        d,  Concealed  knife  of  Deutsch. 


with  convex,  concave  and  double 
edged  blades. 


e,  f,   Guarded  knife  of  Kauffmau, 
with  convex  and  hooked  blades. 


The  advantage  of  the  scalpel  over  the  finger-knife  is  that  it 
may  be  turned  in  any  direction,  so  that  an  incisipn  may  be  made 
longitudinally  or  transversely,  as  the  operator  may  desire.  It  has 
been  suggested  that  an  objection  to  this  kind  of  knife  is  the  pos- 
sibility of  losing  it  in  the  uterus,  but  in  our  clinical  experience 
this  objection  is  not  well  grounded.  To  guard  against  such  a 
possibility,  .some  of  these  instruments  are  made  with  an  eye  at 
the  extremity  of  the  handle,  through  which  a  safety  cord  may 
be  pas.sed  so  that  the  instrument,  if  lost,  may  be  recovered. 


6o2 


Veterinary  Obstetrics 


It  is  important  that  such  scalpels  be  made  very  short  and  the 
handle  be  of  such  a  character  as  to  afford  a  firm  hold.  Such  a 
knife  should  not  exceed  4  inches  in  length,  so  that  it  may  readily 
be  concealed  in  the  hand  and  carried   to  any   part  of  the  uterus. 

Long  Cutting  Hooks,  Sectors  and  Embryotomes.  In  ad- 
dition to  the  finger  knives  and  scalpels,  there  has  been  devised  a 
great  variety  of  larger  instruments  for  section  or  other  divisions 
of  the  fetus,  known  as  long  cutting  hooks,  sectors,  embryotomes, 
etc. 


J 


n 


Fig.  98. 


r\ 


Fig.  97.  Long  Handled  Cutting  Instruments. 

97,  Enibryotome  of  Dopheide.  (Harms).    98.  vSharp  cutting  hook  of  Withers. 

The  Long  Cutting  Hooks  consist  of  long-handled  hooks 
with  the  concave  face  of  the  hook  consisting  of  a  cutting  edge,  as 
in  Fig.  98,  or  h    in  Fig.  106.     The  cutting  end  is  introduced  to 


Instruments  for  Section  603 

the  desired  point  carefully  guarded  by  the  operator's  hand  and  a 
drawing  incision  is  made  as  the  instrument  is  withdrawn,  the 
operator's  hand  still  accompanying  the  hook  and  controlling  the 
extent  and  degree  of  the  cut.  The  sharp  pointed  ones  are  very 
dangerous  to  handle,  and  if  they  are  to  be  used  at  all  ihe  hook 
should  be  very  small  and  short,  so  that  it  can  be  easily  guarded. 
The  long,  stiff  handle  makes  it  exceedingly  difficult  to  safely 
guard  the  instrument  while  it  is  being  introduced,  so  that  any 
violent  expulsive  efforts  or  accidental  movements  of  the  mother 
are  liable  to  cause  a  displacement  of  the  instrument,  with  painful 
consequences  to  the  hand  of  the  operator  or  to  the  uterus  of  the 
mother. 

The  objections  are  overcome  in  some  of  these  instruments  by 
making  the  hook  probe-pointed,  like  in  h  Fig.  106.  This  instru- 
ment is  easily  and  safely  handled  and  proves  highh^  useful 
wherever  it  may  be  applied.  The  obstetrist  may  readily  sever 
the  fetal  ribs  with  it  after  evisceration,  or  may  divide  the  pelvic 
symphysis,  or  the  pelvic  girdle  at  other  points,  or  accomplish  other 
operations.  They  cannot  be  used  for  cutting  the  skin  unless  an 
incision  be  first  made,  through  which  the  probe  or  sphere  may 
be  introduced. 

Embryotomes.  The  group  of  instruments  known  as  embry- 
otonies  are  of  great  variety  in  design  and  purpose.  Some  of  the 
simpler  ones  do  not  differ  essentially  from  the  cutting  hooks. 
The  embryotom  of  Dopheide,  Fig.  97,  consists  essentially  of  a 
closed  knife  attached  to  a  long  and  rigid  handle.  When  introduced 
to  the  part  upon  which  it  is  desired  to  operate,  the  instrument 
opens  automatically  when  the  operator  begins  to  withdraw  it, 
and  may  thus  serve  to  cut  deeply  and  freely  through  the  soft 
tissues.  In  case  it  is  desired  to  stop  the  incision  at  a  given  point, 
it  is  .simply  neces.sary  to  push  the  instrument  backward  again, 
when  it  closes,  and  can  be  grasped  by  the  hand  of  the  operator, 
which  has  been  in  contact  with  it  at  all  times,  and  be  easih'  with- 
drawn. 

The  embryotom  of  Oehmke,  which  appears  to  be  a  very  prac- 
tical instrument,  has  a  lance-like  blade  which  isexpo.sed  by  press- 
ing upon  a  spring  with  the  index  finger  and  is  kept  exposed  as 
long  as  the  pressure  is  continued. 

Most  embryotomes.  Figs.  loi  and  102,  consist  of  more  complex 
machines,  designed  to  cut,  crush  or  tear  through  any  portion  of  a 


6o4 


Veterinary  Obstetrics 


fetus  to  which  they  may  be  applied,  whether  the  tissues  be  soft 
or  hard.  They  have  been  used  in  obstetric  practice  for  a  great 
many  years,  but  have  not  acquired  a  very  wide  application. 

They  consist  in  many  cases  of  two  powerful,  sharp  blades  ope- 
rated as  shears  by  some  mechanism  which  gives  them  sufficient 
power  to  cut  through  an  extremity  at  any  point  where  it  may 
be  grasped.  Sometimes  the  instrument  is  constructed  somewhat 
on  the  plan  of  an  ecraseur,  and  by  .some  mechanical  appliance 
a  sharp  chain  is  forced  through  the  tissues.  Representing  this 
type  of  instrument,  which  has  recently-  become  quite  popular 
in  Germany,  is  the  Pflanz  embryotome,  Fig.  99,  and  the  Pflanz 
extractor,  Fig.  100. 


Fig. 100 

Fig. 9? 

Figs.  99-102.    Embrvotomes,  etc 

99.  Pflanz' embryotome  (Hauptner)      loi.  Obstetric  shears  (Haussman). 
100.   Pflanz' extractor  (Hauptner).         102.   CuUen's  embryotome. 

The  former  consists  of  a  heavy  frame- work  which  might  be 
likened  to  that  of  an  ecraseur,  with  an  ordinar}-  strong  chain, 
which  is  passed  around  the  part  of  the  fetus  to  be  divided.  By 
drawing  upon  this,  the  sharp  chain  or  sector  is  brought  in  contact 
with  the  part  to  be  amputated  and  forced  through  the  soft  tis- 
sues and  bone. 


Instruments  for  Section  605 

The  instrument  is  said  to  be  highly  effective,  but  according  to 
reports  by  some  of  those  who  are  its  most  enthusiastic  admirers, 
it  frequently  cannot  be  applied  to  a  part  which  is  to  be  ampu- 
tated. The  instrument  weighs  approximately  10  pounds,  and  is 
consequently  quite  cumbersome  to  handle.  Its  expense  is  about 
$30  in  America. 

Similar  objections  apply  to  other  embryotomes.  They  are  so 
large  and  heavy  that  they  are  exceedingly  difficult  to  introduce 
into  the  genital  passages  and,  once  this  has  been  done,  the  part 
which  is  to  be  amputated  must  present  in  a  position  essentially 
perpendicular  to  the  long  axis  of  the  pelvic  canal,  since  otherwise 
the  instrument  cannot  be  applied  to  it. 

Aside  from  their  expense,  their  cumbersomeness  in  carrying 
and  the  difficulty  or  impossibility  of  applying  them  to  the  desired 
part,  they  are  exceedingly  difficult  to  properly  care  for  and  dis- 
infect. When  once  applied,  their  action  is  generally  satisfactory, 
if  not  ideal.  The  extractor  of  Pflanz,  Fig.  100,  is  designed 
through  its  powerful  mechanism  to  tear  away  a  fetal  limb,  the 
ring  at  the  distal  end  receiving  the  entire  impact  of  the  tension 
upon  the  limb  by  the  chain,  thus  relieving  the  maternal  parts 
from  any  pressure  whatever. 

Chain- Saws.  Somewhat  closely  allied  to  the  embryotomes 
are  the  chain-saws,  like  that  of  Persson,  Fig.  103  a,  or  the  chain 
sector  of  Masch,  Fig.  103  b,  which  have  been   recommended  for 


Fig.  103.     Obstetric  Saws  .\nd  Sectors. 

a,  Persson's  obstetric  saw.       b.  Chain  sector  of  Masch. 

c,  Obstetric  saw  of  Ohmke. 

the  same  purposes  as  the  embyrotomes  and  are  operated  by  being 
passed  around   the  limb  or   neck  of   the    fetus   which    is    to    be 


6o6  Veteyi7iary  Obstetrics 

amputated  and  then  drawn  back  and  forth  in  a  sawing  man- 
ner. They  are  effective  in  their  work  and  in  some  cases  offer 
special  advantages,  but  on  the  whole  they  have  not  come  into 
general  use.  They  are  comparatively  expensive,  rather  difBcult 
to  apply,  are  not  very  rapid  in  execution,  and  are  exceedingly 
difficult  to  maintain  in  aseptic  and  working  condition. 

Stiff-handled  obstetric  saws  are  also  recommended  by  some 
practitioners.  Short  finger  saws,  with  short  handle  and  finger- 
ring  like  c,  Fig.  103,  are  recommended  by  some,  but  they  have 
little  efficiency  in  most  cases  because  wholly  dependent  upon  the 
inserted  hand,  tightly  compressed  and  largely  powerless,  for  any 
use.  Long  handled  saws  are  more  workable  because  the  saw  can 
be  guarded  with  the  inserted  hand  and  the  force  applied  with 
the  free  hand.  The}-  can  be  used  in  no  operation  and  applied  to 
no  part  for  which  the  obstetric  chisel  is  not  equally  efficient  and 
safe.  We  have  repeatedly  attempted  the  use  of  chain-saws, 
sectors,  and  stiff  handled  saws,  and  have  always  laid  them  aside 
as  greatly  inferior  to  chisels. 

Obstetric  Chisels.  The  simplest  and  most  effective  imple- 
ment for  section  of  fetal  bones  is  the  embryotomy  chisel,  which, 
like  other  instruments,  is  constructed  in  a  variety  of  forms.  We 
use  a  chisel,  Fig.  106  d,  made  of  the  best  steel,  of  ^  or  f^  inch 
diameter,  and  about  30  inches  in  length,  with  the  chisel  end 
about  2  inches  wide  and  tapering  gradually  backward  toward  the 
handle  for  a  distance  of  4  or  5  inches.  The  chisel  blade  is  about 
TF  to  }(  i"-  thick,  so  that  it  may  safely  pass  through  the  hardest 
bone  in  the  fetal  body,  and  the  cutting  edge  of  the  chisel  is  made 
slightly  concave  in  order  to  render  it  less  liable  to  slip  to  one  side. 

Such  a  chisel  is  readily  kept  in  order  and  is  easily  applied  by 
the  operator  to  any  portion  of  the  fetus  which  is  within  his 
reach.  Grasping  the  chisel  blade  in  his  hand,  he  carries  it  to 
the  part  to  be  operated  upon  and,  placing  the  instrument  in  the 
best  direction  possible,  against  the  part,  he  instructs  an  assistant 
to  drive  it  through  the  tissue  with  a  mallet  or  hammer.  When 
driving  the  instrument  through  bone,  it  should  be  forced  but  a 
.short  distance  at  a  time,  then  loosened  and  perhaps  revolved  on 
its  long  axis  in  order  to  pry  the  bones  apart  and  also  to  avoid 
driving  the  chisel  too  far  and  having  it  become  caught  in  such  a 
way  that  it  is  difficult  to  remove  it. 

In  amputating  a  limb,  the  chisel  should  not  be  placed  upon  its 


Instruments  for  Section 


607 


center,  but  at  one  side,  so  that  it  will  cut  completely  through  the 
tissues  on  that  side  to  which  it  is  applied,  and  not  be  driven 
clear  through  the  limb  with  some  of  the  tissues  intact  upon  either 
side  and  thus  be  caught  and  held  as  though  in  a  vice. 

Such  an  instrument   is  cheap,  is  easily  and  safely  applied  by 
the  operator  to  any  point  within  his  reach,  can  be  readily  driven 


r 


\ 


Fig.  104.     Obstetric  Chisels. 

a,  deBi;uin's  vertebra  knife. 

b,  de  Bruin's  embryotomy  chisel. 

c,  Withers'  embr3'otomy  chisel. 


Fig.  105.     Spatulas. 

a,  Spatula  of  Harms. 

b,  Spatula  with  handle. 

c,  Small  spatula  of  deBruin. 

d,  Curved  spatula  of  de  Bruin. 


through  any  tissue  of  the  body  whether  soft  or  hard,  has  little 
tendency  to  break  or  get  out  of  order,  is  easily  kept  clean,  and 
will  accomplish  any  task  in  embryotomy  which  can  be  performed 
by  the  chain-saw,  by  the  Pflanz  embryotome  or  by  any  machine 
however  complicated  or  expensive.  It  can  be  applied  to  any 
part  where  the  other  in.struments  can  and  in  many  places  where 
they  cannot  be  at  all,  or  only  with  very  great  difficulty.     In  the 


6o8  Veten'7iarv  Obstetrics 

amputation  of  the  pelvis  and  posterior  limbs,  in  the  breech  pre- 
sentation, it  is  the  instrument  par  excellence.  In  the  amputation 
of  the  limbs  it  is  quickly  applied  and  safe,  and  its  work  is  rapid 
and  efficient.  Other  types  of  obstetric  chisels,  all  efficient,  are 
shown  in  Fig.  104. 

Supplementary  to  these  instruments  for  section,  there  have 
been  introduced  and  recommended  by  various  operators  a  group 
of  blunt,  flat  instruments  known  as  spatulae,  which  are  designed 
primarily  for  the  purpose  of  separating  the  skin  of  the  fetus  from 
the  subjacent  tissues.  They  have  a  degree  of  merit,  and  aid  con- 
siderably at  times  in  hastening  the  operation  of  detaching  the 
skin  from  the  fetus,  and  thus  facilitate  an  early  completion  of 
the  operation.  Like  all  the  other  instruments  they  are  made  in 
a  great  variety  of  types.  Some  of  the  most  useful  of  these  are 
shown  in  Fig.  105.  They  are  not  essential,  but  rather  auxiliary, 
and  their  place  may  well  be  taken  by  other  instruments. 
The  chisel,  which  we  have  already  described,  an.swers  quite  well 
the  purpose  of  a  spatula  at  any  points  where  the  resistance  may 
be  very  great,  while  elsewhere  we  are  in  the  habit  of  using  the 
thumb  or  fingers  or  the  entire  hand  for  .separating  the  skin  from 
the  under-lying  parts. 

General  Observations   Upon  the  Construction  of 
Obstetric  Instruments. 

We  have  already  suggested  casually  that  obstetric  instruments 
should  be  of  such  a  character  as  to  render  them  easily  cleaned. 
In  our  personal  experience  we  have  found  that  instruments  are 
most  readily  kept  in  order  when  they  are  constructed  of  a  good 
quality  of  .steel,  highly  polished  and  nickel  plated.  Such  instru- 
ments are  not  readily  attacked  by  rust,  are  very  clean  aud  pre- 
sent the  smoothest  po.ssible  surface,  so  as  not  to  irritate  the 
genital  organs.  The  instruments  should  be  as  smooth  and  well- 
rounded  in  all  their  parts  as  is  practicable,  not  only  that  they 
may  work  more  readily,  but  also  that  there  may  be  less  oppor- 
tunity for  the  collection  of  dirt  at  any  point,  which  may  interfere 
with  their  operation  or  constitute  a  bearer  of  infection.  This 
naturally  suggests  that  the  instruments  should  be  of  the  simplest 
character  consistent  with  efficiency  and  that  screws,  joints,  links 
and  chains  should  be  avoided  whenever  and  wherever  practicable. 

There  has  recently   entered  into  veterinary  practice,  in  both 


Cotistricdion  of  Obstetric  Instriunents  609 

Europe  and  America,  a  strong  tendeuc}^  to  the  construction  of 
sectional  instruments  which  may  be  unscrewed  and  consequently 
occupy  a  small  compass,  or  rather  a  shorter  space,  than  if  made 
solid  in  a  single  length.  It  must  be  granted  that  such  instru- 
ments admit  of  being  placed  in  a  more  compact  case,  and  this  is 
really  the  only  advantage  which  can  be  claimed  for  this  plan  of 
construction. 

The  plan  possesses  many  disadvantages.  The  jointed  instru- 
ment is  inevitably  weaker  than  the  solid  one,  and  must  be  made 
heavier  in  order  to  compen.sate  for  the  joint.  The  joint,  espe- 
cially the  female  scre^v,  constitutes  an  ever  present  danger  from 
the  standpoint  of  infection  and  renders  the  instrument  exceed- 
ingly difficult  to  clean.  One  of  the  most  serious  objections  to 
the  obstetric  instrument  with  a  screw  joint  is  its  inefficiency  at  a 
critical  moment.  An  operator  works  for  a  long  time  to  apply  an 
instrument  at  the  proper  point  in  order  to  accomplish  a  certain 
purpose,  and,  just  as  he  is  ready  to  do  his  work,  a  sudden  move- 
ment of  the  animal,  or  other  causes,  leads  to  an  unscrewing  of 
the  instrument.  His  time  and  labor  have  been  wholly  lost  ;  the 
instrumeift  must  be  withdrawn  and  the  screw  joint  tightened 
and  the  operator  must  begin  over. 

It  is  a  custom  also,  of  the  instrument  makers,  to  fit  a  series  of 
obstetric  instruments  to  one  handle  by  means  of  a  screw,  with 
the  idea  that  they  thereby  render  the  outfit  cheaper,  lighter  and 
more  compact.  This  plan  has  a  very  serious  disadvantage  in 
reference  to  efficiency  in  practice.  Convenience  in  carrying  an 
instrument  should  be  subordinate  to  the  question  of  efficiency 
when  the  operator  has  reached  his  case.  If  he  has  been  using 
an  adjustable  handle  with  a  hook,  and  finds  that  he  would  like 
very  much  to  have  a  repeller  instead,  he  will  perhaps  find  the 
hook  so  tightly  .screwed  fast  that  he  cannot  release  it  and  must 
ask  some  bystander  with  dirty  hands  to  unscrew  it  for  him.  In 
the  meantime  dela}'  of  an  important  character  may  have  occurred, 
and  the  position  of  the  fetus  may  have  undergone  unfavorable 
change. 

He  may  desire  to  hold  a  certain  part  with  the  hook  while 
he  uses  the  bone  chisel  or  some  other  instrument,  and  he  is  with- 
out a  handle  for  the  other,  .so  that  he  cannot  simultaneously  use 
the  two.  At  every  point  the  plan  of  a  universal  handle  for  all 
obstetric  instruments  is  wasteful  of  time  and  detrimental  to  effi- 
39 


6io  Veterinary  Obstetrics 

ciency.  After  all,  the  gain  in  reference  to  compactness  is  not 
very  great.  If  the  instruments  are  solid  throughout  their  entire 
length,  the  case  or  roll  to  contain  them  is  necessarily  longer,  but 
need  not  be  so  wide  nor  so  thick,  and  the  actual  cubic  space  oc- 
cupied by  them  is  not  changed.  The  weight  is  no  greater  with 
the  solid  instrument  than  the  jointed  one.  It  is  therefore  a 
question  of  the  form  of  a  container  and  not  of  its  cubical  con- 
tents or  weight.  We  are  therefore  strongly  in  favor  of  a  solid 
instrument,  believing  that  with  it  the  veterinarian  can  do  more 
rapid,  more  efficient  and  safer  work. 

The  handles  of  obstetric  instruments  are  variously  formed  and 
have  certain  advantages  in  their  structure.  In  our  judgment 
and  experience,  the  most  efficient  handle  is  that  consisting  of  an 
oval  ring  of  sufficient  size  for  the  insertion  of  a  man's  hand,  or 
we  might  say  of  a  width  of  3}^  inches.  The  advantage  of  such 
a  handle  is  that  it  gives  a  secure  hold,  through  which  the  opera- 
tor may  exert  his  full  force  in  anj'  direction  that  he  may  wish, 
and  supplies  a  form  of  handle  which  is  not  readily  caught  or  en- 
tangled upon  surrounding  objects.  With  this  ring  handle,  the 
operator  or  an  assistant  can  exert  his  full  power  either  in  repul- 
sion or  in  traction,  or  may  revolve  the  instrument  upon  its  long 
axis  or  push  it  in  any  direction.  The  revolving  of  the  instru- 
ment upon  its  long  axis  is  frequently  of  supreme  importance  in 
obstetric  operations,  and  one  needs  have  a  secure  hold  in  order 
to  accomplish  this  movement. 

It  is  especially  important  to  be  able  to  rotate  a  chisel  upon  its 
long  axis  when  it  is  being  driven  through  bones  and  it  is  desired 
to  break  apart  and  separate  the  bone  which  has  been  only  par- 
tially divided.  It  is  also  highly  important  that  the  operator  or 
a.ssistant  shall  be  able  to  revolve  the  instrument  upon  its  long 
axis  in  case  he  is  attempting  to  implant  a  hook  in  a  given  part. 
The  repeller  also  is  much  safer  if  the  operator  or  assistant  can 
control  it  completely  and  either  turn  it  upon  its  long  axis  or  pre- 
vent it  from  turning,  as  demanded.  The  other  forms  of  handle 
ordinarily  seen  in  obstetric  instruments  are  the  straight  or  olive- 
shaped  handle,  usually  of  wood,  and  the  bar  or  transverse  handle, 
usually  of  metal.  The  olive-shaped  handle  is  in  many  respects 
the  neatest  and  occupies  less  space  in  a  container,  but  it  is  de- 
cidedly wanting  in  efficiency  as  compared  with  the  ring  handle. 


Obstetric    Outfits  6ii 

The  bar  handle  is  efficient,  but  we  believe  it  less  convenient  for 
grasping  than  the  ring,  and  the  projecting  bars  tend  to  catch 
against  objects. 

Obstetric  Outfits. 

We  have  already  asserted  that  the  veterinarian  should  have 
ready  at  hand  an  outfit  for  obstetrics,  which  he  can  secure 
promptly  upon  the  receipt  of  a  call,  knowing  that  he  will  have 
in  his  possession  every  instrument  and  appliance  or  other  ma- 
terial which  the  exigencies  of  difficult  labor  may  demand.  Instru- 
ment makers  in  many  instances  prepare  sets  of  obstetric  instruments 
in  neat  cases,  which  are  very  convenient  in  so  far  as  the  instru- 
ments themselves  are  concerned.  They  contain,  as  a  general 
rule,  an  extensive  array  of  instruments  which,  in  mauj-  cases,  are 
better  fitted  to  impress  the  bystander  than  to  accomplish  efficient 
work.  The  obstetrist's  outfit  need  not  be  expensive  nor  consist  of 
a  great  number  of  instruments  or  appliances.  We  would  suggest, 
as  a  simple  outfit  of  instruments,  the  following  articles,  as  shown 
in  Fig.  io6  : 

I.  Two  %  inch  cotton  cords,  two  -^s  inch  cotton  cords,  one  }4 
inch  cotton  cord,  each  4  or  5  feet  in  length,  with  a  pre- 
pared loop  at  one  end,  and  the  other  securely  wound  with  thread 
to  prevent  untwisting  ;  2.  long,  blunt  hook  ;  3.  short  blunt  hook  ; 
4.  chisel  ;  5.  repeller  ;  6.  finger-knife  ;  7.  scalpel  ;  8.  injecting 
pump.  We  use  a  small  pump  to  which  is  attached  a  pure  gum 
horse  stomach  tube  to  serve  as  tube  and  nozzle.  The  apparatus 
is  simple,  easily  cleaned,  withstands  boiling  perfectly,  and  the 
distal  end  of  the  tube  is  sufficiently  rigid  to  serve  all  purpo.ses  of 
a  nozzle,  while  so  pliable,  well-rounded,  smooth  and  soft  that  it 
cannot  well  injure  even  very  delicate  tissues.  The  horse  stom- 
ach tube  with  an  ordinary  funnel  makes  an  excellent  gravity  in- 
jector, in  some  respects  preferable  to  the  pump.  It  is  quite  as 
efficient  and  durable,  is  cheaper,  and  lighter  to  carry. 

These  instruments  we  would  have  placed,  in  an  orderly  manner, 
in  a  compact  case  of  metal  (tinned  copper)  or  in  a  canvass  roll, 
so  that  we  could  at  anj'  time  thoroughly  disinfect  the  case,  either 
with  or  without  the  instruments,  by  inmiersing  it  in  an  antiseptic 
fluid  or  by  boiling.  The  tinned  copper  case  could  be  filled  with 
hot  water  and  placed  upon  a  stove,  where  it  could  be  boiled  for 
any  length  of  time  desired,  and  both  the  case  and  contained  in- 
struments rendered  thoroughlv  sterile. 


6l2 


Veterinary  Obstetrics 


If  it  is  desired  to  protect  a  metal  case  of  this  character  in  hand- 
ling and  carrying,  it  can  be  enclosed  in  a  canvass  jacket.  In  ad- 
dition to  the  instruments  which  we  have  suggested  here,  the  vet- 
erinarian may  readily  add  others,  which  he  can  include  in  the 
same  case  if  he  desires,  and  which  may  in  his  experience  possess 
a  very  high  value  which  would  fully  warrant  their  use. 

For  a  number  of  vears  we  carried  a  list  of  instruments  consid- 


FiG.  io6.     Ohstetric  Set. 


a,  Aseptible  tinned  copper  case. 

b,  Tray  containing  i  short  blunt  hook, 

I    Colin's    scalpel,  r    curved    finger 
knife,  and  i  .straight  finger  knife. 

c,  Enema  pump,  with  puregutn  stom- 
ach tube  instead  of  customary  tube 
and  nozzle. 

d,  Embryotomy  chisel. 


e,  Repeller  with  detachable  spike. 

f,  Curved  cord  carrier  which  may  be 

used  as  a  blunt  hook. 

g,  Long  blunt  hook. 

h.  Long-handled  cutting  hook  with 
probe  point,  for  severing  ribs  and 
pelvic  bones. 


erably  in  excess  of  those  which  we  have  here  designated,  but 
from  time  to  time  first  one  and  then  another  was  discarded  or 
left  unu.sed,  until  finally  they  were  narrowed  down  to  the  very 
brief  list  which  we  have  here  suggested. 

In  addition  to  this  outfit  of  instruments,  there  are  other  neces- 


Obstetric   Outfits  613 

saries  which  the  veterinarian  should  always  carr^-  in  cases  of 
dystokia,  but  which  we  would  prefer  to  not  include  within  the 
instrument  case,  but  would  carry  in  a  second  container.  This,  like 
the  instrument  case,  should  be  of  a  construction  which  would 
render  it  capable  of  complete  and  thorough  disinfection  or  sterili- 
zation, and  to  this  end  we  would  have  it  constructed,  like  the 
other,  of  canvas  or  of  metal.  In  it  we  should  carry  :  clothing 
for  the  operator  ;  disinfectants,  including  creolin,  lysol  and 
iodoform  ;  anaesthetics  ;  general  operating  instruments,  includ- 
ing a  trachea  tube  and  trocar  ;  hypodermic  syringe  ;  strychnine 
ergotine  or  other  hypodermic  remedies. 

In  the  experience  of  different  practitioners,  other  apparatus  or 
materials  may  be  suggested.  Some  of  the  German  operators  aim 
to  carry  with  them  constantly  some  form  of  truss  or  bandage  to 
prevent  prolapse  of  the  uterus  or  vagina  after  parturition,  while 
others  advise  the  carrying  of  an  obstetric  pulley  or  other  means 
for  developing  mechanical  force. 

The  Dress  of  the  Operator. 

In  dressing  for  an  obstetric  operation,  the  veterinarian  should 
have  due  regard  for  his  personal  health  and  comfort,  for  the 
safety  of  himself  and  the  animal  from  infection,  and  for  conven- 
ience and  economy.  He  is  quite  unwarranted  in  going  into 
work  with  dirty  clothing,  which  may  be  the  bearer  of  serious  in- 
fection for  the  mother,  and  is  equally  unwarranted  in  ruining 
expensive  clothing  in  the  course  of  his  work. 

The  habit  of  some  veterinarians  of  wearing  overalls  which  have 
been  used  in  general  work  and  have  been  befouled  with  dis- 
charges from  suppurating  wounds,  putrid  afterbirths  or  in  pre- 
vious cases  of  parturition,  without  having  been  thoroughly 
washed  and  cleansed,  cannot  be  too  strongly  condemned. 

Two  features  should  be  considered  in  the  question  of  clothing. 
It  should  afford  the  obstetrist  ample  protection  from  cold  and 
wet,  and  should  be  scrupulously  clean.  Whenever  the  weather 
and  surroundings  will  permit,  one  of  the  most  convenient  and 
efficient  methods  for  operating  is  for  the  practitioner  to  strip  to 
his  waist  line,  and  whenever  conditions  will  not  warrant  this  he 
should,  after  stripping,  put  on  a  white  blouse  without  sleeves, 
which  has  been  thoroughly  washed  and  boiled  and  is  at  least 
practically,  if  not  technically  sterile.     If  it  is  necessary  for  his 


6 14  Veterinary  Obstetrics 

comfort  that  he  shall  wear  still  more  clothing  about  his  chest,  it 
should  consist  of  cotton  under-clothing  without  sleeves. 

One  may  work  fairly  well  in  a  blouse  with  long  sleeves  bj' 
rolling  them  up,  but  the  rolled  sleeves  soon  become  saturated 
with  discharges  from  the  animal  and  probably  annoy  the  opera- 
tor also  by  becoming  unrolled.  Moreover,  the  roll  interferes  to 
some  degree  with  the  reach  of  the  arm,  and  the  operator  cannot 
bring  the  shoulder  in  so  close  contact  with  the  vulva  of  the 
patient. 

Some  writers  upon  obstetrics  advise  the  use  of  woolen  instead 
of  cotton  clothing  and  speak  especially  of  a  warm  woolen  jacket, 
but  this  material  is  difficult  to  cleanse  because  it  will  not  with- 
stand boiling.  The  operator  is  consequently  forced  to  resort  to 
the  use  of  disinfectants  which  may  prove  more  or  less  inefficient 
for  the  purpose  desired. 

The  protection  of  the  lower  parts  of  the  body  from  the  waist 
down  offers  a  problem  which  varies  greatly  under  different  con- 
ditions. In  protracted  cases  of  dystokia,  ordinary  overalls  of 
ducking  fail  to  protect  the  operator's  clothing,  and  he  becomes 
quite  wet. 

Occasionally  also  the  operator  must  kneel  or  lie  down  behind 
a  recumbent  animal  in  a  place  which  is  none  too  clean,  with  the 
result  that,  with  any  form  of  pervious  clothing,  he  is  soon  sat- 
urated to  the  skin.  To  guard  the  operator  in  these  respects  the 
best  plan  that  we  have  found  is  the  wearing  of  rubber  trousers, 
which  are  highly  efficient  for  the  purpose  and  are  reasonably 
cheap  and  durable.  These  trousers,  made  of  rubber  cloth,  are 
quite  impervious  to  fluids  of  every  kind,  so  that  one  can  kneel, 
sit  or  lie  in  any  position  behind  a  recumbent  animal  with  im- 
punity. If  to  these  we  add  rubber  boots,  the  operator  is  in  a 
position  to  thoroughly  protect  himself  and  to  come  out  of  the 
worst  and  most  repulsive  dystokia  reasonably  clean  and  com- 
fortable. The  rubber  trousers  and  boots  have  the  disadvantage 
of  not  being  very  resistant  to  some  antiseptics.  A  strong  solution 
of  carbolic  acid  may  ruin  the  fabric.  However,  they  will  with- 
stand a  moderately  strong  solution  of  antiseptics  with  comparative 
impunity,  and  wash  so  easily  that  they  can  be  quite  thoroughly 
cleansed  in  a  mechanical  way.  They  may  be  quite  well  disin- 
fected after  use  with  a  solution  of  corosive  sublimate,  or  still 
better  with  formalin. 


Position  and  Control  of  Patient  615 

Position  and  Control  of  the  Patient. 

One  of  the  most  disagreeable  features  to  the  veterinarian  is  the 
surroundings  in  which  he  finds  his  patient  and  is  compelled  to  do 
his  work.  In  many  cases  this  is  inimical  to  his  comfort  and 
health,  and  it  is  sometimes  a  question  how  far  it  is  proper  for 
him  to  ignore  these  factors  in  the  course  of  his  professional  du- 
ties. It  is  clearly  the  duty  of  the  owners  of  animals  to  provide  a 
comfortable  and  proper  place  in  which  the  veterinary  obstetrist 
may  work,  and  it  is  clearly  not  the  duty  or  function  of  the  veteri- 
narian to  ignore  comfort  beyond  a  reasonable  degree. 

Sometimes  a  stable  is  exceedingly  cold,  but  this,  as  a  rule,  does 
not  seriously  discomfort  the  veterinarj-  obstetrist,  since  once  he 
is  engaged  in  his  work  he  can  usually  keep  warm,  and  it  is  less 
difficult  and  disagreeable  for  him  than  for  the  bystanders,  but 
even  this  discomfort  should  not  be  carried  too  far.  The  veteri- 
narian is  entitled  to  demand  a  reasonably  comfortable  place  for 
his  work. 

Sometimes  the  place  for  his  work  is  disagreeably  hot,  and  we 
have  suffered  at  times  from  working  upon  a  recumbent  animal  in 
the  bright  sunlight,  our  arms  having  been  badly  blistered  by  the 
sun's  rays.  Clearly  it  is  the  duty  of  the  owner  of  an  animal  in 
such  a  position  either  to  provide  some  means  for  transporting  it 
elsewhere  or  a  shade  for  the  protection  of  the  operator  during 
the  work. 

In  many  cases  we  find  the  animal  affected  with  dystokia  con- 
fined in  an  exceediligly  filthy  place,  where  we  cannot  touch  any- 
thing without  becoming  begrimed  with  dirt.  The  veterinarian 
should  demand  that  such  a  place  be  cleaned  up,  and  that  appro- 
priate tables  or  other  conveniences  be  supplied  upon  which  his 
instruments  and  apparatus  can  be  placed,  where  they  can  be 
handled  without  getting  them  befouled.  In  other  instances,  the 
stall  or  stanchion  is  wet  and  filth}^  from  feces  and  urine.  The 
practitioner  should  demand  that  the  filth  be  removed  and  an 
abundance  of  clean,  dry  straw  or  hay  supplied  to  cover  over  the 
floor  of  the  stall  and  surrounding  parts  where  the  work  must  be 
done. 

Sometimes  the  room  is  inadequate,  so  that  one  cannot  operate. 
The  room  may  even  be  unsafe,  as  when  an  upright  post  stands 
in  close  proximity  to  the  rear  end  of  the  patient,  so  that  in  case 


6i6  Veterinary  Obstetrics  ^ 

of  lateral  movements  the  operator  may  be  caught  between  the 
post  and  the  patient  and  his  arm  more  or  less  seriously  injured. 
In  other  cases  a  cow  suffering  from  dystokia  may  be  confined  in 
a  stanchion  with  a  deep  gutter  behind  her,  and  this  may  form  a 
constant  menace  to  the  veterinarian,  if  he  makes  a  misstep.  If 
an  animal  must  be  operated  upon  with  such  a  gutter  in  close 
proximity,  it  .should  be  securely  covered  over  with  boards  in  such 
a  manner  as  to  insure  against  accident,  and  over  the.se  there 
should  be  spread  a  goodly  amount  of  clean  bedding. 

If  the  room,  where  the  animal  suffering  from  dystokia  is  con- 
fined, is  wholly  inadequate  for  any  of  the  reasons  which  we  have 
mentioned  or  for  others,  the  animal  should  be  removed  to  a 
proper  place  for  the  work.  If  a  mare  or  cow  is  able  to  walk,  it 
is  an  easy  matter  to  move  her  to  another  building,  where  rea- 
sonable comfort  and  convenience  can  be  had  ;  but  if  she  is  re- 
cumbent it  is  still  no  bar  to  getting  her  into  a  comfortable  place. 
If  a  goodl}^  amount  of  bedding  is  thrown  upon  the  floor,  a  cow 
or  mare  can  be  taken  b}^  4  or  5  men  for  a  few  feet,  or  a  few  rods 
for  that  matter,  without  much  delay  or  difflculty,  if  the  veterina- 
rian knows  how  to  control  their  efforts.  For  this  purpose  it  may 
be  necessary  to  demolish  a  partition  or  to  take  other  action 
which  maj^  to  some  extent  injure  the  owner's  property  or  cause 
him  some  labor  to  repair,  but  the  operator  is  entitled  to  such 
surroundings  as  will  furnish  him  with  a  reasonable  degree  of 
safety  and  comfort  and  permit  him  to  do  his  work  in  a  way 
which  will  promise  some  hope  of  success.  In  many  instances  the 
obstetrist  must  put  up  with  very  numerous  inconveniences,  but 
these  should  be  reduced  to  a  minimum. 

The  position  of  the  pregnant  animal  during  obstetric  opera- 
tions is  of  fundamental  importance.  Generally,  in  the  larger 
animals  most  operations  can  be  best  carried  out  with  the  patient 
in  the  standing  position.  In  this  position  the  abdominal  floor 
slopes  downward  and  forward  below  the  pubis  and  the  gravid 
uterus  drops  forward  toward  the  diaphragm.  This  admits  of 
more  ready  repulsion  of  the  fetus,  facilitates  the  correction  of 
any  deviations  in  its  extremities,  and  favors  the  carrying  out  of 
most  obstetric  operations. 

Sometimes  the  animal,  especially  the  cow,  is  exceedingly  ob- 
stinate and  refuses  to  stand  even  under  the  greatest  punishment. 
It  is  usually  of  little  use  to  lift  the  cow  by  force,  becau.se  she 


Position  and  Control  of  Patient  617 

absolutely  refuses  to  try  to  stand.  If  slings  are  placed  under  her 
and  she  is  raised  by  means  of  pulleys,  she  still  thwarts  the  ob- 
stetrist's  aim  by  lying  limp  in  the  apparatus  and  producing  the 
same  or  even  worse  conditions  than  though  she  were  lying  down. 

The  most  efficient  method  of  getting  an  obstinate  cow  to  stand 
is  by  means  of  a  well-trained  dog.  When  such  a  dog  is  brought 
into  the  stall  and  will  take  hold  of  the  cow  in  a  vigorous  manner, 
if  she  has  enough  strength  to  rise,  she  will  get  up  very  promptly, 
and,  as  long  as  the  dog  will  stand  b3^  ready  to  interfere  the  mo- 
ment she  attempts  to  lie  down,  she  will  continue  to  stand  as  long 
as  she  is  able.  It  might  not  be  an  unwise  plan  for  the  veterinary 
obstetrist,  with  much  cattle  obstetrics,  to  regard  a  well- trained 
dog  as  a  part  of  his  obstetric  equipment  and  have  the  animal  ac- 
company him  in  all  cases  of  dystokia,  read}'  to  render  such  a 
service. 

Some  animals  suffering  from  dystokia  are  vicious,  and  the  op- 
erator must  take  precautions  against  injury  from  them.  In 
carnivora  it  is  wise  to  muzzle  the  patient  before  attempting  any 
work  which  may  induce  any  vicious  resistance.  In  ruminants 
there  is  almost  no  danger  to  the  operator  because  of  any  vicious- 
ness  upon  the  part  of  the  patient.  Very  rarely  the  cow  may 
kick,  but  this  we  have  not  observed. 

It  is  very  rare  that  the  mare  offers  any  violent  resistance  to  the 
work  of  the  operator.  Some  have  suggested  that  in  all,  or  in 
most  cases,  an  assistant  should  hold  up  the  mare's  forefoot,  but 
in  an  extensive  experience  among  mares  we  have  encountered 
only  one  which  required  any  definite  restraint  in  so  far  as  vicious- 
ness  was  concerned.  Almost  always  the  mare  stands  quietly,  or 
at  most  merely  steps  from  side  to  side,  and  does  not  offer  to  kick. 
In  the  one  exception  in  our  experience  we  found  it  necessary  to 
cast  the  mare  and  tie  all  four  feet,  because  she  persistently  and 
viciously  kicked  and  fought,  and  rendered  our  work  both  highly 
dangerous  and  wholly  inefficient  until  she  was  thoroughly  secured. 
The  securing  of  the  animal,  by  tying,  compressed  the  abdomen 
and  greatly  increased  the  difficulty  of  our  operation.  The  diffi- 
culty would  have  been  largely  obviated  by  general  anaesthesia. 

Although  the  standing  position  is  usually  the  most  favorable 
one  for  operating,  it  is  not  uniformly  so,  and  in  some  instances 
recumbency  is  preferable. 

Whether  the  recumbency  is  unavoidable  or  is  brought  about 


6i8  Veterhiary  Obstetrics 

by  the  operator  for  special  reasons,  the  position  of  the  recumbent 
animal  is  highly  important. 

If.  for  instance,  an  animal  is  recumbent  and  there  is  a  deviation 
of  the  fetal  head  toward  the  left  side  of  the  mother,  it  would  be 
highly  unfavorable  for  the  operator,  should  the  mother  lie  upon 
her  left  side,  because  the  weight  of  the  fetal  body  would  thus  be 
thrown  upon  its  head.  This  would  necessitate  lifting  the  fetal  body 
in  order  to  correct  the  deviation  of  the  head  and  bring  it  into  the 
proper  position.  If  the  patient  lay  upon  her  right  side  instead,  the 
fetal  head  would  rest  upon  its  body  and  it  would  be  more  readily 
extended.  Hence  in  many  instances  it  is  desirable  to  change  the 
attitude  of  the  recumbent  animal  or  even  to  cast  the  patient  in 
order  to  effect  certain  manipulations  or  changes  of  position.  Us- 
ually, when  an  animal  is  recumbent,  she  should  be  placed  with  her 
hind  parts  elevated,  in  order  that  the  fetus  may  drop  away  forward 
toward  the  diaphragm,  and  afford  increased  room  and  facility 
for  repulsion,  changes  in  position  or  other  desired  operations. 
It  is  important  generally  that  the  recumbent  animal  should  lie 
prone  upon  her  side  with  all  her  limbs  free  and  extended. 

It  is  very  disadvantageous  to  the  operator  for  the  patient  to 
lie  upon  her  sternum,  since  this  position  causes  undue  pressure 
upon  the  abdomen  and  crowds  the  gravid  uterus  against  or  into 
the  pelvis  so  tightly  as  to  render  repulsion  well  nigh  impossible, 
and  any  other  changes  in  the  position  of  the  fetus  or  the  correc- 
tion of  any  deviation  of  an  extremity  very  difficult. 

In  order  to  elevate  the  hind  quarters  of  a  recumbent  animal, 
extra  bedding  may  be  placed  beneath  the  posterior  parts  to  any 
degree  desired.  Sometimes  advantage  may  be  taken  of  sloping 
ground,  like  a  terrace,  and  we  have  placed  such  an  animal  in  a 
door-way  where  the  floor  within  was  higher  than  the  ground  with- 
out. Padding  the  door  well  with  straw,  the  cow  is  placed  with 
her  head  outward  and  her  buttocks  in  the  stable,  at  a  higher 
elevation. 

The  elevation  of  the  posterior  parts  may  also  be  brought  about 
by  placing  the  recumbent  animal  upon  a  heavy  door  or  on  a 
platform  of  heavy  boards,  and  raising  that  portion  of  the  door  or 
platform  upon  which  the  posterior  portion  of  her  body  rests,  sup- 
port it  by  means  of  blocks  placed  underneath.  Usually,  the 
greater  the  elevation  of  the  posterior  parts  of  the  recumbent  ani- 


Position  of  the  Patient  619 

mal,  the  better  for  the  operator.  In  order  to  prevent  the  patient 
from  sliding  down  the  incline,  ropes  maj-  be  attached  to  the  hind 
feet,  and  held  by  assistants  or  attached  to  a  post  or  beam. 

Even  greater  advantage  may  be  afforded  sometimes  by  placing 
stout  ropes  upon  the  hind  legs,  carrying  them  over  pulleys  at- 
tached to  a  beam  above,  and,  turning  the  patient  upon  her  back, 
more  or  less  completely  suspend  her  with  the  head  downwards. 
This  causes  the  fetus,  along  with  the  rumen  and  other  viscera, 
to  drop  forward  by  gravity,  and  affords  room  for  version  or  other 
manipulations.  The  position  cannot  be  maintained  for  a  very 
long  period. 

The  question  of  the  exact  attitude  of  the  patient  during  ob- 
stetric operations  is  to  be  determined  in  each  case  by  the  charac- 
ter of  the  obstacle  to  parturition. 


The  expulsive  efforts  of  the  mother  frequently  constitute  an 
important  impediment  to  obstetric  operations,  and  sometimes 
render  an  otherwise  very  trivial  procedure  exceedingly  difficult, 
or  impos.sible.  Sometimes  the  slight  deviation  of  a  forelimb 
could  be  corrected  in  a  few  minutes  if  the  patient  would  not 
strain,  but  under  constant  and  violent  expulsive  efforts  it  may 
become  a  very  laborious  operation  of  long  duration.  So  with 
many  other  manipulations.  It  is  consequently  important  that 
we  should  understand  and  apply  as  fully  as  possible  our  means 
for  controlling  the  expulsive  efforts  of  the  mother. 

In  many  cases  the  expulsive  efforts  can  be  largely  prevented  by 
attracting  the  animal's  attention,  either  by  frightening  it  some- 
wjiat  or  by  some  physical  punishment  of  a  moderate  character. 
In  the  mare  a  twitch  upon  the  nose  will  sometimes  tend  to  inhibit 
violent  expulsive  efforts.  In  other  cases  slight  strokes  upon  the 
nose  and  lips  with  a  strap,  stick  or  rope  will  so  attract  her  at- 
tention as  to  stop  the  straining.  The  owner  may  be  able  to 
attract  her  attention  by  gently  stroking  her  with  the  hand,  by 
moving  the  head  up  and  down  or  otherwise  keeping  her  atten- 
tion somewhat  attracted  by  caressing  her. 

The  mare  may  also  be  largely  prevented  from  straining  by  pinch- 
ing the  back  or  loins  with  the  fingers  or  by  placing  a  stick  of 
wood,  especially  one  with  square  corners,  across  the  loins, 
and  having  a  man  on  either  side  press  down  upon  the  stick  in  a 


620  Veterinary  Obstetrics 

way  to  cause  pain  when  the  animal  attempts  to  arch  her  back 
during  an  expulsive  effort.  This  plan  is  even  more  effective  in 
the  cow,  or  her  straining  may  be  overcome  by  tying  a  hard  rope 
across  the  back  in  such  a  way  that  it  will  not  permit  her  to 
elevate  the  spinal  column  in  order  to  strain.  For  this  purpose  we 
use  a  coarse  rope,  attach  one  end  near  the  floor  on  one  side, 
carry  it  directly  over  her  loins,  draw  it  through  a  ring  or  around 
a  post  near  the  floor  upon  the  other  side,  and  make  it  fast  at  such 
a  point  that  the  cow's  back  cannot  be  raised  above  the  normal 
level. 

It  has  been  proposed  to  overcome  the  violent  expulsive  efforts 
of  our  larger  domestic  animals  by  means  of  tracheotomy.  In 
this  way  the  animal  cannot  strain  so  hard  because  of  tlie  fact  that 
she  cannot  close  the  larynx  and  retain  the  air  in  the  lungs,  since 
it  promptly  escapes  through  the  trachea  tube.  This  cannot,  how- 
ever, wholly  ov^ercome  the  expulsive  efforts,  but  is  worthy  of 
trial. 

When  these  expedients  fail,  or  we  desire  to  wholly  control  the 
struggles  and  expulsive  efforts  of  the  animal,  we  may  resort  to  an- 
aesthesia. We  have  resorted  to  chloroform  anaesthesia  in  dys- 
tokia  in  the  mare,  with  the  best  results,  and  feel  that  this  method 
of  control  has  been  entirely  too  much  neglected  by  veterinary 
practitioners.  The  veterinary  obstetrist,  especially  when  dealing 
with  mares,  should  always  carry  a  sufficient  amount  of  chloro- 
form to  produce  anaesthesia,  and  should  be  ready  to  resort  to  it 
whenever  the  exigencies  of  the  case,  either  from  a  humane  or  a 
surgical  standpoint,  may  demand  it. 

The  Prevention  of  Infection  During  Obstetric 
Operations. 

There  is  no  place  in  veterinary  practice  where  the  rules  of  dis- 
infection are  more  important  than  in  obstetric  work.  Nowhere 
else  do  we  encounter  so  large  and  highly  receptive  a  surface  for 
infection  as  in  the  uterus,  denuded  as  it  is  of  its  protective  epi- 
thelium at  the  time  of  birth. 

The  operator  should  be  provided,  as  we  have  suggested,  with 
ample  clothing,  which  has  been  thoroughly  sterilized  and  disin- 
fected. If  he  has  recently  been  engaged  in  the  handling  of  a 
putrid  wound  or  some  infectious  or  transmissible  di.sease,  and 
especially  if  he  has  recently  been  engaged  upon  a  case  of  retained 


Preventio7i  of  Infection  621 

afterbirth  or  in  removing  a  putrid  fetus  from  another  animal,  he 
should  first,  by  all  rules  of  surgical  practice,  have  taken  a  thor- 
ough bath  and  had  a  complete  change  of  clothing,  in  addition  to 
having  thoroughly  and  carefully  disinfected  all  those  portions  of 
his  body  which  have  been  in  any  way  soiled  or  contaminated 
during  the  previous  operation.  He  owes  this  duty,  not  only  to 
the  owner  of  the  animal,  but  equally  to  his  own  reputation  as  a 
practitioner. 

When  called  to  a  case  of  dystokia,  he  should  prepare  an  abun- 
dant supply  of  efficient  disinfecting  solutions  which  he  can  use 
in  disinfecting  anew  his  hands  and  arms  immediatel}'  before  be- 
ginning his  operation. 

The  thorough  cleansing  and  disinfection  of  the  hands  and  arms 
serves  a  double  purpose  in  practice.  It  protects  the  patient 
against  any  infection  which  the  operator  may  carry  upon  his 
hands  or  arms  and,  when  the  skin  and  skin  glands  of  the  operator's 
hands  and  arms  are  well  saturated  with  a  disinfecting  solution', 
it  affords  to  him  a  definite  protection  against  infection  from  the 
animal. 

This  danger  of  infection  to  the  operator,  especially  in  cases  of 
a  putrid  fetus  or  afterbirth,  constitutes  one  of  the  greatest  risks 
with  which  the  veterinarian  has  to  contend.  There  are  few  vet- 
erinarians who  have  not,  at  one  or  more  times,  suffered  more  or 
less  seriously  from  infection  from  these  causes,  and  it  is  of  funda- 
mental importance  that  this  danger  be  guarded  against  as  thor- 
oughh'  as  possible. 

Such  infection  usually  occurs,  not  on  the  hands,  but  on  the 
arras,  where  the  skin  is  more  delicate  and  the  hair  folicles  and 
sweat  glands  offer  a  better  opportunity  for  the  entrance  of  micro- 
organisms. iVpparently  those  persons  who  sweat  freely  are 
most   subject  to  infection   in  obstetric  operations. 

Some  depend  chiefly  upon  the  lubrication  of  the  hands  and 
arms  with  oil  or  fat,  to  which  possibly  some  disinfectant  has 
been  added,  but  it  has  been  our  constant  observation  that  fats 
and  oils  are  immediately  dissolved  by  the  fetal  fluids,  and  conse- 
quently cease  to  afford  any  protection  almost  as  .soon  as  the  hand 
and  arm  have  been  introduced  into  the  genital  passages.  Such 
anointing  of  the  arms  is  of  little  value  from  the  standpoint  of 
thejjrevention  of  infection  of  the  operator,  but  has  some  value  as 
a  lubricant.  Infection  of  the  operator's  hands  and  arms  may  be 
largely  or   wholly  prevented   in   several   wa^'S. 


622  Veteri7iary  Obstetrics 

We  may  use  a  variety  of  disinfectants,  and  the  thorough  use 
of  any  one  of  them  will  render  a  more  or  less  efficient  service. 
Lysol  has  a  marked  superiority  as  a  disinfectant  in  these  cases, 
because,  in  addition  to  possessing  a  high  bactericidal  power,  the 
solution  is  unctuous  and  renders  the  hands  and  arms  slippery  as 
would  oil  or  fat,  and  thus  favors  their  introduction  into  the  geni- 
tal passages.  Possibly  a  better  protection  to  the  operator  may 
be  afforded  by  astringent  antiseptics.  Corrosive  sublimate,  with 
its  high  bactericidal  power,  possesses  astringency  to  a  consider- 
able degree,  and  tends  thereby  to  close  the  mouths  of  the  hair 
follicles  and  glands  in  a  way  to  prevent  the  invasion  of  the  dis- 
ease organisms.  Permanganate  of  potash  also  has  a  very  high 
efficienc}',  and  is  more  astringent  than  the  corrosive  sublimate. 
It  has  .still  another  very  estimable  quality,  in  cases  of  putrid  de- 
composition of  the  fetus,  in  that  it  is  one  of  the  best,  if  not  the 
best  deodorizer  which  is  in  common  use.  After  using  this 
drug  it  is  necessary  to  use  a  warm  concentrated  solution  of  oxalic 
acid  to  decolorize  the  stain  on  the  skin.  If  some  one  of  these 
antiseptics  is  used  frequently  and  freely  in  this  way  and,  as 
.soon  as  one  supply  of  the  solution  becomes  contaminated,  it  is 
thrown  away  and  a  fresh  solution  prepared,  much  will  be  accom- 
plished toward  preventing  any  infection  of  the  operator's  hands 
or  arms. 

Preliminary  to  any  measures  looking  to  the  prevention  of  in- 
fection of  the  hands  and  arms  of  the  operator  by  the  direct  appli- 
cation of  antiseptics  to  these  parts,  should  be  the  disinfection  of 
the  patient.  Before  undertaking  the  examination  or  operation, 
the  tail,  vulva,  and  all  the  surrounding  parts  should  be  thoroughly 
cleansed  and  disinfected.  If  the  vaginal  canal  is  .soiled,  it  should 
be  thoroughly  flushed  out  with  a  disinfectant.  If  the  fetus  is 
putrid,  there  should  be  repeatedly  forced  into  the  uterine  cavity, 
alongside  of  the  fetus,  large  volumes  of  a  warm  disinfecting  fluid, 
preferably  of  lysol,  because  of  its  unctuous  character.  Not  only 
should  the  uterine  cavity  be  filled  with  large  volumes  of  such 
disinfectants  prior  to  the  beginning  of  the  operation,  but  the  dis- 
infection should  be  repeated  frequently  throughout  the  entire 
operation.  By  such  a  plan,  not  only  is  the  operator  protected, 
in  the  largest  measure  possible,  but  the  patient  also  is  protected 
against  serious  infection  through  abrasions  which  may  exist  or 
be  caused  in  the  cour.se  of  the  operations. 

If  the  animal  is  recumbent  and  cannot  be  induced  to  stand,  it 


Exa  m  in  a  Hon  of  th  e  Pa  tien  t  623 

is  desirable  to  spread  a  clean  sheet  or  cloth,  which  has  been 
dipped  in  a  disinfecting  solution,  immediately  behind  the  animal 
in  a  way  to  cover  over  any  bedding  or  litter  and  prevent  it  from 
being  dragged  into  the  genital  tract  of  the  mother  upon  the  hands 
or  arms  of  the  operator. 

After  the  removal  of  the  fetus,  in  all  cases  of  dystokia,  it  is 
important  at  once  to  follow  with  the  removal  of  the  membranes, 
if  practical,  after  which  the  uterus  should  again  be  disinfected 
thoroughly  with  a  large  volume  of  antiseptic  solution,  providing 
always  that  we  can  be  sure  that  the  integrity  of  the  uterine  walls 
has  been  preserved  and  that  there  are  no  penetrating  wounds 
into  the  peritoneal  cavity.  In  the  latter  case  we  should  simply 
attempt  to  remove  mechanically  all  the  infectious  material,  so  far 
as  is  in  our  power,  and  be  very  careful  to  not  inject  fluids  into  the 
uterus  which  will  find  their  way  into  the  peritoneal  cavity  and 
probably  at  once  cause  the  collapse  and  death  of  the  patient. 
If  it  has  been  clearly  determined  that  the  uterus  is  wholly  intact, 
the  injection  of  large  volumes  of  warm  disinfectants  into  ics  cav- 
ity produces  three  important  results  :  disinfects  the  cavity  and 
decreases  the  danger  to  the  patient  later,  from  infection  and  its 
consequences  ;  serves  an  important  purpose  by  straightening  out 
the  walls  of  the  uterus  and  tending  to  correct  any  displacements 
of  the  organ — if  one  of  the  horns  is  somewhat  displaced  or  has 
begun  to  evaginate  or  evert,  it  tends  to  restore  it  to  its  proper 
position  ;  the  presence  of  the  warm  solution  in  the  uterus,  in  suf- 
ficient volume  to  cause  distension,  stimulates  a  quite  vigorous 
contraction  of  the  organ — involution — which  tends  strongly  to 
eliminate  the  uterine  cavity  and  prevent  prolapse  of  the  uterus  or 
vagina. 

The  Examination  of  the  Patient. 

Before  proceeding  with  any  operations  in  cases  of  dystokia,  it 
is  essential  that  the  practitioner  should  make  a  careful  examina- 
tion of  his  patient.  First  he  should  determine  as  well  as  practi- 
cable her  condition,  whether  she  is  strong  and  vigorous  or  weak 
and  debilitated,  or  he  .should  determine  if  there  is  anything  in 
her  general  condition  which  would  suggest  some  serious  or  fatal 
lesion,  such  as  internal  hemorrhage  from  a  uterine  rupture. 
This  knowledge  can  be  gained  partly  by  the  general  appear- 
ance of  the  patient  and  partly  by  examination  of  the  pulse  and 
visible  mucous  membranes. 


624  Veterinary  Obstetrics 

It  is  highly  important  also  that  the  veterinarian  determine 
very  early,  both  from  a  forensic  and  a  professional  standpoint, 
whether  empirics  or  others  have  meddled  with  the  case  prior  to 
his  arrival  and  have  caused  thereby  more  or  less  serious  injury, 
which,  if  passed  unnoticed,  may  later  lead  to  serious  embarrass- 
ment to  him. 

It  is  exceedingly  unfortunate,  for  example,  for  a  veterinarian 
to  be  called  to  attend  a  case  which  has  previously  been  meddled 
with  by  an  empiric,  to  the  extent  of  rupturing  the  uterus  or 
causing  some  other  fatal  lesion,  and  to  proceed  with  the  opera- 
tion of  delivering  the  animal  without  having  first  discovered  that 
the  fatal  injury  exists.  Should  this  error  be  committed,  the  vet- 
erinarian is  almost  inevitably  blamed  with  having  caused  the  in- 
jury himself  and  might  even  be  held  legally  responsible  for  the 
consequences. 

In  one  case  we  were  called  to  attend  a  valuable  mare  suffering 
from  dystokia,  in  which  the  head  of  the  fetus  was  deviated  to  the 
side  and  an  empiric  had  attempted  to  catch  the  head  with  a  butcher '  s 
hook  in  order  to  correct  the  deviation,  but  failed  to  do  this  and 
had  ruptured  the  uterus  instead.  We  were  not  advised  that 
anyone  had  attempted  delivery,  and  in  fact  meddling  with  the 
case  was  denied.  We  proceeded  to  perform  embryotomy  without 
examining  the  uterus  very  carefully  except  in  the  posterior  re- 
gion. When  nearly  through  with  our  operation  of  embryotomy, 
the  rupture  was  discovered  owing  to  the  prolapse  of  the  intes- 
tines of  the  mare  through  the  rent  in  the  uterus.  It  was  only 
under  hard  pressure  that  the  owner  was  finally  compelled  to  ad- 
mit that  other  parties  had  attempted  the  delivery  before  we  had 
been  called. 

Similar  experiences  are  common  in  veterinary  practice,  and 
should  always  be  guarded  against  as  carefully  as  possible,  because 
such  oversight  is  liable  at  any  time  to  very  unfavorably  affect 
the  professional  standing  of  the  veterinarian. 

In  such  an  examination  the  practitioner  should  also  determine 
the  condition  of  the  genital  organs  in  every  way,  whether  the 
pas.sages  are  fully  dilated  or  are  dilatable,  whether  they  are  nor- 
mal or  obstructed,  or  if  they  are  inflamed,  swollen  or  necrotic. 

It  is  highly  important  also  to  learn  at  once  whether  or  not 
there  is  any  displacement  of  the  uterus,  such  as  tonsion.  The 
condition  of  the  fetus  is  also  highly  important  in  reference 
to  the  course  to  be  pursued  and  the  prognosis.      It  should  be  de- 


Examination  of  the  Patient  625 

termined  as  early  as  possible  if  the  fetus  be  dead  or  alive,  and,  in 
case  it  is  dead,  much  depends  upon  whether  or  not  it  has  under- 
gone decomposition. 

In  ruminants  an  emphysematous  or  putrid  fetus  may  fre- 
quently be  removed  with  excellent  results,  since  they  are  very 
resistant  to  infection  from  this  source,  while  it  is  a  well  known 
clinical  fact  that  it  is  difficult  to  save  the  life  of  a  mare  if  her 
fetus  has  become  putrid.  It  is  also  exceedinglj^  difficult  to  save 
the  life  of  a  mare  if  she  has  been  in  labor  more  than  24  hours, 
although  much  will  depend  upon  the  position  in  which  the  fetus 
lies,  whether  it  has  become  impacted  in  the  pelvic  canal  or  not, 
and  the  amount  of  interference  which  the  mare  has  suffered  at 
the  hands  of  incompetent  persons. 

Ji;  *  ^  ;•;  ;■;  ;:;  % 

It  is  highly  important  that  the  veterinarian  determine  precisely 
the  nature  of  the  obstacle  which  is  to  be  overcome,  to  which  end 
it  is  essential  that  he  should  be  able  to  identify  the  various  por- 
tions of  the  fetus  by  the  sense  of  touch,  and  to  determine  there- 
by the  presentation,  position  and  deviation  with  which  he  has 
to  deal.  While  apparently  it  should  be  easy  for  the  operator  to 
determine  the  portion  of  the  fetus  which  he  touches,  it  is  not, 
after  all,  a  Hght  task. 

The  differentiation  between  the  anterior  and  posterior  limbs 
sometimes  offers  very  great  difficulty.  Some  writers  give  cer- 
tain rules  by  which  one  may  differentiate  between  an  anterior  and 
a  posterior  limb,  but  their  rules  are  not  wholly  applicable.  Some 
suggest  that  certain  joints  of  the  limb  bend  in  a  given  direction. 
In  dystokia,  however,  a  limb  may  be  in  such  a  position  that  it  can 
not  possibly  be  determined  in  which  direction  it  would  bend,  be- 
cause it  is  so  firmly  impacted  that  it  cannot  be  bent  or  moved  in 
any  direction. 

Inside  the  uterus,  with  that  organ  closely  investing  the  fetus, 
the  differences,  to  the  touch,  between  the  anterior  and  posterior 
limbs  are  not  so  marked  sometimes  as  the  obstetrist  would  wish. 
If  he  can  readily  reach  the  fetal  body,  he  may  quite  easily  deter- 
mine which  leg  he  is  dealing  with.  He  cannot,  however,  tell 
the  fore  and  hind  feet  apart  until  he  at  least  reaches  the  carpus 
and  tarsus.  Even  then  the  tarsus  may  be  so  extended  that  it 
presents  a  very  strong  resemblance  to  the  carpus,  though  they 
may  generally  be  differentiated  because  the  os  calcis,  with  the 
40 


626  Veterinary  Obstetrics 

tendo- Achilles  attached  to  its  summit,  is  more  prominent  and 
clear-cut  than  the  pisiform  bone  of  the  carpus  with  its  attached 
tendons.  If  the  elbow  can  be  reached  and  compared  ^with  the 
stifle,  they  are  generally  quite  easily  distinguished,  and  as  soon 
as  we  can  reach  above  these  two  parts  the  difficulty  of  differenti- 
ation usually  ceases  to  exist. 

In  examining  the  limbs  for  purposes  of  identification,  the  in- 
experienced veterinarian  must  preserve  his  equanimity  and  not 
be  too  hasty  in  his  conclusions,  but  deliberately  search  the  ex- 
tremities with  which  he  is  dealing  until  they  are  clearly  identi- 
fied upon  anatomical  grounds. 

In  the  event  of  3  or  4  limbs  being  presented  simultaneously, 
it  is  sometimes  more  difficult  to  trace  and  identify  each  member 
because  of  their  intricate  entanglement.  The  passages  are  so 
filled,  because  of  the  extra  number  of  limbs,  that  one  can  insert 
the  arm  only  with  difficulty,  and  under  such  .severe  pressure  that 
the  sense  of  touch  is  somewhat  dulled.  When  the  feet  of  two 
fetu.ses  present  simultaneously,  they  are  liable  to  cause  very  great 
confusion  in  diagnosis,  and  one  needs  be  very  careful  to  deter- 
mine if  twins  exist  or  not. 

Sometimes  twins  may  offer  in  the  inlet  one  hind  limb  of  each 
fetus,  the  head  and  one  or  both  fore  feet  of  one  fetus  with  one 
or  both  hind  feet  of  the  other  twin,  or  other  confusing  variations. 
All  such  po.ssibilities  are  to  be  carefully  considered. 

In  fact,  we  might  state,  as  a  rule  in  practice,  that  a  foot  should 
not  be  drawn  upon  to  any  great  extent  with  a  view  to  extract- 
ing a  fetus,  unless  we  have  first  determined  by  exploration  that 
it  belongs  to  the  fetus  which  we  desire  to  exert  traction  upon. 
If  the  veterinarian  is  at  all  careless  in  his  diagnosis,  he  may  get 
hold  of  one  limb  belonging  to  one  fetus  and  another  limb  belong- 
ing to  a  second  fetus,  and  proceed  to  draw  upon  them  as  belonging 
to  one,  with  embarrassing  results. 

It  must  be  constantly  remembered  also,  in  the  identification  of 
the  feet  of  one  or  more  fetuses  which  are  presenting,  that  a  sin- 
gle fetus  may  be  deformed  in  such  a  way  that  both  the  anterior 
and  posterior  parts  of  the  body  are  simultaneously  presented,  and 
thus  we  may  have  offered  at  the  pelvic  inlet  the  head  and  all  four 
feet.  This  is  especially  true  in  the  cow,  where  we  meet  with  two 
forms  of  monsters  which  are  exceedingly  confusing  in  this  respect. 
The  most  common  of  these  forms  is  the  schistocormus  reflexus,  in 
which  the  fetus  is  virtually  turned  inside  tout,  so  that  its  viscera 


Exaviination  of  the  Patient  627 

are  lying  outside  the  fetal  body,  free  in  the  uterine  cavity, 
while  the  skin  of  the  posterior  part  of  the  body  is  turned  inside 
out  and  envelops  the  anterior  portion  as  a  bag,  with  the  hair  on 
the  inside  and  the  head  and  all  four  feet  presenting  toward  the 
pelvis,  without  regard  for  any  systematic  arrangement,  in  a  con- 
fusing tangle. 

A  more  orderly  deformit^^  of  the  fetus,  which  we  have  seen  in 
the  cow,  is  the  campylorrhachis  coitortus,  in  which  there  is  an 
abrupt  lateral  curvature  of  the  spine,  without  the  body  being 
open.  In  this  we  find  the  fetal  head,  resting  upon  the  two  fore 
limbs,  presenting  at  the  pelvic  inlet,  and  with  it  the  two 
hind-feet  with  the  soles  of  the  feet  turned  upward;  or  in  other 
words,  we  find  the  anterior  portion  of  the  fetus  in  an  apparently 
normal  anterior  presentation,  dorso-sacral  position,  with  the  head 
and  anterior  feet  presenting  in  the  most  favorable  manner,  and 
also  an  apparently  normal  posterior  presentation,  dorso-sacral 
position,  with  the  hind  feet  fully  extended  in  the  pelvis.  Such 
a  presentation  is  exceedingly  confusing  because  it  constantly 
suggests  twins,  though  when  attempts  are  made  to  repel  one  part 
and  advance  the  other  it  is  found  to  be  impossible.  On  the  other 
hand,  when  one  part  is  repelled  the  other  recedes,  and  when 
one  is  advanced  the  other  advances  likewise. 

In  some  cases,  where  there  are  important  teratologic  condi- 
tions, it  is  difficult  to  determine  the  part  of  the  body  with  which 
one  is  dealing.  It  is  necessary  to  study  carefully  the  anatomical 
relations  of  each  part.  In  hydrocephalus,  with  a  large  amount 
of  fluid  in  the  greatly  distended  cranial  cavity,  the  part  some- 
times reminds  one  very  much  of  the  fluctuating  abdomen  of  the 
fetus,  and  can  be  differentiated  only  by  finding  and  recognizing 
the  ears,  eyes,  mouth,  or  some  other  definite  part  of  the  fetus. 

So  with  every  other  part,  the  veterinarian  must  continue  his 
search  until  he  is  able  to  fully  recognize  the  anatomical  charac- 
ters with  which  he  is  dealing.  It  may  be  necessary,  for  this 
purpose,  to  extend  his  search  for  a  considerable  distance  in  every 
direction  in  order  to  make  out  fully  and  safely  the  character  of 
the  position  with  which  he  has  to  deal.  The  special  difficulties 
of  diagnosis  in  given  cases  will  be  more  fully  considered  under 
their  various  heads. 

The  General  Handling  of  Dystokla. 

A  thorough  examination,  such  as  we  have  already  outlined, 
should   result   in   a  diagnosis  of  the  presentation  and  position  of 


628  Veterinary  Obstetrics 

the  fetus  and  its  relation  to  the  genital  organs  and  the  pelvis, 
should  give  us  a  clear  conception  of  the  difficulties  which  are  to  be 
overcome,  and  indicate  the  method  by  which  they  may  be  sur- 
mounted. 

It  is  also  essential,  after  the  examination  has  been  made,  that  a 
judicious  prognosis  should  be  reached,  both  as  related  to  the 
mother  and  to  the  fetus  or  fetuses.  It  should  be  determined  whether 
the  life  of  the  mother  can  probably  be  saved,  and  by  what  means, 
and  whether,  in  case  she  is  saved,  her  condition  will  be  such  as 
to  render  it  worth  our  while  either  from  an  economic  or  a  senti- 
mental standpoint.  If  the  life  of  the  mother  cannot  be  saved  by 
an  operation,  it  is  evidently  needless  to  make  a  prolonged  effort 
in  her  behalf.  If  she  may  be  saved,  but  her  condition  will  ren- 
der her  of  little  or  no  economic  value,  or  would  overcome  any 
sentimental  reasons  for  preserving  her  life,  then  the  situation 
should  be  made  perfectly  clear  to  the  owner.  For  example,  in 
a  case  of  dystokia  in  the  mare,  which  has  been  meddled  with  by 
an  empiric,  and  in  which  the  fetus  has  been  dead  for  along  period 
of  time  and  has  become  putrid,  and  perhaps  in  addition  there  is  a 
rupture  in  the  uterus  which  must  inevitably  lead  to  a  fatal  termi- 
nation, it  is  clearly  injudicious  for  the  veterinarian  to  attempt 
delivery,  and  he  should  strongly  insist  upon  the  destruction  of 
the  animal. 

On  the  other  hand,  so  long  as  there  is  reasonable  hope  that 
the  animal's  life  may  be  saved,  it  is  the  duty  of  the  veterinarian 
to  do  whatever  may  be  in  his  power  to  accomplish  this  purpose. 

The  veterinarian,  in  his  prognosis,  should  refrain  with  equal 
care  from  radical  optimism  and  pessimism.  The  destruction  of 
a  patient  suffering  from  dystokia  should  not  be  recommended  or 
urged  except  upon  the  most  unequivocal  grounds.  It  is  a  com- 
mon observation  for  one  veterinarian  to  pronounce  a  case  hope- 
less and  the  dystokia  insurmountable,  and  for  another  veterinarian, 
by  intelligent  work,  to  save  the  life  and  value  of  the  animal. 

Sometimes  the  veterinarian  gives  an  unfavorable  prognosis 
and  advises  destruction  in  order  to  escape  from  a  difficult  or  re- 
pulsive task.  This  is  very  bad  policy,  and  lowers  the  standing  of 
the  veterinarian.  If  possible  to  save  the  patient,  the  veterinarian 
should  proceed  to  make  an  earnest  attempt  to  do  so.  After 
having  done  his  utmost,  his  responsibility  ends.  In  other  in- 
stances, like  in  severe  cases  of  rupture  of  the  prepubian  tendon, 
it  is  impossible  to  bring  about  a  recovery  of  the  mother  from  the 


General  Handling  of  Dystokia  629 

injury,  in  so  far  as  her  general  appearance  is  concerned,  but  she 
must  be  forever  left  with  an  immense  hernia  which  virtually  de- 
stroys her  value  in  any  position  where  appearances  have  any 
weight.  Hence,  although  the  life  of  the  mare  may  be  saved,  her 
value  is  usually  destroyed.  But  she  may  have  a  temporary  value 
for  raising  the  foal  which  is  to  be  born  at  the  time,  or  even  a 
permanent  value  if  the  owner  does  not  object  to  the  appearances. 

The  obstetrist  must  also  reach  as  rehable  a  conclusion  as  pos- 
sible in  reference  to  the  life  of  the  fetus,  and  determine  if  it  is 
possible  to  save  it  or  not.  We  have  already  suggested  that  the  foal 
perishes  quickly  when  expulsive  efforts  set  in,  while  the  calf  does 
not,  and  this  and  other  known  facts  should  be  considered  in  de- 
termining the  probability  of  extracting  the  fetus  in  a  living  con- 
dition, if  it  is  still  alive  when  the  veterinarian  reaches  the  patient- 
In  the  mare,  if  the  obstacles  to  birth  are  of  such  a  character  that 
much  time  will  inevitably  be  demanded  to  overcome  them,  it  is 
quite  clear  that  a  living  foal  is  not  to  be  expected,  and  conse- 
quently, if  conditions  so  indicate,  the  veterinarian  is  fully  war- 
ranted in  proceeding  at  once  with  embryotomy. 

Sometimes  the  obstacles  are  such  that  we  may  be  able  to  save 
the  life  of  either  the  mother  or  fetus  equally  well,  but  cannot 
save  both.  In  such  instances  the  veterinarian  is  placed  in  a 
position  where  it  is  necessary  to  consider  which  of  the  animals, 
the  mother  or  the  fetus,  possesses  the  greater  value,  and  the  life 
of  which  can  be  most  certainly  saved.  The  decision  must  largely 
rest  with  the  owner,  though  the  veterinarian  needs  be  in  a  posi- 
tion to  place  the  question  clearly  before  him. 

Having  reached  a  satisfactory  diagnosis  and  prognosis,  the 
veterinarian  needs  determine  upon  a  definite  plan  of  procedure, 
and  this  may  be  either  tentative  or  final.  Generally  speaking, 
the  veterinarian  must  consider  the  consequences  of  his  plan  upon 
the  mother  and  the  fetus,  the  amount  of  labor  which  will  devolve 
upon  him,  and  the  consequent  economic  feature  to  the  owner. 

In  many  cases  it  is  desirable  to  adopt  a  tentative  plan  of  pro- 
cedure, with  an  alternate  final  operation  in  case  the  first  should 
fail.  It  is  essential  that  the  tentative  plan  should  possess 
certain  definite  possibilities,  and  consequently  offer  hope  of 
a  favorable  solution.  We  might  illustrate  this  by  compar- 
ing two  analogous  positions  in  the  foal  and  calf.  In  each 
of  these,  in  the  anterior  presentation  and  dorso-sacral  position, 
the  head  is  frequently  deviated  laterally.     In  the  calf  the  neck 


630  Veterinary  Obstetrics 

is  very  short,  and  the  head  is  usually  within  reach,  so  that  the  de- 
viation may  be  corrected  with  more  or  less  facility.  With  the 
foal  this  deviation  is  quite  frequently  due  to  a  deformity  of  the 
neck,  known  as  wry-neck,  in  which  case  the  neck  has  been 
extremely  bent  during  a  great  part  of  its  intra-uterine  life  and  the 
head  rests  far  back  in  the  foal's  flank,  where  it  is  difficult  or  im- 
possible for  the  obstetrist  to  reach  it.  Even  if  it  can  be  secured, 
it  may  still  be  almost  impossible  to  correct  the  deviation  because 
of  the  deformity.  In  case  of  the  calf,  the  tentative  plan  of  cor- 
recting the  deviation  almost  always  succeeds,  and  should  be  ap- 
plied. In  many  instances,  in  the  foal,  the  correction  of  the  de- 
viation is  so  improbable  that  it  may  be  injudicious  to  attempt  it, 
but  we  should  rather  proceed  at  once  to  embryotomy.  Even  if 
such  a  foal  be  extracted  alive,  it  would  still  be  worthless  because  of 
its  deformed  head  and  neck.  Judgment  must  be  used,  and  a  ten- 
tative plan  not  carried  too  far,  exhausting  the  strength  of  both 
obstetrist  and  patient  in  an  attempt  to  accomplish  something 
which  must  eventually  be  abandoned  and  another  plan  sub- 
stituted. 

Already  we  have  had  occasion  to  suggest  that  the  obstetrist 
should  carefully  husband  his  strength.  There  is  still  an  abun- 
dance of  work  for  him,  and  the  overcoming  of  dystokia  not  in- 
frequently proves  a  herculean  task  and  leaves  him  in  the  end 
quite  exhausted  from  the  severe  ordeal.  We  would  not,  how- 
ever, over-emphasize  this  strain  upon  the  physical  powers  of  the 
veterinary  obstetrist,  as  some  writers  have  done,  and  have  him 
believe  that  this  work  is  extraordinarily  trying  or  dangerous. 
We  have  not  found  that  it  offers  any  markedly  greater  difficulties 
than  other  surgical  procedures.  When  the  veterinary  obstetrist 
promptly  attends  a  case,  he  usually  has  time  to  plan  his  work  de- 
liberately and  to  carry  it  out  without  extraordinary  haste.  There 
come  crises  in  these  operations,  as  well  as  in  others,  where  a  man 
must  act  quickly  at  a  given  point  in  order  to  accomplish  his  pur- 
po.se,  but  as  a  general  rule  there  is  every  reason  for  deliberation 
and  careful  planning  of  every  portion  of  the  work. 

A  great  source  of  strength  and  efficiency  to  the  veterinary'  ob- 
stetrist is  ambidextrousness,  which  can  be  acquired  by  any  one 
with  proper  practice.  When  the  operator  can  use  each  hand  and 
arm  with  equal  facility,  his  efficiency  is  more  than  doubled.  It 
is  usually  the  hands  and  arms,  not  the  body,  which  really  be- 
come fatigued  during  obstetric  operations. 


OBSTETRIC  OPERATIONS. 

In  overcoming  dystokia,  a  number  of  operations  may  l)e  de- 
manded, which  vary  greatly  in  character  and  which  may  admit 
of  many  variations  in  technic.  It  is  but  natural  that  the  obstet- 
rist  should  be  as  conservative  as  possible  in  the  selection  and  car- 
rying out  of  a  plan  for  the  overcoming  of  obstacles  to  delivery. 
He  should  have  in  mind  the  entire  list  of  available  obstetric  ope- 
rations, and  determine  which  of  these  he  should  elect  to  carry  out 
in  a  given  case.  In  determining  upon  a  plan  for  operating,  he 
should  consider  first  that  plan  which  is  the  most  conservative, 
since  if  it  succeeds  it  is  best  from  the  standpoint  of  the  well-being 
of  the  mother,  of  the  fetus,  of  the  operator,  and  of  the  eco- 
nomic interests  of  the  owner. 

The  chief  obstetric  operations  are  : 

1.  Mutation,  or  changing  the  position  of  the  fetus. 

2.  Forced  extraction. 

3.  Embryotomy. 

4.  Caesarian  section,  or  gastro-hysterotomy  and  hj^sterec- 

tomy. 

I.  Mutation. 

In  the  preceding  pages  we  have  indicated  that,  in  order  for 
birth  to  take  place  normally,  it  is  essential  that  the  fetus  should 
present  in  a  longitudinal  direction,  either  anteriorly  or  posteri- 
orly, and  that  it  is  highly  important,  if  not  quite  necessary,  that 
the  fetus  should  be  in  the  dorso-sacral  position.  In  the  larger 
domestic  animals,  it  is  essential  that,  in  the  anterior  presentation, 
both  fore-feet  should  be  well  extended,  and  the  head  resting  upon 
these  with  the  nose  reaching  nearly  to  the  fetlock  joint.  In  the 
posterior  presentation,  the  two  posterior  limbs  should  be  fully 
extended.  Any  deviation  from  this  attitude  in  the  larger  animals 
calls  for  more  or  less  interference  on  the  part  of  the  obstetrist, 
in  order  that  birth  may  occur. 

It  has  been  noted  that  in  the  smaller  domestic  animals  the  at- 
titude of  the  fetus  in  its  passage  through  the  birth  canal  differs 
somewhat  from  the  above.  In  the  carnivora,  when  in  the  ante- 
rior presentation,  the  head  usually  presents  alone,  with  the  feet 
doubled  back  beneath  the  chest.  The  position  of  the  fetus  or  the 
deviation  of  parts  is  exceedingly  variable,  and  it  is  the  function 
of  the  obstetrist  to  bring  each  part  into  the  normal  presentation 


632  Veterhiarv  Obstetrics 

and  position,  or  otherwise  overcome  the  obstacles  to  birth.  The 
chief  operations  or  manipulations  b)'  which  it  is  hoped  to  correct 
the  position  or  attitude  of  a  fetus  are  repulsion,  rotation,  version 
and  extension. 

A.  Repulsion  or  retropulsion  of  the  fetus  con.sists  of  push- 
ing it  backward,  or  away  from  the  pelvis,  toward  the  diaphragm, 
in  order  that  it  may  be  returned  into  the  abdominal  cavity,  and 
contemporaneously  into  the  uterine  cavity,  where  space  is  avail- 
able for  changing  the  position  of  the  various  extremities  or  of 
the  entire  body.  It  is  necessitated  by  the  fact  that  the  pelvic 
canal  is  so  narrow,  and  so  completely  filled  by  the  fetus  when  it  has 
once  entered,  that  there  is  little  or  no  room  for  carrying  out  any 
extensive  changes  in  the  attitude  of  the  fetus,  and  consequently 
it  must  be  repelled  or  pushed  away  from  this  narrow  channel 
into  a  more  commodious  cavity,  where  ample  room  may  be 
obtained. 

While  considering  the  various  obstetric  instruments  and  their 
uses  on  page  595,  we  have  described  the  methods  for  producing 
repulsion. 

B,  Rotation.  It  has  already  been  stated  that,  in  order  for  a 
fetus  to  pass  readily  through  the  birth  canal,  it  must  offer  in  the 
longitudinal  presentation  and  the  dorso-sacral  position.  When 
presenting  otherwise,  it  is  desirable,  if  not  necessary,  that  the 
fetus  be  rotated  upon  its  long  axis  until  it  is  brought  into  the 
dorso-sacral  position,  and  its  expulsion  or  extraction  thus  facili- 
tated or  rendered  possible. 

The  rotation  of  the  fetus  upon  its  long  axis  is  naturally  most 
practicable  when  its  body  is  lying  within  the  abdominal  cavity, 
because,  when  it  is  advanced  into  the  pelvic  canal,  it  is  exceedingly 
difficult  to  bring  about  such  a  rotation  owing  to  the  limited  room. 
In  accomplishing  rotation  it  is  to  be  borne  in  mind  that  a  fetus 
entering  the  birth  canal  in  any  other  than  the  dorso-sacral  posi- 
tion is  in  an  unstable  attitude  and  tends  to  rotate  to  the  proper 
position,  except  as  prevented  by  the  firm  impaction  of  the  fetal 
body  in  the  narrow  channel. 

The  aim  of  the  obstetrist  is  to  aid  these  natural  forces  as  far 
as  possible  in  accomplishing  the  object  desired.  First  of  all,  the 
body  of  the  fetus  should  be  pushed  away,  if  possible,  into  the  ab- 
dominal cavity,  while  its  limbs  are  retained  in  the  pelvic  canal, 
as  levers,  through   which  the  rotation   may  be  largely  accom- 


Obstetric  Operations  633 

plished.  Preparatory  to  rotation  it  is  highly  advantageous  to  in- 
ject into  the  uterus,  about  the  fetus,  a  weak  solution  of  lysol  or 
other  emollient  liquid,  to  lubricate  the  uterine  cavity  and  permit 
the  body  of  the  fetus  to  be  more  readily  revolved. 

Most  cases  demanding  rotation  offer  in  the  posterior  presenta- 
tion, and  usually  in  the  dorso-pubic  position.  In  these,  after 
the  repulsion  of  the  fetus  and  lubrication  of  the  parts,  the  two 
posterior  feet  should  be  secured  by  means  of  cords,  to  be  held  by 
assistants.  The  operator  inserts  one  hand  with  the  palm  up- 
wards and  passes  it  over  the  brim  of  the  pubis  beneath  the  but- 
tocks of  the  fetus  in  such  a  way  that  the  buttocks  rest  in  the 
palm  of  his  hand.  The  pubic  brim  serves  as  a  fulcrum,  upon 
which  the  operator  uses  his  hand  and  arm  as  a  lever  of  the  first 
class.  Lifting  upwards  against  the  buttocks  of  the  fetus  renders 
its  position  less  stable  and  tends  to  cause  it  to  revolve  to  the  right 
or  left  and  approach  the  dorso-sacral  position.  The  instability 
which  has  thus  been  produced  may  be  accentuated  by  the  opera- 
tor exerting  his  force  somewhat  obliquely  upwards  to  the  right 
or  left,  instead  of  pushing  directly  upward.  This  tends  to  rotate 
the  body  of  the  fetus  in  that  direction  which  may  .seem  most 
favorable. 

The  assistant  in  charge  of  the  corded  hind  feet  actively  sec- 
onds the  efforts  of  the  operator  by  such  means  as  the  obstetrist 
may  direct.  It  has  been  suggested  by  some  writers  that  the  two 
feet  may  be  tied  together  and  a  short  lever  passed  between  them, 
upon  which  the  assistant  may  exert  a  rotary  force  upon  the  fetal 
body  in  that  direction  which  the  operator  may  direct,  thus 
rendering  effective  the  efforts  of  the  veterinarian.  In  our  personal 
experience,  we  have  usually  had  the  assistant  grasp  one  or  both 
of  the  hind  limbs,  flex  the  feet  at  the  fetlock  until  the  pastern 
of  each  foot  is  at  right  angles  to  the  metatarsus,  and,  using  the 
pastern  as  a  lever,  exert  a  rotary  force  upon  the  limb  and 
through  it  upon  the  fetal  body.  We  have  found  this  method 
highly  efficient. 

Another  very  effective  method,  in  our  experience,  has  been 
the  application  of  what  we  may  term  cross-traction  upon  the  hind 
limbs.  A  cord  is  placed  upon  each  limb,  and  each  cord  given 
into  the  hands  of  separate  assistants.  The  operator  places  his 
hand  beneath  the  croup  of  the  fetus,  over  the  brim  of  the  pubis 
of  the  mother,  as  in  the  preceding  plan.     If  he  wishes  to  rotate 


634  Veterhiarv  Obstetrics 

the  ventral  surface  of  the  body  of  the  fetus  toward  the  right  of 
the  mother,  he  lifts  upward  and  to  the  left,  upon  the  buttocks, 
while  the  assistant  having  charge  of  the  cord  upon  the  right  foot 
stands  upon  the  right  side  of  the  patient  and  draws  obliquely 
upward  to  the  right,  changing  the  direction  gradually  to  the 
right  and  thence  downwards.  The  assistant  having  charge  of 
the  cord  upon  the  left  foot  crosses  it  behind  the  right,  draws 
gently  obliquely  backward  to  the  left,  and  aids  the  rotation 
by  holding  the  fetus  away  from  the  right  side  of  the  pelvis. 

In  the  anterior  presentation,  the  general  plan  of  the  operation 
is  similar,  though  it  may  be  rendered  far  more  difficult  by  the 
presence  of  the  head  and  neck.  It  may  even  be  necessary  that 
the  head  be  amputated  before  the  rotation  can  be  effected.  Aside 
from  this  the  plan  should  be  carried  out  essentially  the  same,  ex- 
cept that  the  operator's  hand  acts  upon  the  withers  of  the  fetus, 
instead  of  upon  the  buttocks,  as  in  the  preceding  case. 

C.  Version.  Since  it  is  essential  that  a  fetus  present  longi- 
tudinally in  order  to  be  expelled,  it  follows  that,  when  it  presents 
more  or  less  transversely,  such  an  attitude  needs  be  changed  to 
the  longitudinal  presentation  before  the  fetus  can  enter  the  pelvic 
canal.  In  other  words,  we  must  change  the  presentation  of  the 
fetus  by  bringing  its  long  axis  into  a  line  parallel  with  the  spinal 
axis  of  the  mother.  Empirics  occasionally  state  that  they  have 
accomplished  version  of  the  fetus  when  it  has  presented  longitu- 
dinally and  have  changed  a  posterior  presentation  into  an  anteri- 
or one.  This  assertion  has  been  to  some  extent  copied  by  some 
veterinary  writers.  It  must  be  very  plain  to  any  intelligent  vet- 
erinary obstetrist  of  experience  that  such  an  operation  is  impos- 
sible, under  normal  conditions,  and  could  only  be  carried  out  in 
cases  where  the  uterine  cavity  is  very  large  and  the  fetus  very 
small,  in  which  case  there  is  evidently  no  good  reason  whatever 
for  carrying  it  out.  Version  is  confined  in  obstetric  practice 
to  the  changing  of  a  transverse  into  a  longitudinal  presentation. 

Version  may  be  of  two  classes — anterior  and  posterior. '  The 
operator  usually  prefers  to  convert  a  transverse  into  a  posterior 
presentation,  because  he  then  needs  deal  with  but  two  extremi- 
ties, the  hind  limbs ;  whereas,  were  he  to  convert  into  an  ante- 
rior presentation,  he  would  need  bring  the  head  and  both  anterior 
limbs  into  the  passage. 


Obstebic  Operatio7is  635 

When  the  fetus  presents  transversely,  with  either  the  dorsal  or 
the  ventral  surface  toward  the  pelvic  inlet,  its  version  must  be 
accomplished  by  causing  one  extremity'of  the  fetus  to  advance 
and  the  other  to  recede.  This  is  caused  by  exerting  traction  on  one 
extremity  while  repelling  the  other.  When  the  fetus  presents 
transversely  it  usually  does  so  by  the  ventral  surface,  with  the 
head  and  all  feet  more  or  less  in  reach,  and  several  or  all  of  them 
requiring  attention  upon  the  part  of  the  obstetrist.  Assuming 
that  the  obstetrist  desires  to  convert  a  ventral  transverse  into  a 
posterior  presentation,  he  first  identifies  the  two  posterior  limbs 
and  attaches  cords  to  these.  In  the  foal  he  should  usually  next 
amputate  the  two  anterior  limbs  (see  Subcutaneous  Amputation 
of  the  Anterior  Limbs)  in  order  to  render  the  operation  easier 
for  the  operator  and  safer  for  the  mare.  The  amputation  is  not 
usually  advisable  in  the  cow,  and  is  not  always  ab.solutely  neces- 
sary in  the  mare. 

When  the  question  of  amputation  of  the  torelimbs  has  been 
decided,  and  carried  out  or  not  as  circumstances  may  dictate,  an 
assistant  exerts  traction  upon  the  two  posterior  limbs,  while  the 
operator  applies  or  directs  repulsion  upon  the  sternum  or  other 
portion  of  the  head  end  and  pushes  it  away  as  far  as  possible  into 
the  uterine  cavity,  while  the  posterior  end  of  the  fetus  is  being 
advanced  by  the  traction  upon  its  hind  limbs.  While  the  version 
is  being  accomplished  the  operator  should  see  that  the  necessary 
rotation  of  the  fetus  on  its  long  axis  is  also  occurring.  The 
required  rotation  is  best  attained,  in  such  cases,  by  what  we 
have  described  on  page  633  as  cross  traction.  When  the  version 
has  become  essentially  completed  and  the  rotation  accomplished, 
the  extraction  of  the  fetus  is  continued  by  means  of  traction  up- 
on the  posterior  limbs. 

Should  the  operator  desire  to  convert  a  ventral  transverse  into 
an  anterior  presentation,  which  we  never  advise,  he  would  secure 
and  apply  traction  to  the  two  fore  limbs  and  the  head,  and  at  the 
same   time   repel   the  posterior   limbs  as  far  forward  as  possible. 

In  the  dorsal  transverse  presentation,  the  version  needs  be  exe- 
cuted in  a  manner  similar  to  that  designated  for  the  ventral  pre- 
sentation. Here  extremities  are  not  available  for  the  exertion 
of  force.  If  it  is  desired  to  convert  into  a  posterior  presentation, 
which  we  prefer,  the  head  end  of  the  fetus  is  to  be  repelled  by 
force  applied  obliquely  forward  and  toward  the  head   end  of   the 


636  Veterinary  Obstetrics 

fetus,  until  the  tail  may  be  reached  and  traction  applied  to  it,  or  a 
hook  implanted  in  the  anus  or  about  the  buttocks,  so  that  traction 
may  be  applied  to  the  tail  end,  causing  it  to  advance  until  the 
hind  legs  may  be  secured  and  the  traction  applied  to  them. 
When  the  posterior  limbs  have  been  secured  and  the  feet  have  been 
brought  into  the  passage,  it  yet  remains  to  rotate  the  fetus  and 
convert  the  dorso-ilial  into  the  dorso-sacral  position,  after  which 
the  rules  for  delivery  in  posterior  presentation,  dorso-sacral 
position,  apply. 

D.  Extension  and  Adjustments  of  the  Extremities.  In 
dealing  with  the  attitude  of  the  fetus  during  parturition,  we  have 
described  the  normal  position  of  the  extremities  and  have  noted 
that,  when  they  become  materially  deviated,  they  produce  more 
or  less  serious  obstacles  to  the  expulsion  of  the  fetus.  The  de- 
viations with  which  the  obstetrist  must  deal  are  those  of  the 
head,  neck  and  limbs. 

The  correction  of  these  deviations  must  be  carried  out  anterior 
to  the  pelvic  cavity,  within  the  abdomen.  It  is  consequently 
essential,  in  most  cases,  that  the  fetus  be  repelled  in  order  to 
bring  about  these  corrections.  It  should  be  constantly  remem- 
bered that,  in  a  large  proportion  of  cases,  repulsion  of  the  body  of 
the  fetus,  and  those  extremities  which  are  presenting  normall)', 
has  a  constant  tendency  to  bring  about  a  correction  of  the  devi- 
ation. 

If  the  head  is  deviated  to  the  right  or  the  left,  upward  or  down- 
ward, repulsion  of  the  fetal  body  tends  constantly  to  cause  the 
head  and  neck  to  become  extended.  The  reflexed  head  comes 
in  contact  with  the  uterine  walls,  which  resist  its  retreat  while 
the  body  is  being  repelled,  and  the  head  then  tends  to  come  for- 
ward into  its  normal  attitude.  The  same  is  more  or  less  true 
with  most  of  the  deviations  of  the  extremities,  which  are  con- 
stantly aggravated  as  the  fetus  advances  toward  the  vulva,  and 
tend  as  constantly  to  be  ameliorated  or  even  overcome  when  the 
fetus  is  repelled  into  the  uterine  cavity. 

In  addition  to  the  two  foregoing  factors,  the  securing  of  room 
and  the  natural  tendency  for  these  parts  to  become  extended  in 
their  proper  position  during  repulsion,  the  veterinarian  must  in- 
telligently apply  his  knowledge  of  mechanics  and  anatomy  to 
his  task.  If  the  head  is  reflected  to  the  left  side  of  the  fetus 
along  the  right  side  of   the  mother,  it   is  very  evident  that,   if 


Obstetric  Operations  637 

the  patient  is  lying  upon  her  right  side,  the  weight  of  the 
fetus  upon  its  bent  neck  will  offer  a  serious  mechanical  obstacle 
to  the  correction  of  the  deviation.  In  such  a  case  the  re- 
cumbent patient  should  be  turned  to  her  left  side.  Similar 
directions  apply  also  to  deviations  of  the  limbs,  and  should  con- 
stantly be  borne  in  mind  in  all  such  work. 

Another  point  of  mechanical  advantage  which  should  be  con- 
stantly applied  is  that,  if  we  wish  to  extend  a  flexed  extremity, 
we  can  at  least  double  the  efficiency  of  our  efforts  by  the  simul- 
taneous application  of  traction  upon  the  distal  end  of  the  flexed 


Fig.  107.     Schematic  Ili^ustration  ok  the  Extension  of  a  Fore 
Limb  flexed  at  the  Carpus.     (Franck.  ) 

extremity  and  repulsion  upon  its  proximal  end  or  upon  the  fetal 
body.  For  example,  in  the  deviation  of  the  head  to  the  left,  if  we 
can  apply  traction  to  the  head  by  means  of  a  hook  in  the  orbit, 
mouth  or  nose,  or  by  a  cord  attached  to  the  inferior  maxilla,  as 
shown  in  Fig.  108,  and  described  on  page  581,  while  the  body  of 
the  fetus  is  being  repelled  by  force  applied  to  the  sternum  or  base 
of  the  neck,  the  efficiency  of  our  efforts  is  very  greatly  increased. 
The  simultaneous  application  of  these  two  forces  should  be  the 
constant  aim  of  the  veterinarian.  The  traction  may  be  applied 
with  hooks  or  cords  ;  the  repulsion  by  the  operator's  hand,  or  by 
a  repeller  in  the  hands  of  an  assistant. 

In  extending  a  flexed  limb,  the  same  general  mechanical  rules 
are  to  be  applied.  Take  for  example  a  fetus  presenting  anteriorly 
in  the  dorso-sacral  position,  an  anterior  limb  flexed  at  the  carpus. 
Fig.  107.  When  the  fetus  has  been  repelled,  with  or  without 
decapitation,  and  sufficient  room  for  operating  obtained,  the  re- 
tained foot  is  corded  at  the  pastern,  or  as  near  to  that  point  as  is 
possible,  by  one  of  the  two  methods  described  on  page  579,  and 
the  cord  is  entrusted  to  an  assistant. 


638 


Veterinary  Obstetrics 


If  impossible  at  first  to  attach  the  cord  about  the  pastern,  it 
should  be  made  fast  as  low  down  on  the  metacarpus  as  possible. 
While  traction  is  applied  upon  this  cord  by  an  assistant,  the 
operator  may  pass  a  second  cord  beyond  the  first,  and,  as  the  foot 
is  being  brought  nearer  by  traction  upon  the  first  cord,  the  noose 
of  the  second  may  be  pushed  over  the  fetlock  and  engaged  upon 


Fig.  ioS.     Method  of  Securing  the  Lower  J.wv  by  means 
OF  A  Looped  Cord. 
the  pastern.     It  is  to  be  emphasized  that  in  correcting  a  devia- 
tion of  a  limb,  whether  anterior  or  posterior,  the  ultimate  aim  is 
to  get  the  noose  upon   the  pastern.     Until   that   can   be  accom- 
plished, the  correction  of  the  deviation  is  uncertain. 


Obstetric  Operatio7is  639 

While  the  fetus  is  being  repelled,  the  assistant  draws  upon  the 
cord  and  advances  the  foot.  The  carpus,  by  this  process,  and 
with  the  aid  of  the  operator,  passes  into  the  lumbar  region, 
directed  obliquely  outwards  and  upwards  into  the  upper  portion 
of  the  flank  in  order  to  afford  the  greatest  possible  amount  of 
room.  The  carpus  (or  tarsus)  must  not,  for  this  purpose,  abut 
against  the  unyielding  lumbar  vertebrae  or  lateral  processes,  but 
must  be  pushed  outward  against  the  yielding  flank,  and  room 
thereby  afforded  for  the  necessary  extension  of  the  foot.  At  the 
proper  time  the  operator  inserts  his  hand,  palm  upwards,  be- 
tween the  pubic  brim  and  the  foot  of  the  fetus;  grasping  the  toe 
in  the  palm  of  his  hand,  the  assistant,  by  the  operator's  direction, 
applies  traction  upon  the  cord,  and  the  foot  glides  over  the  pubic 
brim,  to  become  extended  in  the  pelvic  canal. 

Should  the  anterior  limb  be  completely  retained,  instead  of 
merel)'  flexed  at  the  carpus,  the  procedure  is  similar.  The  foot 
is  now  wholly  out  of  reach,  and  the  forearm  can  be  reached  only 
with  difficulty,  or  not  at  all  until  repulsion  has  occurred.  When 
sufficiently  repelled,  the  forearm  is  grasped  with  the  hand  and 
corded  while  the  repulsion  is  continued,  and  the  carpus  is 
gradually  drawn  up  until  it  comes  against  the  pubic  brim,  when 
its  further  correction  is  carried  out  in  the  same  manner  as  above 
suggested. 

Similar  rules  apply  to  the  corrections  of  the  deviations  of  the 
posterior  limbs;  that  is,  the  fetus  must  be  repelled  from  the  pelvic 
inlet,  and  that  part  of  the  limb  which  can  be  reached  must  be 
corded  and  brought  up.  This  in  itself  acts  as  a  repellant  to  the 
fetal  body,  and  finally  the  tarsus  is  pushed  obliquely  outwards 
and  upwards  into  the  upper  flank  region,  the  pastern  corded,  and 
the  toe,  enclosed  in  the  hollow  of  the  operator's  hand,  is  guided 
over  the  pubic  brira  and  extended  in  the  pelvic  canal. 

The.se  changes  in  position  constantly  require  a  careful  applica- 
tion of  mechanical  principles,  and  are  to  be  carried  out  with 
caution.  The  work  should  be  done  as  gently  as  possible,  in  order 
to  avoid  arousing  violent  expulsive  eiforts.  When  they  do  occur, 
and  constitute  too  great  an  obstacle,  they  should  be  overcome  by 
such  means  as  those  suggested  on  page  619.  While  generally 
we  would  bring  about  these  corrections  without  haste,  when  we 
reach  a  critical  point  it  is  frequently  essential  that  they  should  be 
accomplished  v^ery  promptly.     Thus,  when  the  carpus  or  tarsus 


640  Veterinary  Obstetrics 

has  been  pushed  into  the  upper  flank  region  and  the  toe  or  fet- 
lock is  impacted  against  the  brim  of  the  pubis,  it  is  important 
that  the  operation  be  completed  promptly,  both  because  any  un- 
necessary delay  may  lead  to  a  return  of  the  foot  to  its  former 
position  and  because  violent  expulsive  efforts  of  the  mare  may 
cause  serious  injuries  to  the  uterus  or  other  parts. 

II.  Forced  Extr.\ction. 

By  forced  extraction  we  understand  the  withdrawal  of  the 
fetus  from  the  mother,  through  the  genital  canal,  by  the  applica- 
tion of  traction,  without  changing  the  position  of  the  fetus  or  any 
of  its  extremities  which  may  be  deviated,  or  reducing  its  size. 
It  is  applied  in  those  cases  where  the  abnormal  size  or  position  of 
the  fetus,  or  of  one  of  its  extremities,  is  such  that  the  obstetrist 
believes  that  it  is  better  to  draw  the  fetus  away  by  force  than  to 
correct  the  position,  or  deviation,  or  to  perform  embryotomy  or 
Caesarian  section. 

The  reasons  which  may  prompt  the  obstetrist  to  resort  to 
forced  extraction  may  be  quite  varied.  It  may  be  that  forced 
extraction  will  offer  the  best  or  only  opportunity  for  saving  the 
life  of  the  fetus.  In  the  foal,  for  instance,  forced  extraction,  in 
rare  cases,  might  save  its  life,  whereas  the  delay  which  might  be 
essential  to  the  correction  of  the  position  would  lead  to  its  death. 

From  the  standpoint  of  saving  the  life  of  the  mother,  it  may 
sometimes  be  safer  to  re.sort  to  forced  extraction  than  to  submit 
her  to  a  tedious  operation,  not  unaccompanied  by  dangers,  in 
correcting  the  position  of  the  fetus,  in  embryotomy  or  in  Caesar- 
ian section.  As  a  general  rule,  in  the  larger  animals  embryot- 
omy, properly  carried  out,  is  less  dangerous  to  the  mother  than 
forced  extraction.  It  is  only  in  very  rare  cases  that  this  rule  is 
reversed.  In  the  smaller  animals  embryotomy  is  usually  im- 
practical, and  our  choice  of  procedure  frequently  rests  between 
forced  extraction  and  Caesarian  section. 

From  the  standpoint  of  the  operator,  forced  extraction  is  easier 
and  consumes  much  less  time,  but  the  results  are  generally  un- 
satisfactory. The  higher  the  knowledge  and  skill  of  the  veter- 
inary ob.stetrist,  the  less  frequently  does  he  resort  to  forced  ex- 
traction of  the  fetus. 

The  empiric  habitually  resorts  to  forced  extraction  in  a  very 
brutal  manner,  and  with  great  losses  to  the  owners  of  patients. 


Forced  Extraction  641 

We  have  frequently  known  empirics,  who  were  not  competent  to 
perform  embryotomy  when  a  foal  presented  anteriorly  with  the 
two  anterior  limbs  in  the  birth  canal  and  the  head  completeh^ 
deviated  to  the  side,  to  apply  a  sufficient  amount  of  brute  force  to 
tear  the  fetus  away  in  a  most  inhuman  manner.  Sometimes  they 
hitch  a  horse  or  horses  to  the  foal,  and  tear  it  away  very  roughly. 
One  empiric  in  our  territory  resorted  habitually  to  tying  a  strong 
rope  to  the  two  anterior  feet  of  the  foal  and  fixing  the  other  end 
of  it  to  a  tree  or  a  strong  post,  and  then,  by  means  of  a  whip  or 
other  punishment,  forcing  the  mare  to  pull  away  her  own  fetus 
in  a  most  brutal  manner.  So  far  as  I  was  able  to  follow  his 
operations,  they  invariably  resulted  in  the  death  of  both  the  mare 
and  fetus. 

Other  veterinary  obstetrists  advise  forcible  extraction  in  various 
positions,  though  with  more  foresight  and  care.  Some  report 
good  results,  but  so  far  as  we  have  learned  never  so  good  as 
though  embryotoni}'  had  been  properly  performed. 

Forced  extraction  should  not  be  employed  in  most  cases  of 
improper  presentation  or  position  of  the  fetus.  It  cannot  succeed 
in  any  transverse  presentation,  but  only  in  those  which  are 
longitudinal. 

Forced  extraction  should  be  limited,  in  its  application,  to  those 
cases  where  the  fetus  is  comparatively  large  and  in  the  normal 
position,  and  in  which  the  withdrawal  of  the  fetus  by  force  will, 
in  the  judgment  of  the  obstetrist,  prove  better  for  the  interests 
of  the  owner,  as  affecting  the  life  of  the  mother,  the  fetus,  or  both, 
than  would  other  means  of  delivery  ;  and  to  those  cases  of  un- 
natural position  or  deviation  of  the  extremities  in  wdiich  it  would 
be  better  and  safer  for  the  mother  or  fetus,  or  both,  to  force  the 
fetus  through  the  birth  canal  without  its  position  having  been 
corrected. 

Per-sonally,  we  have  limited  forced  extraction  to  those  cases 
where  a  large  fetus,  or  a  fetus  of  normal  size  enlarged  becau.se  of 
emphj'.sema,  presents  in  a  normal  po.sition,  and  in  our  experience 
such  a  course  has  been  fully  warranted.  We  have  already  dealt 
with  the  technic  of  forced  extraction  when  dealing  with  instru- 
ments of  traction  on  page  586. 

III.   Embryotomy. 

Embryotomy    is    the   diminution   of  the  size  of  the  fetus  by 
means  of  the  removal  of  some  of  its  parts,  in  a  manner  to  overcome 
41 


642  Veterhiary  Obstetrics 

the  obstacles  to  its  birth.  Necessarily  embryotomy  involves  the 
sacrifice  of  the  life  of  the  fetus,  if  it  is  still  living,  and  the  object 
of  the  operation  becomes  limited  to  the  preservation  of  the  life 
of  the  mother.  It  is  a  comparatively  common  operation  in  the 
larger  animals,  but  is  virtually  inapplicable  in  the  smaller  ones. 

Embryotomy  possesses  certain  dangers,  such  as  injuries  to  the 
maternal  organs,  from  a  slip  or  misdirection  of  an  instrument  or 
from  the  projection  of  a  severed  fetal  bone  which  may  wound  or 
penetrate  the  uterus  or  other  parts.  Not  infrequently  it  involves 
a  long  and  tedious  operation,  which  may  greatly  exhaust  the 
.strength  of  the  patient. 

For  the  operator,  embryotomy  frequently  means  a  protracted 
and  disagreeable  operation,  with  danger  of  wounds  from  instru- 
ments, injuries  from  the  mother,  or  infection  in  case  the  fetus  is 
putrid.  Nevertheless  embryotomy  is  one  of  the  most  common 
and  valuable  obstetric  operations,  and  requires,  for  its  proper  ap- 
plication, thorough  study,  supplemented  by  exten.sive  and  prac- 
tical experience. 

The  performance  of  embryotomy  may  involve  any  portion  of 
the  fetal  body,  and  presents  the  greatest  possible  variations 
according  to  the  presentation  and  position.  The  veterinarian 
must  have  a  thoroughly  practical  knowledge  of  the  anatomy  of 
the  fetus  and  the  resistance  of  tissues  and  parts.  Embryotomy 
ma}'  be  necessary  or  advisable  in  every  presentation  and  position 
which  the  fetus  may  assume,  whether  it  be  normal  or  abnormal. 
We  shall  deal  with  the  question  as  related  to  the  removal  or 
destruction  of  certain  portions  of  the  fetal  body,  and  leave  the 
application  of  the.se  to  be  considered  under  the  various  forms  of 
dystokia. 

We  shall  consider  the  technic  of  the  various  embryotomy 
operations,  as  the}'  may  be  demanded  in  the  four  fundamental 
presentations,  in  the  order  we  have  already  described  on  page 
537- 

A.  The  Anterior  Presentation. 

a.  Amputation  of  the  Head.  Decapitation.  In  the  anterior 
presentation,  with  one  or  both  fore  limbs  retained  and  the  fetal 
head  engaged  in  the  pelvic  canal  or  protruding  from  the  vulva, 
repulsion  of  the  fetus  is  generally  necessary  in  order  to  correct 
the  deviation  of  the  limb.     In  many  cases  the  repulsion  of  the 


Embryotomy  643 

head  is  inexpedient  or  impossible,  and  the  amputation  of  the  head 
is  made  advisable  or  necessary  in  order  that  the  fetal  body  may  be 
repelled  and  the  deviated  extremity  brought  into  position. 

Technic.  Attach  a  cord  to  the  inferior  maxilla,  as  shown  in 
Fig.  108,  or  around  the  neck  of  the  fetus,  or  fix  a  blunt  hook  in 
the  orbit,  and  have  one  or  more  assistants  draw  the  head  out  as 
far  as  possible. 

Make  a  circular  incision  through  the  integument,  encircling 
the  head  at  a  convenient  point,  and  separate  the  skin  backward, 
by  forcing  the  hand  between  it  and  the  bones  or  by  using  the 
chisel  or  spatula  or  dissecting  it  away  with  a  scalpel,  continuing 
the  separation  over  the  occiput  to  the  atloid  region.  Make  a 
transverse  incision  below,  across  the  trachea  and  esophagus  and 
surrounding  muscles,  and  above  through  theligamentum  nuchae. 
Grasp  the  head  firmly  with  both  hands,  flex  it  upon  the  neck, 
and  twist  it  forcibly  on  its  long  axis,  rupturing  the  articular  lig- 
aments and  the  remaining  soft  tissues,  detaching  the  head  at  the 
occipito-atloid  articulation.  The  removal  of  the  head  greatly 
diminishes  the  bulk  of  the  fetus  ;  the  remnant  may  now  be  re- 
pelled, the  deviated  parts  brought  into  the  desired  position,  or 
other  operations  performed. 

b.  Cephalotomy.  When  the  fetal  head  has  not  advanced 
far  into  the  pelvic  canal  or  cannot  enter  the  pelvic  inlet  on  ac- 
count of  the  comparatively  large  size  of  the  head,  when  the  pelvis 
is  narrowed  by  a  tumor  or  callus,  or  when  the  fetal  head  is  grossly 
enlarged  because  of  hydrocephalus,  it  may  become  necessary 
to  diminish  the  size  of  the  head,  though  it  is  not  in  a  position  to 
be  amputated. 

Technic.  In  these  cases  the  head  is  usually  so  firmly  en- 
gaged in  the  canal  that  no  further  fixation  is  necessary.  After 
thoroughly  cleansing  and  disinfecting  the  parts,  inject  a  copious 
amount  of  tepid  lysol  solution  into  the  vagina.  Carry  the  ob- 
stetric chisel  into  the  passage,  carefully  guarded  in  the  hand, 
and  place  it  accurately  upon  that  part  of  the  head  of  the  fetus 
where  it  is  desired  to  begin  the  operation,  generally  on  the  me- 
dian line  of  the  nose  with  the  blade  of  the  chisel  standing  parallel 
to  the  septum  nasi  of  the  fetus.  Holding  the  blade  of  the  chisel 
firmly  against  the  part,  with  the  hand  in  such  a  position  as  to 
effectively  guard  the  instrument  from  slipping  aside  and  wound- 


644  Veieri?iary  Obstetrics 

ing  the  maternal  organs,  steady  and  direct  the  handle  with  the 
other  hand  and  have  an  assistant  drive  the  chisel,  b}^  means  of 
blows  of  proper  vigor  with  a  mallet,  into  the  bones  of  the  face 
and  head. 

Do  not  drive  the  chisel  deeper  than  the  length  of  the  blade, 
without  first  stopping  and  forcibly  revolving  the  instrument  upon 
its  long  axis  and  l)reaking  the  fetal  bones  apart.  The  partially 
detached  pieces  of  bone  may  be  torn  away  with  the  fingers  of  one 
hand,  and  the  chisel  u.sed  to  complete  the  .separation  of  the  frag- 
ment. Repeat  the  use  of  the  chisel  here  and  there  upon  the 
head,  as  often  as  may  be  necessary  in  order  to  bring  about  the 
required  diminution,  taking  care,  at  all  times,  not  to  wound  the 
maternal  parts  and  to  conserve  as  far  as  practicable  the  fetal  skin 
of  the  face  and  head,  in  order  that  it  may  protect  the  maternal 
parts  from  the  jagged  fetal  bones  during  the  remainder  of  the 
operation.  The  removal  of  the  partially  detached  pieces  of  bone 
may  in  many  ca.ses  be  greatly  facilitated  by  looping  a  cord  over 
them  and  having  an  assistant  apply  traction  sufficient  to  pull 
them  away,  while  the  operator  guards  the  maternal  organs  by 
holding  the  piece  of  bone,  during  its  detachment  and  extraction, 
in  the  palm  of  his  hand. 

In  hydrocephalus  the  diminution  of  the  head  alone  usuall}^ 
removes  the  sole  obstacle  to  delivery.  The  same  is  true  occa- 
sionally of  beginning  emphysema,  where  as  yet  only  the  head  is 
greatly  involved.  In  other  cases,  the  destruction  of  the  head 
and  face  does  not  wholly  relieve  the  dystokia.  It  may  be  neces- 
sary to  continue  the  diminution  by  decreasing  the  volume  of  the 
neck  and  body.  The  cervical  vertebrae  may  be  divided  with  the 
chisel  on  their  median  line,  the  muscular  and  ligamentous  at- 
tachments broken  down  or  cut  with  the  chisel,  and  the  bone  frag- 
ments secured  in  a  rope  noose  and  drawn  away,  covered  by  the 
hand  during  their  withdrawal.  Later  the  fetal  body  may  be 
further  diminished  by  subcutaneous  amputation  of  the  fore  limbs 
at  the  shoulder,  evisceration,  destruction  of  the  pelvic  girdle,  or 
other  means  to  be  later  described. 

c.  Amputation  of  the  Head  and  Neck.  In  the  anterior  presentation, 
when  the  head  is  completely  deviated  and  it  is  impossible  or  impracticable 
to  return  it  to  its  nor tnal  position,  some  veterinary  obstetrists  advise  that 
the  neck  be  severed  and  the  head  with  the  distal  portion  of  the  neck  with- 
drawn, after  which  the  bodv  of  the  fetus  is  extracted. 


Eju  bryotomy .  645 

Technic.  Some  obstetrists  advise  the  use  of  Persson's  chain-saw,  Fig.  103 
or  the  chain  sector  of  Masch.  More  recently  there  has  come  into  high 
repute,  in  some  portions  of  continental  Europe,  the  embryotom  of  Pfianz, 
Fig.  99.  These  instruments  are  passed  around  the  curved  neck,  and  act 
chiefly  from  the  distal  side  of  the  member. 

The  most  effective  instrument  of  the  group  is  apparently  the  Pflanz 
embryotom.  However,  any  one  of  them  will  accomplish  the  purpose,  once 
they  haV^e  been  passed  around  the  neck,  but  this  offers  considerable  difficulty. 
The  chain-saw  and  sector  have  the  disadvantage,  as  compared  with  the 
Pflanz  embryotom,  that  the)'  must  be  drawn  backward  and  forward  in 
order  to  saw  their  way  through  the  tissues,  and  constantly  tend  to  wound 
the  soft  parts  of  the  genital  canal  by  coming  in  contact  with  them.  This  may 
be  largely  or  wholly  obviated  by  passing  a  sheath  of  leather  or  other 
material  over  the  chain,  and  working  it  through  this. 

When  the  Pflanz  embryotom  has  been  applied  to  the  part,  danger  of  iujur\- 
becomes  virtually  excluded,  and  the  work  of  section  is  rapidly  and  easily 
carried  out. 

In  the  application  of  these  instruments,  some  operators  claim  that  there 
is  an  advantage  in  first  passing  a  cord  around  the  neck,  with  the  bent  porte- 
cord  or  the  bent  cord-sound.  Once  the  cord  has  been  passed  around  the 
neck  and  is  attached  to  the  chain-saw  or  sector,  the  latter  may  be  eisily 
drawn  into  position. 

With  the  Pflanz  instrument,  a  smooth  chain  is  first  used  to  pass  around 
the  neck,  which  is  free  from  any  danger  of  inj  ury  to  the  soft  parts  of  the 
mother  and  is  comparatively  easy  to  handle. 

Other  operators  divide  the  neck  by  means  of  cutting  instruments  acting 
upon  the  front  or  proximal  side,  and  use  for  this  purpose  the  finger-knife, 
bistoury,  or  chisel,  but  with  these  instruments  the  process  is  a  comparatively 
tedious  one,  as  it  is  difficult  to  cut  through  every  portion  of  the  tissues. 
With  the  knife  it  is  impracticable  to  sever  the  cervical  column,  since  the 
vertebrcC  cannot  be  disarticulated,  and  it  becomes  necessary  to  use  so  iie 
more  powerful  instrument  for  severing  the  bony  column.  This  may  best  be 
done  with  the  chisel. 

Each  plan  has  its  advantages  and  disadvantages.  The  latter  may  be  pre- 
ferable or  necessary  where  it  is  extremely  difficult  or  even  impossible  to 
apply  the  chain  to  the  neck. 

In  our  personal  experience  we  have  not  found  it  desirable  to  resort  to  the 
amputation  of  the  neck  in  cases  of  deviation  of  the  head,  but  have  constantly 
preferred  to  amputate  one  anterior  limb  subcutaneousl}-,  followed  by 
evisceration,  which  operations  we  shall  describe  below,  after  which  the  fetal 
renmant  may  be  extracted  without  difficult^',  with  the  head  turned  back, 
or  the  head  may  be  readily  brought  into  position  ,as  the  operator  may  prefer. 

d.    Subcutaneous    Amputation   of   the    Anterior    Limbs. 

Amputation  of  the  anterior  limbs  i.s  very  frequently  called  for 
in  obstetric  practice,  especially  in  the  mare,  chiefly  in  cases  of 
the  ventral  transverse  presentation,  with  all   four  feet   offering 


646  Veterifiary  Obstetrics 

and  the  head  retained  ;  in  cases  of  wry  neck  in  the  foal  in  the 
anterior  presentation,  dorso-sacral  position,  when  it  is  impracti- 
cable to  correct  the  deviation  of  the  head  ;  or  in  any  case  in  the 
mare  or  cow  where  deviation  of  the  head  cannot  be  corrected  or 
is  not  so  readily  performed  as  is  the  amputation  of  the  limb. 

Techiiic.  The  larger  herbivorous  animals  are  devoid  of  a 
clavicle,  and  the  anterior  limb  is  attached  to  the  thorax  by  means 
of  the  skin  and  muscles  only,  and  is  therefore  comparatively  easily 
amputated.  Attach  a  cord  to  the  pastern  of  the  limb,  the 
shoulder  of  which  lies  most  expo.sed  or  is  most  readily  reached, 
and  have  one  or  two  assistants  exert  traction  upon  it,  and 
draw  it  out  as  far  as  possible  with  safety  to  the  mother.  Insert 
one  hand,  armed  with  the  hooked  embryotomy  knife,  well  guarded 
in  the  palm  of  the  hand  and  resting  against  the  limb  of  the  fetus 
up  to  the  top  of  the  scapula  or  as  nearly  thereto  as  can  be 
reached  ;  press  the  knife  into  the  skin  and  subcutaneous  tissues 
and,  drawing  the  hand  downward  along  the  leg,  slit  the  skin  and 
subcutaneous  tissues  freely  and  deeply  from  the  top  of  the 
scapula  down  to  the  pastern.  Lay  aside  the  knife  and  force  the 
fingers  between  the  skin  and  subjacent  tissues  of  the  limb  and, 
while  the  a.ssistant  maintains  gentle  traction,  separate  the  skin 
from  the  parts  beneath  by  forcing  the  hand  or  the  ball  of  the 
thumb  through  the  loose  connective  tissue  until  the  upper  region 
of  the  scapula  is  reached. 

The  separation  of  the  skin  from  the  subjacent  parts  may  re- 
quire at  certain  points,  like  the  region  of  the  olecranon  or  carpus, 
the  aid  of  the  chisel  or  knife  to  divide  firm  bands  of  connective 
tissue.  The  separation  of  the  skin  from  the  subjacent  parts  re- 
moves the  chief  resistance  to  the  tearing  of  the  limb  away  from 
the  body.  Until  the  .skin  has  been  separated  from  the  subjacent 
tissues  over  the  leg  and  shoulder,  it  should  be  kept  intact  at  the 
pastern,  so  that,  when  traction  is  applied,  the  skin  as  well  as  the 
leg  is  rendered  tense  and  the  skinning  is  greatly  favored.  When 
the  skinning  of  the  leg  and  shoulder  is  completed,  the  skin  is  to 
be  divided  at  the  foot  by  girdling  the  pastern.  The  detached 
skin  will  be  of  no  further  importance,  and  may  be  ignored.  If 
required,  it  may  be  grasped  and  corded  with  a  small  cord. 

Next  in  power  of  resistance  are  the  pectoral  muscles.  These 
may  be  torn  asunder  by  first  being  separated  into  small  bundles 
and  then  torn  through  with   the  fingers,   between  the  sternum 


Em  bryotomy  64  7 

and  the  limb.  The  process  may  be  aided  by  incision  with  a  knife 
or  with  the  chisel. 

When  the  foregoing  are  well  divided,  the  remaining  impedi- 
ments to  tearing  the  shoulder  away  consist  essentially  of  the 
trapezius  and  rhomboideus  muscles  at  the  top,  the  latissimus 
dorsi  behind,  and  the  great  serratus  and  angularis  scapula,  all  of 
which  come  into  action  only  when  the  shoulder  is  nearlj^  severed, 
and  then  offer  no  serious  resistance.  Consequently  it  is  only 
necessary  to  separate  the  skin  from  the  limb  and  divide  the  pecto- 
ral muscles  in  order  to  readily  draw  the  limb  away  by  traction. 

When  the  skin  has  been  detached  and  the  pectoral  muscles  di- 
vided, two  or  three  assistants  exert  traction  upon  the  limb,  while 
the  operator  places  his  hand  against  the  sternum  and  pushes  iu 
the  opposite  direction.  The  impact  upon  the  maternal  organs 
from  the  traction  may  be  reduced  to  any  desired  degree,  by  ap- 
plying a  repelling  force  to  the  sternum  of  the  fetus. 

The  impact  upon  the  maternal  organs  equals  the  difference  be- 
tween the  traction  applied  upon  the  cord  and  the  repulsion  applied 
to  the  fetal  sternum.  Should  the  hand  of  the  operator  not 
suffice,  the  repeller  should  be  applied,  carefully  guarded  by  the 
hand  of  the  operator,  the  necessary  force  being  supplied  by  one 
or  more  assistants. 

Should  the  traction  fail  to  bring  the  limb  away  promptly,  the 
operator  should  attempt  to  extend  the  divi.sion  of  the  muscles 
attaching  the  limb  to  the  thorax,  while  moderate  traction  upon 
the  limb  is  continued. 

Further  diminution  of  the  size  of  the  fetus  may  now  be  had  by 
the  removal  of  the  other  limb  in  the  same  way.  This  is  especially 
desirable  in  the  transverse  presentation  with  all  four  limbs  in 
the  passage.  The  size  of  the  trunk  may  also  be  further  reduced 
by  evisceration,  as  described  on  page  658. 

When  a  foal  presents  anteriorly  in  the  dorso-sacral  position, 
with  lateral  deviation  of  the  head  which  it  is  impracticable  to 
correct,  the  subcutaneous  removal  of  one  anterior  limb,  followed 
by  evisceration,  so  reduces  the  volume  of  the  fetus  that  the  rem- 
nant can  be  easily  withdrawn  without  correcting  the  deviation, 
of  the  head.  It  also  renders  the  fetal  remnant  so  flaccid,  and 
so  far  increases  the  room  by  the  reduction  of  size,  that  the  devia- 
tion is  easily  corrected. 


64S  VeteriJiary  Obstetrics 

In  the  ventral  presentation,  the  subcutaneous  removal  of  both 
anterior  limbs  greatly  facilitates  version,  and  reduces  to  a  mini- 
mum the  dangers  of  injuries  to  the  uterus  during  version,  owing 
to  a  foot  being  caught  in  its  walls. 

e.  Amputation  at  the  Humero-Radial  Articulation.  Am- 
putation at  this  point  is  rarely  desirable,  but  may  at  times 
be  necessary  in  the  mare  in  order  to  remove  an  anterior  limb 
when  it  is  impossible,  on  account  of  the  position,  to  reach  the 
shoulder. 

Technic.  Attach  a  cord  to  the  pastern,  as  in  the  preceding, 
and  have  an  assistant  render  the  leg  tense  by  exerting  moderate 
traction.  Introduce  the  hand,  armed  with  the  embryotomy 
knife,  carefully  concealed  in  the  palm,  and  girdle  the  skin  around 
the  articulation.  Passing  above  the  head  of  the  olecranon  on  the 
posterior  side,  divide  the  attachment  of  the  anconean  group  of 
muscles  by  a  cut  directed  forward.  Then  divide  transversely,  as 
far  as  possible,  the  muscles  and  ligaments  passing  over  the  artic- 
ulation. Rotate  the  limb  forcibly  on  its  long  axis  while  strong 
traction  is  maintained,  and  rupture  the  remaining  ligaments  until 
the  limb  is  completely  detached  and  comes  away. 

In  cases  of  limited  room,  it  may  sometimes  be  easier  to  detach 
the  .skin  of  the  limb  from  the  pastern  up  to  the  articulation,  as 
in  the  operation  for  the  subcutaneous  amputation  of  the  limb  at 
the  shoulder,  as  described  above.  By  this  plan  the  skin  is  sepa- 
rated up  to  the  olecranon,  the  muscles  divided  transversely,  and 
the  operation  otherwi.se  carried  out  as  in  the  preceding  para- 
graph. 

f.  Detruncation  in  the  Anterior  Presentation.  When 
a  fetus  in  the  anterior  presentation  has  one  or  both  pos- 
terior limbs  deviated  forward  beneath  its  body,  and  the  feet  en- 
gaged against  or  in  the  pelvis,  it  may  be  necessary  or  advisable 
in  the  mare,  and  possibly  rarely  in  the  cow,  that  the  trunk  of  the 
fetus  be  divided  in  order  to  bring  about  delivery  without  serious 
or  fatal  injury  to  the  mother. 

Technic.  Secure  the  two  hind  feet  by  means  of  cords.  Ap- 
ply cords  to  the  two  anterior  limbs  and  head,  and  have  one  or 
two  assistants  draw  the  anterior  part  of  the  fetus  as  far  out  as  is 
practicable  and  safe.  Then  girdle  the  fetal  body  innnediately 
against  the  maternal  vulva,  by  making  an  incision  through  the 


Embryotomy  649 

skin  and  skin  muscle.  It  is  frequently'  best  at  this  point  to  re- 
move one  shoulder  subcutaneously,  as  described  on  page  645,  and 
follow  with  evisceration,  as  described  on  page  658,  in  order  to 
give  greater  operative  room  and  increased  mobility  of  the  fetus- 
Insinuate  the  hand  between  the  skin  and  the  deeper  structures, 
and  forcibly  separate  the  skin  from  the  fetal  body  backward  until 
the  last  rib  is  passed.  Force  the  finger  tips  through  the  abdom- 
inal wall  behind  the  last  rib  and,  passing  along  the  entire  poste- 
rior border  of  each  last  rib,  separate  the  abdominal  walls  from 
the  ribs  and  sternum.  After  the  abdominal  muscles  have  been 
detached  and  the  fetus  has  been  eviscerated,  rotate  the  thorax 
upon  its  long  axis.  This  will  cause  a  division  of  the  vertebral 
column  near  the  dorso-lumbar  articulation,  and  the  anterior  por- 
tion of  the  fetus  will  fall  away. 

Secure  the  two  posterior  feet  with  cords,  unless  this  has  already 
been  done  ;  spread  the  detached  skin,  which  has  been  pushed 
back  from  the  thorax,  carefully  over  the  stump  of  the  lumbar 
vertebrae  ;  push  the  remnant  of  the  fetal  trunk  into  the  uterus 
with  the  hand,  while  an  attendant  draws  upon  the  cords  attached 
to  the  hind  feet  and  advances  them  along  the  genital  passages, 
thus  causing  a  posterior  presentation.  This  may  result  in  a 
dorso-pubic  po.sition,  w  lich  should  be  converted  to  dorso-sacral, 
when  the  extraction  of  the  fetus  can  be  readily  brought  about. 

g.  Destruction  of  the  Pelvic  Girdle  in  the  Anterior 
Presentation.  Somewhat  rarely,  perhaps  most  frequently  in 
the  cow,  the  pelves  of  the  mother  and  fetus  become  interlocked 
and  the  antero-external  angles  of  the  fetal  ilia,  I'  Fig.  109,  become 
locked  with  the  shafts  of  the  maternal  ilia  I,  at  C,  in  such  a  man- 
ner that  any  safe  degree  of  traction  fails  to  overcome  it. 

Technic.  Remove  one  anterior  limb  subcutaneously,  page 
645,  and  eviscerate,  page  658,  through  an  opening  made  by  the 
removal  of  two  or  three  of  the  exposed  ribs.  Introduce  the 
chisel  through  this  opening,  carry  it  back  with  the  hand  and 
place  it  against  the  shaft  of  the  fetal  ilium  I'.  Have  an  assistant 
drive  the  chisel  through  the  iliac  shaft,  from  before  to  behind, 
and,  when  the  chisel  blade  is  well  buried  in  the  ilium,  revolve  the 
instrument  forcibly  upon  its  long  axis  and  thoroughly  divide  the 
pelvic  girdle  by  separating  the  cut  ends  of  the  bone.  Then 
withdraw  the  chisel  and  replace  it  against  the  pubic  brim,  either 


650 


Veteriyiarv  Obstetrics 


at  the  s}'mphysis  pubis  or  opposite  the  foramen  ovale,  and  drive 
it  through  the  pubis  and  ischium  at  either  of  these  points.     Again 


revolve  the  chisel  forcibly  upon  its  long  axis,  and  thoroughly 
break  the  bones  apart.  The  coxo- femoral  articulation  is  thus 
detached   and   isolated,    so  that  the  entire  limb  may  drop  back- 


Ef?ibryotomy .  651 

ward  beyond  its  fellow,  and  the  remnant  of  the  severed  ilium  I'  can 
drop  inward  or  move  in  any  direction.  The  entire  pelvis  thus 
loses  its  rigidity  and  undergoes  diminution  in  size,  so  that  it  can 
readily  be  withdrawn. 

B.   Embryotomy  in  the  Posterior  PrEvSEntation. 

a.  Amputation  of  the  Posterior  Limbs  at  the  Tarsus. 
When  a  fetus,  especially  a  foal,  presents  posteriorl^^  with  one 
or  both  posterior  limbs  retained  at  the  tarsus,  it  may  be  difficult 
or  impossible  to  repel  the  fetus  and  extend  the  feet.  The  diffi- 
culty of  the  correction  of  such  a  deviation  is  intensified  by  re- 
cumbency, the  comparatively  large  size  of  the  fetus,  and  by  fetal 
emphj'sema.  In  such  cases  it  is  frequently  easier  for  the  ob- 
stetrist  and  safer  for  the  mother  to  amputate  the  limb  or  limbs 
at  the  tarsus. 

Technic.  Pass  a  cord  around  the  leg  above  the  tarsus,  as  indi- 
cated in  Fig.  no,  and  have  an  assistant  hold  the  leg  steady  by 
gentle  traction.  Introduce  the  chisel,  carefully  guarded  in  the 
palm  of  the  hand,  and  place  it  against  the  lower  part  of  the  tar- 
sus, as  shown  between  T  and  T.  The  chisel  should  be  placed 
as  nearly  perpendicular  to  the  long  axis  of  the  metatarsus  as  pos- 
sible. The  proper  direction  of  the  chisel  may  at  times  be  greatly 
favored  by  placing  the  cord  upon  the  metatarsus  instead  of  the 
tibia,  thus  forcing  the  tarsus  toward  the  sacrum  of  the  mother 
and  tending  to  throw  the  metatarsus  straight  across  the  pelvic 
cavity. 

The  chisel  should  at  all  times  be  held  in  the  palm  of  the  hand, 
with  the  dorsal  surface  of  the  hand  against  the  vaginal  or  uterine 
walls,  and  the  instrument  carefully  guarded  and  guided  during 
the  entire  operation.  The  amputation  should  preferably  be 
through  the  lower  section  of  the  tarsus,  but  may  be  made  through 
the  head  of  the  metatarsus.  The  chisel  should  not  be  ^driven 
entirely  through  the  hock  without  removal,  as  it  may  oecome 
caught  and  clamped  between  the  divided  bones;  instead,  drive  it 
first  for  only  a  few  inches  along  the  lateral  side  of  the  tarsus,  being 
sure  that  the  skin  at  that  point  is  included  in  the  cut  along  with 
the  bone.  Then  loosen  the  chisel,  and  force  the  divided  bones 
apart  by  rotating  the  instrument  upon  its  long  axis,  after  which 
it  may  be  driven  somewhat  deeper  into  the  tarsus,  until  the  foot 
is  completely  severed. 


652 


Veterinary  Obstetrics 


Withdraw  the  severed  metatarsus,  remove  any  dangerous  frag- 
ments of  bone  remaining  on  the  stump,  and  see  that  the  latter  is 
safely  secured  by  a  cord  passing  around  the  leg  above  the  os  cal- 


cis.     Repeat  the  operation  on  the  other  hock  in  a  similar  manner. 

Apply  traction  to  the  two  limbs,  and  effect  a  posterior  delivery. 

The  technic  for  amputating  at  the  tarsus  varies  with  different 


Embryotomy.  653 

obstetrists.  and  those  who  prefer  to  use  the  chain-saw,  sector, 
Pflanz  instrument,  or  other  foim  of  embryotom,  would  ampu- 
tate with  such  an  instrument.  Any  one  of  them  is  efficient, 
providing  always  that  the  hock  is  easih^  reached  and  lies,  or  can 
be  placed,  in  such  a  position  that  the  instrument  can  be  applied. 
It  is  possible  also,  though  very  difficult,  to  amputate  the  hock 
with  a  scalpel. 

Instead  of  amputating  the  hock,  in  cases  where  it  is  offering 
a  serious  obstacle  to  parturition,  some  operators  sever  the  tendo- 
Achilles,  by  which  means  they  permit  the  metatarsus  to  fold 
against  the  inferior  surface  of  the  tibia  and  the  toe  of  the  foot  to 
become  somewhat  extended,  so  that  it  will  offer  less  obstruction. 

b.  Intra-Pelvic  Amputation  of  the  Posterior  Limbs  in 
the  Breech  Presentation.  This  operation  is  designed  for  the 
overcoming  of  dystokia  due  to  a  posterior  presentation  with  the 
hind  limbs  completely  retained  in  the  uterus,  the  so-called  breech 
presentation,  when  the  deviation  cannot  be  readily  corrected. 

Technic.  Introduce  one  hand,  armed  with  the  embryotomy 
knife,  scalpel  or  chisel,  through  the  maternal  passages,  until  the 
perineum  of  the  fetus  is  reached,  and  make  a  free  incision 
through  that  part,  including  the  anus  in  the  male  fetus  and  the 
anus  and  vulva  in  the  female,  enlarging  the  incision  sufficiently 
to  admit  the  operator's  hand  into  the  fetal  pelvis. 

Locate  the  great  sciatic  ligament  of  the  fetal  pelvis  and,  in- 
serting the  knife  into  it  just  behind  the  shaft  of  the  ilium,  divide 
the  former  backward  to  the  perineum,  thus  enlarging  the  pelvic 
cavity  and  giving  ample  operating  room.  If  the  pelvis  of  the 
fetus  is  too  small  to  admit  the  hand  of  the  operator  at  all  before 
severing  the  sciatic  ligament,  this  may  be  accomplished  by  cau- 
tiously cutting  from  behind  forward  with  Colin's  scalpel  or  with 
the  chisel. 

When  this  has  been  severed  and  sufficient  operating  room,  at- 
tained, carry  the  chisel  in  the  hand  and  place  it  against  the  shaft 
of  the  ilium,  as  shown  between  I'  and  I',  as  nearly  perpendicular 
to  the  long  axis  of  the  iliac  shaft  as  possible.  Keeping  the  hand 
in  touch  with  the  chisel  blade,  have  an  assistant  drive  it  through 
the  bone  until  it  and  its  periosteum  are  completely  severed. 
Forcibly  rotate  the  chisel  upon  its  long  axis,  in  order  to  complete 
the  division  of  the  bone  and  attached  soft  parts.  Disengage  the 
chisel,  and    then    place    it    against    the    symphysis    pubis    or 


654 


Veterinary  Obstetrics 


against  the  ischium  opposite  the  foramen  ovale,  and  drive 
it  through  the  ischium  and  pubis  at  one  of  these  points.  Again 
revolve    the    chisel    upon   its  long    axis    and,    using    it    as    a 


lever,  separate  the  isolated  portion  of  the  pelvis  as  com- 
pletely as  practicable  from  the  surrounding  tissues.  With  the 
fingers,  aided  by  the  chisel  if  necessary,  detach  the  muscles  from 


E?nbryoto?ny.  655 

the  isolated  segment  of  the  pelvic  girdle  for  a  short  distance 
from  each  severed  end.  Attach  a  strong  looped  cord  about  the  de- 
tached pelvic  segment,  and  tighten  the  noose.  Have  one  or  more 
assistants  apply  traction  as  indicated  in  Fig.  1 1 1  B.  The  chief 
obstacle  to  the  withdrawal  of  the  limb  is  the  great  gluteus  muscle, 
which  should  be  sought  for,  identified,  and  torn  through  with  the 
fingers  at  a  distance  of  5  or  6  cm.  from  its  attachment  to  the 
great  trochanter  of  the  femur.  This  is  best  done  while  steady, 
firm  traction  is  being  applied  to  the  limb  by  an  assistant,  thus 
tensing  the  muscle. 

Other  important  points  of  resistance  are  the  attachments,  pos- 
teriorly, of  the  skin,  vulva  and  anus  to  the  ischium  through  the 
medium  of  aponeurosis  ;  and  anteriorly,  chiefly  on  the  median 
line,  of  the  prebubic  tendon.  These  should  be  divided  with  the 
knife  or  chisel.  Vigorous  traction  may  now  be  applied  by  means 
of  the  cord,  while  the  operator  guards  the  advancing  end  of  the 
detached  piece  of  pelvis  with  the  palm  of  the  hand,  in  order  to 
prevent  injury  to  the  maternal  organs. 

Sometimes  the  isolated  piece  of  the  pelvis  tears  loose  from  the 
femur  and  comes  away  alone.  In  such  a  case,  tlie  cord  is  to  be 
applied  over  the  head  and  trochanter  of  the  femur,  and  traction 
again  exerted,  drawing  the  limb  away  in  a  reversed  po.sition. 
As  it  advances,  the  skin  is  turned  backward  or  everted  until  the 
region  of  the  hock  is  reached,  where  the  integument  does  not  so 
readily  separate  and  only  requires  to  be  divided  to  allow  the 
limb  to  come  away. 

During  the  removal  of  the  limb,  the  operator  is  to  constantly 
note  the  progress  by  manual  exploration,  and  sever  by  tearing  or 
cutting  any  tendons  or  muscles  which  offer  special  obstruction 
to  the  operation.  During  the  tearing  away  of  the  limb,  the 
operator  largely  or  wholly  counteracts  the  impact  of  the  traction 
upon  the  maternal  organs,  by  applying  repulsion  toother  portions 
of  the  fetal  pelvis,  either  with  his  hand  or  with  the  aid  of  a 
repeller  in  the  hands  of  an  assistant. 

Repeat  the  operation  upon  the  opposite  limb  in  the  same 
manner,  except  that  but  one  incision  need  be  made  through  the 
bone,  that  is,  through  the  shaft  of  the  ilium.  During  the  entire 
work  the  operation  is  carried  out  subcutaneously,  or  rather  intra- 
fetally,  and,  if  properly  performed,  the  maternal  parts  are  amply 
guarded  against  injur}'. 


656 


Veieri7iarv  Obstetrics 


The  size  of  the  fetal  trunk  may  be  further  reduced,  if  desired, 
by  evisceration,  as  described  on   page  658.     The  remnant  of  the 


fetus   may  then   be   extracted,    by   traction   upon  a  cord  looped 
about  the  lumbar  region  of  its  spinal  column. 

After  evisceration  has  been  accomplished,  should  the  fetal  rem- 


Embryotomy  657 

nant  still  seem  too  large,  because  of  emphysema  or  for  other 
reasons,  to  be  safel}^  drawn  through  the  pelvic  canal,  further 
diminution  in  volume  should  be  accomplished.  The  chisel  may 
be  carried  into  the  fetal  cavity  and  placed  against  the  last  rib, 
close  alongside  the  spinal  column.  Light  blows  upon  the  chisel 
by  an  assistant,  the  cutting  end  constantly  accompanied  by  the 
operator's  hand,  readily  severs  each  rib  succes.sivel3^  The  oper- 
ation can  be  applied  on  each  side  of  the  spinal  column,  .so  that 
all  ribs  are  divided. 

The  ribs  may  also  be  severed  by  means  of  the  long-handled 
sphere-pointed  cutting  hook,  Fig.  106  h.  The  instrument  is 
introduced  into  the  fetal  body-cavity  and  hooked  over  the  first 
anterior  rib,  or  the  most  anterior  rib  within  reach,  and  the  ribs 
are  cut  one  after  another  as  the  instrument  is  drawn  backward. 
The  sphere  upon  the  point  obviates  the  danger  of  the  instrument 
penetrating  the  fetal  skin  and  wounding  the  maternal  organs. 

If  neither  of  these  instruments  is  at  hand,  the  obstetrist 
may  destroy  the  ribs  by  manual  force.  The  tips  of  one  or  more 
fingers  may  be  forced  through  the  intercostal  muscles  between 
the  last  two  ribs,  the  intercostals  then  torn  asunder  from  the  base 
or  .spinal  end  down  to  the  sternal  cartilages,  and  the  rib  grasped 
and  broken.  Rib  after  rib  may  be  treated  thus  until  all  are 
broken.  This  is  a  tedious  operation,  and  there  is  constant  danger 
to  the  operator  of  wounds  from  the  sharp  broken  rib  ends. 

The  division  of  the  ribs  is  of  very  great  importance.  It  allows 
complete  collapse  and  obliteration  of  the  fetal  body  cavity,  and 
renders  the  fetal  remnant  very  flaccid  and  pliable.  More  im- 
portant perhaps,  it  permits  the  escape  of  the  imprisoned  gases  of 
emphysema  under  the  pressure  of  the  labor  pains. 

When  the  ribs  have  been  destroyed,  further  diminution  may  be 
accomplished  by  securing  a  scapula  from  inside  the  chest,  cording 
it  and  drawing  the  leg  out  through  the  cavity  of  the  fetal  bod}'. 

The  amputation  of  the  hind  limbs  may  be  accomplished  by 
other  means.  The  above  plan  offers  the  greatest  decrease  in 
the  volume  of  the  fetus  ;  the  manipulations  are  carried  on  ex- 
clusively within  the  fetal  body,  insuring  the  greatest  possible 
safety  to  the  patient,  and  when  completed  afford  ready  means 
for  evisceration.  The  operation  is  neither  tedious  nor  difficult, 
when  compared  with  obstetric  operations  generally. 
42 


658  Veterinary  Obstetrics 

Some  operators  advise  the  use  of  Persson's  chain-saw,  or  the  Pflanz  ma- 
chine, and  amputate  the  posterior  limbs  as  close  to  the  hip-joint  aspossiVjle. 
The  application  of  these  instruments  is  not  always  easy.  In  either  case  a 
cord  or  chain  is  passed  around  the  limb  as  close  as  possible  to  the  hip-joint, 
and  the  limb  is  then  severed  in  the  manner  described  on  pages  604 
and  644,  for  the  neck  in  the  anterior  presentation. 

Other  operators  would  cut  through  the  soft  tissues  with  a  scalpel  and 
attempt  to  disarticulate  the  femur  from  the  pelvis.  It  must  be  extremely 
difficult  to  disarticulate  such  a  joint  as  this  while  the  fetus  is  confined  in  the 
uterus  and  the  limb  is  virtually  immovable. 

c.  Evisceration.  The  evisceration  of  the  fetu.s  is  frequently 
desirable  in  obstetric  practice,  and  has  a  variet)^  of  uses.  It  de- 
creases the  volume  of  the  fetal  trunk  greatly,  and  permits  its  more 
ready  passage  through  the  genital  canal.  For  example,  in  the 
anterior  presentation,  with  lateral  deviation  of  the  head,  it  ren- 
ders the  fetal  trunk  flaccid,  through  the  removal  of  the  viscera 
supporting  the  body  walls,  and  permits  the  body  remnant  to  be 
bent  or  moved  more  readily  for  the  correction  of  any  deviations ; 
it  permits  freedom  of  intra-fetal  operations  directed  against  other 
parts,  as  for  detruncation,  page  648,  or  for  the  destruction  of  the 
pelvic  girdle,  page  649.  When  a  putrefying  fetus  becomes  enor- 
mously enlarged  as  a  result  of  emphysema,  evisceration  removes 
the  ga.ses  collected  in  the  viscera  and  body  cavity,  and  permits 
the  escape,  under  pressure  in  the  birth  canal,  of  much  of  the  gas 
imprisoned  within  the  body  walls. 

Techyiic.  Evisceration  may  be  employed  in  either  the  anterior 
or  the  posterior  presentation,  possibly  in  extremely  rare  cases  in 
transverse  presentations. 

I.  In  the  anterior  presentation,  unless  the  fetus  is  far  advanced 
through  the  vulva,  evisceration  is  best  performed  by  the  removal 
of  one  or  more  of  the  anterior  ribs.  The  ribs  are  generally  best 
reached  by  the  removal  of  the  shoulder,  as  already  described  un- 
der subcutaneous  amputation  of  the  anterior  limbs,  on  page  645. 
When  the  ribs  have  been  laid  bare  in  the  manner  described, 
the  operator  can  thrust  the  finger  tips  through  the  muscles  in  the 
first  intercostal  space,  and  enlarge  the  opening  thus  made  by  tear- 
ing through  the  muscles,  upwards  to  the  spinal  column  and  down- 
wards to  the  sternum  ;  then,  grasping  the  rib  near  its  middle, 
he  can  fracture  it  by  means  of  a  sudden  and  vigorous  pull.  The 
fractured  ends  may  then  be  grasped,  and  pulled,  broken  or 
twisted  off. 


Embryotomy  659 

The  chisel  may  be  brought  into  use,  if  required,  in  order  to 
divide  the  rib,  the  hand  of  the  operator  constantly  guiding  and 
guarding  the  chisel  blade.  The  operation  is  then  to  be  repeated, 
if  required,  upon  the  second  and  third  ribs,  until  an  opening  into 
the  chest  is  secured,  ample  in  size  for  the  introduction  of  the  ope- 
rator's hand. 

Force  one  hand  through  the  opening,  and  tear  the  mediastium 
from  the  thoracic  walls,  above  and  below.  Then  grasp  either  the 
trachea  at  its  bifurcation,  or  the  heart,  and  tear  away  the  lungs 
and  heart,  as  nearly  as  possible  in  one  mass.  The  heart,  which 
constitutes  the  greatest  bulk  of  the  thoracic  viscera,  is  best 
grasped  in  the  pahn  of  the  hand,  with  the  fingers  engaging  the 
aorta  and  pulmonary  arteries. 

When  the  thoracic  viscera  have  been  withdrawn,  thrust  the 
fingers  through  the  diaphragm,  locate  the  liver,  isolate  the  area 
of  the  diaphragm  to  which  it  is  attached,  and,  engaging  both 
with  the  fingers,  remove  the  two  together. 

The  liver,  in  a  normal  fetus,  constitutes  the  chief  intra-abdom- 
inal mass,  and  occupies  more  space  than  all  the  other  organs  com- 
bined. After  the  liver  has  been  removed,  the  intestinal  tube, 
with  its  contents,  may  be  withdrawn  without  difficulty,  as  its 
attachments  are  feeble.     The  kidnej^s  may  also  be  removed. 

Evisceration  of  a  fetus  in  the  posterior  presentation  is  prefer- 
ably performed  through  the  pelvis,  generally  in  connection  with 
intra-pelvic  amputation  of  the  posterior  limbs,  page  653.  It  may 
be  performed  without  destruction  of  the  pelvic  girdle,  by  making 
an  incision  through  the  perineal  region  and  then  severing  the 
sacro-sciatic  ligament  as  directed  for  that  operation. 

When  free  entrance  has  been  gained  into  the  abdominal  cav- 
ity, introduce  the  hand  and  withdraw  the  alimentary  tube;  then 
rupture  the  diaphragm  about  the  liver  and  tear  away  the  latter 
organ  in  the  same  manner  as  in  the  anterior  presentation.  The 
liver  is  so  friable  that  it  cannot  well  be  removed  by  grasping  the 
organ  itself,  but  comes  away  entire,  with  the  central  part  of  the 
diaphragm. 

Remove  the  heart  and  lungs  as  directed  in  the  anterior  presen- 
tation. 

The  efficiency  of  the  evisceration  in  decreasing  the  volume  and 
rigidity  of  the  fetal  body  may  be  furthered  by  the  division  of  the 
fetal  ribs  as  noted  on  page  656. 


66o  Veterinary  Obstetrics 

Embryotomy  under  Special  Conditions. 

In  the  foregoing  pages  we  have  described  embryotomy  as  it 
may  be  carried  out  in  dystokia,  with  the  fetus  presenting  under 
conditions  which  are  more  or  less  subject  to  classification.  These 
directions  constitute  a  general  outline,  the  principles  of  which 
are  more  or  less  applicable  in  all  cases.  There  occur,  however, 
many  quite  atypical  cases  to  which  these  general  principles  must 
be  adapted. 

In  the  various  forms  of  monstrosities,  some  plan  must  be 
evolved  by  which  the  monster  may  be  sufRciently  reduced  in  size 
to  permit  of  its  removal.  Double  monsters  may  be  divided  as 
nearly  as  possible,  or  a  portion  of  each  body  may  be  removed, 
including  evisceration,  so  that  the  remnants  of  the  more  or  less 
double  body  may  be  removed  together. 

Sometimes  other  persons  have  performed  partial  embryotomy, 
in  a  way  to  greatly  embarrass  the  veterinarian.  A  limb  has  been 
amputated,  at  such  a  place  that  it  becomes  a  positive  menace  to 
the  patient  and  interferes  with,  rather  than  aids  in,  its  delivery. 
Such,  for  example,  is  the  amputation  of  an  anterior  limb  at  the 
carpus,  when  the  foal  is  presenting  anteriorly  or  in  the  trans- 
verse presentation.  In  such  cases  the  stump  of  the  limb  must 
not  be  pushed  back  into  the  uterine  cavity,  but  must  be  ampu- 
tated higher  up,  until  at  least  the  fore-arm  has  been  removed. 
We  meet  with  similar  mutilations,  when  the  fetus  presents  pos- 
teriorly and  some  portion  which  has  protruded  beyond  the  vulva 
has  been  cut  away.  We  have  also  met  with  cases  in  the  anterior 
presentation,  with  the  two  hind  feet  projecting  forward  and  en- 
gaged in  the  pelvis,  in  which  detruncation  had  been  performed 
through  the  thorax,  and  jagged  bones  left,  which  seriously 
abraded  the  soft  tissues  of  the  mother.  It  is  absolutely  neces- 
sary in  such  a  case  that  the  spinal  column  be  shortened  by  the 
removal  of  all  the  dorsal  vertebrae  and  ribs,  in  order  that  ver- 
sion may  be  accomplished  and  the  remnant  converted  into  the 
posterior  presentation.  It  is  also  essential  that  the  spinal  column 
be  shortened  in  order  that  a  flap  of  the  skin  and  soft  ti.ssues  may 
be  acquired,  which  will  cover  the  spinal  stump  and  protect  the 
uterus  and  vagina  from  injury. 

Early  in  our  ob.stetric  career  we  were  called  to  attend  a  cow 
which  was  suffering  from  dystokia.     The  presentation  had  been 


Exercises  in  Mutations  and  Ei7ibryotoniy  66 1 

anterior,  and  apparently  normal,  but  the  calf  was  somewhat  large 
and  it  was  necessary  to  apply  traction.  A  local  practitioner 
hitched  a  horse  to  the  calf,  and  succeeded  in  advancing  it  until 
the  fetal  and  maternal  ilia  became  interlocked.  The  fetus  was 
then  cut  in  two  in  the  dorso-lumbar  region,  and  the  posterior 
portion  remained  in  the  uterus.  With  our  inexperience,  we  failed 
to  accomplish  delivery. 

Various  courses  might  have  been  successfully  pursued.  It 
would  not  have  been  difficult  to  have  reached  into  the  fetal  pelvis 
and  engaged  it  with  a  blunt  hook  fixed  over  the  posterior  border 
of  an  iliac  shaft.  Holding  the  fetal  remnant  securely  by  means 
of  the  hook  or,  if  preferred,  by  a  cord  pa.ssing  around  the  iliac 
shaft,  we  could  place  the  chisel  against  the  other  iliac  shaft  and 
divide  it.  Next  we  could  place  the  chisel  opposite  the  pelvic 
symphysis  or  the  foramen  ovale,  and  again  divide  the  pelvis  on 
the  median  side  of  the  hip  joint.  We  could  then  loop  a  cord 
about  the  isolated  segment  of  the  pelvis  and,  exerting  traction 
thereon,  remove  it,  with  the  hind  limb.  The  remnant  would 
then  be  easily  extracted,  since  the  size  of  the  croup  would  have 
been  reduced  one-half. 

Complications  of  the  greatest  variety  may  thus  arise,  and  are 
to  be  met  by  judicious  planning  and  having  the  necessary  instru- 
ments and  appliances  at  hand  for  carrying  out  the  work. 

Exercises  in  the  Mutations  of  the  Fetus  and  in 
Embryotomy. 

The  veterinarian  who  attends  a  case  of  dystokia,  without  having 
first  learned  by  personal  experience  the  mechanism  by  which 
dystokia  is  to  be  overcome,  always  labors  under  a  serious  handi- 
cap. Every  veterinarian,  before  entering  upon  an  obstetric 
practice,  should  make  himself  personally  familiar  with  the  various 
operations  which  he  may  be  called  upon  to  perform  in  the  over- 
coming of  dystokia.  Each  of  these  operations  xwa.y  be  planned 
and  carried  out  without  great  difficulty,  and  in  a  manner  which 
will  give  to  the  veterinarian  valuable  training,  which  will  prove 
a  great  help  to  him  in  the  actual  work. 

Various  plans  are  proposed  and  carried  out  with  a  view  to 
teaching  these  operations  in  an  efficient  manner. 


662  Veterinary  Obstetrics 

The  author  has  had  prepared  a  special  skeleton  of  the  cow, 
which  has  been  strongl)^  mounted  and  securely  fixed,  so  that  any- 
desired  force  may  be  used  upon  it  without  danger  to  the  appar- 
atus. Inside  the  skeletal  cavity  we  have  placed  a  leather  sac,  in 
imitation  of  the  uterus.  New-born  calves  are  procured  and 
killed,  and  the  body  placed  in  the  artificial  uterus  in  any  position 
which  may  be  desired,  and  the  student  is  asked  to  correct  the 
vicious  position  or  deviation  of  an  extremity,  or  to  perform  em- 
bryotomy by  a  definite  plan.  In  such  a  case,  the  work  closely 
simulates  that  encountered  in  actual  practice.  The  fetus  is  out 
of  sight,  and  the  leather  sac  may  be  so  adjusted  that  any  desired 
degree  of  pressure  upon  the  fetus  may  be  commanded. 

The  operation  must  be  carried  out  through  the  pelvis,  and  the 
height  of  the  pelvis  from  the  floor  is  es.sentially  the  same  as  en- 
countered in  actual  practice  in  the  standing  animal. 

Any  veterinarian  who  has  not  enjo^-ed  the  privilege  of  such 
opportunities  in  college,  or  who  has  not  satisfactorily  availed 
himself  of  such  opportunities,  need  not  be  debarred  from  the 
benefits  of  such  work.  Numerous  devices  have  been  described 
and  used,  many  of  which  are  easily  and  cheaply  constructed,  and 
readily  available  to  any  practitioner.  One  can  take  an  ordinary 
stout  box,  of  sufficient  dimensions  to  contain  the  new-born  fetus, 
and  may  make  an  opening  at  one  end,  about  the  size  of  the  pelvic 
canal.  He  may  then  procure,  from  time  to  time,  new-born 
calves  and,  placing  them  in  the  box,  proceed  to  practice  the 
various  changes  in  position  or  different  forms  of  embryotomy,  as 
described.  If  he  desires  to  approach  more  nearly  to  the  normal 
conditions,  he  may  use  the  pelvis  of  a  cow  or  mare,  through  which 
to  do  his  work,  and  beyond  it  secure  the  fetus  in  a  box  or  bag. 
Such  apparatus  may  be  placed  upon  a  strong  table,  or  otherwise 
secured,  at  a  height  convenient  for  the  work.  Such  exercises  in 
obstetric  surgery  are  of  so  great  importance  that  any  inexperi- 
enced veterinarian  who  has  to  do  with  dystokia  can  not  properly 
afford  to  neglect  them,  because  they  give  to  him  an  experience 
which  renders  his  actual  work  far  more  efficient  and  satisfactory. 
They  decrease  greatly  the  strain  of  his  work  in  actual  practice, 
and  increase  enormously  his  success  as  a  practitioner. 


IV.   CAESARIAN  SECTION  OR  GASTRO-HYSTEROTOMY. 

Caesarian  section  is  the  removal  of  a  fetus  or  fetuses  from  the 
uterus  by  means  of  an  incision  made  through  the  abdominal 
walls. 

It  has  its  use  as  a  last  resort  in  an  attempt  to  save  the  life  of 
the  fetus,  the  mother,  or  both,  when  other  forms  of  delivery  are 
impossible  or  impracticable. 

It  is  one  of  the  oldest  operations  in  history  and  has  been  per- 
formed since  the  earliest  times,  both  in  human  and  veterinary 
obstetrics.  In  earlier  times  it  was  performed  chiefly  with  a  view 
to  saving  the  life  of  the  fetus,  and  in  many  cases  that  of  the 
mother  was  deliberately  sacrificed  in  order  to  accomplish  this 
end.  Since  the  advent  of  antiseptic  surgery,  added  to  the  use 
of  anaesthetics,  the  operation  has  attained  a  wider  application  and 
tends  frequently  to  conserve  the  life  of  both  mother  and  fetus. 

Quite  naturally  the  operation  is  most  readily  carried  out  and 
is  most  successful  in  the  smaller  domestic  animals,  both  on  ac- 
count of  their  size  and  because  of  their  comparative  immunity  to 
septic  infection.  In  the  sow,  bitch  and  cat  it  frequently  occurs 
that  both  parent  and  offspring  survive  if  the  operation  is  per- 
formed at  the  proper  time  and   under  strict  aseptic  precautions. 

It  is  usually  comparatively  easy  to  extract  a  living  calf  from 
the  cow,  but  the  mother,  under  present  plans  of  operating, 
generally  succumbs. 

The  operation  may  be  successfully  performed  in  the  mare,  in 
so  far  as  extracting  a  living  foal  is  concerned,  but  we  have  no 
records  where  the  life  of  a  mare  has  been  thus  saved.  Neces- 
sarily the  foal  must  be  extracted  very  early  in  case  of  difficult 
labor,  or  it  perishes  because  of  the  detachment  of  its  placenta. 

The  chief  indications  for  the  performance  of  hysterotomy  in 
the  larger  animals  are  :  imminent  death  of  the  mother,  where 
there  is  hope  of  saving  the  life  of  the  fetus  ;  displacements  of 
the  gravid  uterus,  such  as  irreducible  torsion  or  hernia  ;  and 
extra-uterine  gestation. 

In  the  sow,  bitch  and  cat,  should  the  pelvis  be  abnormally 
narrow  or  a  fetus  become  lodged  anterior  to  the  pelvis,  whether 
from  over-size,  mal-presentation  or  emphysema,  embryotoni}-  is 
impossible,  owing  to  the  smallness  of  the  pelvic  canal;  mutations 
for  the  correction  of  deviations  are  well-nigh  impossible;  and  forced. 


664  Veteri?iary  Obstetrics 

extraction  is  frequently  dangerous  or  impossible.  Thus  the  veter- 
inary obstetrist  is  forced  to  choose  between  hysterotomy  and  the 
destruction  of  the  patient. 

Technic.  When  a  pregnant  animal  meets  with  a  sudden  and  fatal 
accident,  is  in  death  throes,  or  her  death  is  imminent,  Caesarian 
section  may  be  roughly  performed  by  quickly  making  a  free  incision 
through  the  abdomen  at  the  most  convenient  point,  exposing  the 
uterus,  incising  its  walls,  and  promptly  liberating  the  fetus. 
When  such  emergency  does  not  exist  and  the  operation  may  be 
more  deliberately  planned  and  performed,  the  technic  may  be 
varied  according  to  the  individual  case,  the  species  of  animal  or 
preferences  of  the  obstetrist.  Some  operators  prefer  to  make 
the  laparotomy  upon  the  median  line  in  the  linea  alba;  others 
prefer  to  operate  in  the  flank.  In  the  smaller  Animals,  it  seems 
to  be  largely  a  question  of  choice  on  the  part  of  the  individual 
operator,  though  evidently  there  are  advantages  and  disadvan- 
tages in  each  plan.  In  the  larger  animals,  like  the  mare  and 
cow,  the  operation  through  the  linea  alba  is  impracticable  under 
present  conditions,  so  far  as  the  preservation  of  the  life  of  the 
mother  is  concerned,  because  the  immense  weight  of  the  ab- 
dominal viscera  prevents  the  surgeon,  with  his  present  appliances, 
from  closing  the  abdominal  incision  in  such  a  manner  as  to  sup- 
port the  viscera  and  prevent  their  protrusion. 

In  all  animals  the  flank  operation  is  evidentl}^  safer  in  reference 
to  prolapse  of  the  abdominal  organs  as  a  result  of  the  breaking,  or 
tearing  out  of  the  sutures.  After  the  operation  the  flank  wound 
may  be  kept  cleaner,  since  it  does  not  come  into  so  constant  and 
immediate  contact  with  the  ground  or  floor  when  the  animal  is 
lying  down.  In  the  bitch  and  sow  the  flank  incision  has  a  fur- 
ther advantage  over  that  through  the  linea  alba.  In  these  ani- 
mals the  double  row  of  mammae  leaves  the  median  line  in  a  deep 
furrow,  which  renders  suturing  difficult. 

One  advantage  of  the  linea  alba  incision  is  the  possibility  of 
affording  drainage  to  an  infected  uterine  cavity,  when  such  is 
not  available  through  the  vagina  because  of  some  serious  dis- 
placement of  the  organ,  such  as  irriducible  torsion  or  transverse 
rupture  through  the  cervix.  In  a  pet  animal,  the  resultant  scar 
may  be  less  objectionable  in  the  linea  alba. 

The  securing  of  the  animal  for  the  operation  must  correspond 
with  the   plan  and    the  intended    position  of    the   laparotomy. 


Ccssariayi  Section  665 

Harms  states  that  the  operation  on  the  cow  may  be  performed 
upon  the  animal  in  the  standing  position,  but  it  would  seem  to 
us  that  such  a  plan  would  offer  very  great  difficulties.  With 
most,  if  not  all  animals,  it  is  essential  that  they  be  cast,  or  se- 
cured and  placed  upon  the  operating  table  in  lateral  recumbency, 
for  the  flank  incision,  or  in  the  dorsal  position  in  case  the  linea 
alba  is  selected. 

From  a  humane  as  well  as  an  operative  standpoint,  anaesthesia 
or  narcosis  should  be  induced.  Keller  (Zeitschrift  fur  Tierme- 
dizin,  B.  11,  S.  122)  recommends  for  the  bitch  the  subcutaneous 
injection  of  muriate  of  morphine  in  doses  not  exceeding  0.06  g., 
and  later,  if  marked  pain  and  struggling  ensue,  the  inhalation  of 
a  small  amount  of  ether.  De  Bruin  (B.  T.  W.,  January  3,  1907) 
considers  chloroform  or  other  anaesthesia  highly  dangerous  in  the 
sow,  and  has  had  unfortunate  results  therefrom,  .so  that  he 
recommends  local  anaesthesia,  consisting  of  cocaine  muriate 
0-3~0-  5  g-  ill  10  cc.  of  distilled  water,  with  the  addition  of  5 
drops  of  I- 1000  solution  of  adrenalin  chloride.  Other  plans  for 
inducing  local  anaesthesia  of  the  abdominal  walls  may  be  used, 
and  when  the  abdominal  cavity  is  open  the  anaesthesia  may  be 
extended  to  the  uterus  itself. 

Chloroform  anaesthesia  in  the  cow  and  sheep  is  somewhat 
dangerous,  because  of  their  great  tendency  to  regurgitate  food 
from  the  rumen  and  then  inhale  it  into  the  bronchi.  If  chloro- 
form anaesthesia  is  produced  in  the  cow,  it  might  be  well  to  ad- 
minister it  through  a  trachea  tube  in  order  to  guard  against  food 
inhalation.  We  may  also  resort  to  local  anesthesia  in  the  cow, 
remembering  constantly  that  the  principal  pain  in  the  operation 
consists  of  the  incision  through  the  skin,  after  which  as  a  general 
rule  there  is  little  evidence  of  intense  pain.  Complete  anaesthesia 
is  essential  in  the  mare,  if  we  propose  to  attempt  to  save  her 
life  by  the  operation. 

In  securing  an  animal  for  the  operation,  she  should  always  be 
extended  at  full  length,  the  hind  legs  drawn  backward  and  the 
anterior  limbs  forward,  so  that  they  will  be  completely  out  of 
the  way.  In  small  animals  this  extension  of  the  limbs  may  be 
maintained  with  the  aid  of  assistants,  but  in  the  larger  animals  it 
is  essential  that  the  patient  be  stretched  by  means  of  ropes  at- 
tached to  the  hind  and  fore  limbs  respectively,  the  other  ends  of 
which  are  securely  fixed  to  posts  or  other  secure  objects. 


666  Veterinary  Obstetrics 

If  we  wish  to  preserve  the  life  of  the  mother,  we  should  be 
careful  to  select  a  place  for  operating  which  is  clean  and  free 
from  dust.  If  the  animal  is  placed  upon  a  bed  of  straw  or 
other  material,  the  bedding  should  be  carefully  moistened  with 
an  antiseptic  and  all  necessary  means  taken  to  prevent  any  stirring 
up  of  dust  by  the  struggles  of  the  animal. 

The  operating  field  should  be  carefully  cleaned  and  disin- 
fected. The  hair  should  be  removed  by  shaving  ov^er  an  ample 
area,  which  should  then  be  disinfected  by  cleansing  with  soap  and 
hot  water  with  a  stiff  brush,  followed  by  a  thorough  wa.shing 
with  alcohol  or  ether  to  dissolve  the  fat,  after  which  the  part 
should  be  thoroughly  washed  with  i-iooo  corrosive  sublimate 
solution  or  other  reliable  disinfectants. 

In  addition  to  these  precautions,  Keller  suggests  that  at  the 
point  of  incision  the  area  should  be  saturated  with  tincture  of 
iodine  in  order  to  complete  the  disinfection  of  this  region.  Prior 
to  the  application  of  the  tincture  of  iodine,  all  liquids  should  be 
wiped  away  with  antiseptic  gauze. 

After  thorough  disinfection,  the  neighboring  portions  of  the 
body  of  the  animal  should  be  covered  over  with  cheese-cloth, 
towels  or  other  suitable  fabric,  which  has  been  sterilized  or  dis- 
infected so  as  to  prevent  dust  and  hair  getting  into  the  wound 
from  the  animal's  body.  The  sterile  or  antiseptic  cover  also 
affords  a  safe  resting  place  for  any  protruding  abdominal  viscera. 
Immediately  over  the  location  where  the  wound  is  to  be  made, 
there  should  be  placed  an  ample  piece  of  sterilized  gauze,  in 
which  an  opening  is  made  of  the  same  dimensions  as  that  in  the 
abdominal  wall. 

The  incision  is  then  to  be  made  into  the  abdominal  cavity. 
Generally  one  scalpel  should  be  used  for  making  the  skin  incision, 
laid  aside,  and  a  second  scalpel  used  to  continue  the  incision  into 
and  through  the  deeper  parts.  In  the  flank  the  incision  should 
begin  at  about  the  level  of,  or  slightly  below,  the  external  angle 
of  the  ilium,  midway  between  it  and  the  last  rib,  and  extend 
downward  in  an  approximately  perpendicular  direction. 

After  the  skin  incision  has  been  made,  we  may  continue  it 
directly  through  the  muscles;  or  in  the  flank  operation  we  may 
.separate  the  muscle  fibers  in  their  longitudinal  direction,  either 
with  the  blade  or  the  handle  of  the  scalpel,  and  not  cut  across 
the  muscle  fibers  at  all.     The  latter  plan  of  incision  would  involve 


Ccrsarian  Section  667 

a  different  direction  of  the  opening  for  each  layer  of  the  abdomi- 
nal wall.  That  through  the  external  oblique  muscle  would  be 
obliquely  downward  and  backward,  while  that  of  the  internal 
oblique  would  be  downward  and  forward,  and  the  two  openings 
would  consequently  cross  each  other  like  an  X. 

The  peritoneum  may  be  incised  with  the  scalpel,  by  placing 
an  index  finger  against  it  and  then  passing  the  scalpel  along  the 
finger  until  it  reaches  the  membrane,  when  a  very  slight  thrust 
will  force  it  through.  This  should  be  done  carefully  in  order  to 
avoid  wounding  the  viscera,  and  as  soon  as  the  scalpel  has  pene- 
trated the  peritoneal  cavity,  as  is  indicated  by  the  disappearance 
of  resistance,  the  instrument  should  be  promptly  withdrawn. 
The  incision  can  then  be  enlarged  by  means  of  a  probe-pointed 
bistoury  guided  by  the  finger,  or  it  may  be  readily  torn  by  the 
fingers. 

The  X-formed  incision  closes  automatically,  without  sutures 
in  its  deeper  parts,  and  prevents  any  protrusion  of  the  vis- 
cera. It  is  more  tedious  than  a  direct  incision  into  the  peri- 
toneal cavity,  and  is  not  so  convenient  for  the  operator.  The 
size  of  the  wound  must  necessarily  depend  upon  that  of  the 
species,  and  should  be  no  larger  than  necessary  to  permit  the 
ready  withdrawal  of  the  fetus,  enclosed  within  the  uterus. 

If  the  laparotomy  is  performed  upon  the  media^i  line,  the  in- 
cision is  made  direct,  and  should  begin  shghtly  anterior  to  the 
pubis,  and  extend  forward  a  sufficient  distance  to  provide  an 
ample  opening  for  the  withdrawal  of  the  gravid  uterus. 

Having  made  the  incision  into  the  peritoneal  cavity,  the 
operator  passes  his  hand  around  the  gravid  uterus,  draws  it  out 
and  lays  it  carefully  upon  the  sterilized  gauze  surrounding  the 
wound.  An  incision  is  then  made  into  the  uterus  at  the  desired 
point,  generally  upon  the  convex  surface  opposite  the  attach- 
ment of  the  broad  ligaments,  and  in  a  longitudinal  direction. 
If  the  incision  is  made  near  the  broad  ligaments,  it  causes  more 
hemorrhage,  because  the  blood  vessels  at  this  point  are  more 
numerous  and  larger. 

Should  the  suggestion  of  Harms  be  followed  and  the  opera- 
tion on  the  cow  be  undertaken  in  the  standing  position,  the  in- 
cision in  the  right  flank  is  made  merely  large  enough  to  permit 
the  extraction  of  the  calf  through  it.  The  uterus  is  then  pressed 
against  the  abdominal  opening,  the  organ  inci.sed,  and   the   fetus 


668  Veterinary  Obstetrics 

extracted,  care  being  exercised  to  prevent  liquids  from  falling 
into  the  peritoneal  cavity. 

In  multiparous  animals  it  is  usually  desirable  to  extract  all  the 
fetuses  through  a  single  uterine  incision,  and  for  this  purpose  it 
is  more  convenient  to  make  the  opening  in  one  cornu,  near  the 
bifurcation,  so  that  the  fetuses  from  the  other  horn  may  be 
readily  pressed  around  through  the  uterine  body  to  the  incision 
which  has  been  made.  In  some  cases,  where  the  fetuses  are 
emphysematous  and  dry,  they  adhere  so  firmly  to  the  uterine 
walls  that  they  cannot  be  moved  any  great  distance  without 
serious  injury  to  the  organ,  and  consequently  it  may  be  neces- 
sary to  make  two  or  more  incisions. 

When  the  incision  into  the  uterus  has  been  made,  the  fetus,  or 
in  multiparous  animals,  that  fetus  which  is  nearest  to  the  in- 
cision, is  pressed  out  through  the  wound  by  compressing  the 
uterus,  or  the  hand  may  be  passed  into  the  uterine  cavity  and 
the  fetus  grasped  in  its  membranes  and  drawn  out.  In  the 
smaller  animals,  with  several  fetuses,  the  others  in  the  same  horn 
are  pressed  toward  the  opening  one  after  another,  or  the  operator 
reaches  his  hand  into  the  organ  and  removes  the  fetuses  one  by 
one.  When  the  incised  horn  has  been  emptied,  he  proceeds  to 
empty  the  opposite  horn  by  pressing  the  fetuses  into  the  body  of 
the  uterus  and  then  turning  them  toward  the  incision. 

When  making  the  incision  into  the  uterus,  care  should  be 
taken  not  to  incise  the  fetal  membranes  if  it  is  possible  to  detach 
them  and  press  the  fetus  out  completely  invested  in  all  its 
membranes.  This  may  be  done  in  the  sow,  bitch  and  cat.  In 
the  cow  we  cannot  accomplish  this,  and  consequently  it  is 
necessary  to  incise  the  fetal  membranes  before  the  fetus  is  re- 
moved from  the  uterus.  The  longitudinal  incision  in  the  uterus 
should  be  ample  to  permit  the  fetus  to  pass  from  it  without 
great  force,  lest  the  incision  become  extended,  probably  in  a 
transver.se  direction,  by  the  tearing  of  the  muscular  walls,  pro- 
ducing a  very  difficult  wound  to  suture. 

If  the  fetuses  are  living,  they  should  be  freed  from  their  mem- 
branes as  soon  as  extracted,  and  an  as.sistant  should  be  ready  to 
take  care  of  them.  If  the  fetuses  are  dead  and  the  fetal  mem- 
branes decomposed,  it  may  be  advisable  to  carefully  mop  out  the 
uterine  cavity  with  antiseptics  and  then  to  remove  all  liquid  as 
far  as  po.ssible  by  means  of  sterilized  gauze.  « 


CcBsarian  Section  669 

The  wound  in  the  uterus  is  then  to  be  closed  by  means  of 
Lembert's  or  other  intestinal  sutures  of  silk. 

Before  suturing  the  uterus,  all  parts  except  that  in  which  the 
incision  has  been  made  should  be  returned  into  the  abdominal 
cavity.  After  the  uterine  wound  has  been  closed  by  a  series  of 
interrupted  sutures,  the  remainder  of  the  organ  should  be  allowed 
to  drop  back  into  the  peritoneal  cavity. 

The  abdominal  incision  should  be  closed  by  interrupted  sutures. 
If  the  laparotomy  has  been  performed  through  the  linea  alba,  it 
is  desirable  to  suture,  separately,  the  peritoneum,  the  muscles  and 
the  skin.  The  peritoneal  wound  may  be  closed  with  continuous 
or  interrupted  catgut  sutures  which  have  been  immersed  in  tinc- 
ture of  iodine.  The  sutures  for  the  muscles  and  skin  should  be 
of  strong  silk,  thoroughly  sterilized  or  rendered  antiseptic.  After 
the  skin  has  been  sutured,  Keller  suggests  that  all  the  external 
sutures  be  saturated  with  tincture  of  iodine,  to  guard  against 
suture  infection. 

The  animal  should  then  be  placed  in  a  comfortable  room  to  re- 
cover from  the  anaesthesia,  and  allowed  to  rest  quietly.  No  food 
whatever,  and  only  very  small  quantities  of  water,  should  be 
allowed  for  24  to  48  hours  after  the  operation,  but  later,  if  the 
animal  shows  an  appetite,  it  may  have  a  small  allowance  of  suit- 
able liquid  food,  later  a  restricted  allowance  of  succulent  or  soft 
food,  and  finally  in  the  course  of  8  or  10  days  may  be  put  upon  a 
regular  diet. 

Hysterectomy.  Under  certain  conditions  of  dystokia  which 
cannot  be  relieved  by  other  means,  where  the  fetus  or  fetuses 
have  undergone  putrid  decomposition  and  the  uterus  is  in  such 
a  state  of  infection  or  disease  that,  according  to  the  judgment  of 
the  veterinarian,  recovery  of  the  organ  cannot  be  reasonably  an- 
ticipated, it  may  be  deemed  best  to  amputate  the  entire  organ. 
Such  an  operation  totally  destroys  the  breeding  value  of  the  ani- 
mal, and  its  sole  use  is  the  saving  of  the  life  of  the  mother.  The 
operation  has  been  limited  to  the  smaller  animals  like  the  sow, 
bitch  and  cat,  in  those  cases  where  decomposition  of  the  fetus 
or  fetuses  and  infection  of  the  uterus  are  such  as  to  bar  success- 
ful hysterotomy. 

The  confinement  of  the  patient,  disinfection  of  the  operative 
area,  anaesthesia  or  narcosis  and  other  preparations,  along  with 
the  abdominal  incision,  are  the  same  as  for  hysterotomy  and  the 


670  Veterinary  Obstetrics 

uterus  is  to  be  lifted  out  of  the  abdominal  cavity  in  the  same 
manner.  After  the  organ  has  been  exposed,  the  utero-ovarian 
arteries  and  all  visible  arteries  in  the  broad  ligaments  should  be 
securely  ligated,  and  a  firm  ligature  of  silk  placed  around  the 
cervix  or  vagina.  The  entire  uterus,  horns,  and  ovaries  should 
then  be  excised,  and  the  vaginal  stump  securely  detained  out- 
side the  wound. 

In  order  to  prevent  the  escape  of  the  putrid  contents  of  the 
uterus  in  the  neighborhood  of  the  wound,  it  is  best  to  apply  a 
double  ligature  to  the  cervix  or  vagina  and  sever  the  organ  be- 
tween the  two.  The  vaginal  stump  should  be  thoroughly 
disinfected,  by  drying  it  first  with  sterile  gauze  and  then 
thoroughly  cauterizing  the  mucous  membranes  with  the  thermo- 
cautery or  nitrate  of  silver.  Tincture  of  iodine  thoroughly 
applied  to  the  stump,  while  it  is  held  outside  the  wound  until  the 
alcohol  has  evaporated,  may  also  suffice.  The  stump  of  the 
vagina  is  then  to  be  allowed  to  return  into  the  abdominal  cavity. 
If  infection  of  the  peritoneal  cavity  is  feared,  it  may  be  irrigated 
with  normal  salt  solution  in  the  hope  of  mechanically  cleansing  it. 

Sometimes  partial  hysterectomy  is  preferable  to  the  preceding. 
In  irreducible  torsion  of  the  uterus  or  transverse  rupture  of  the 
uterus  from  torsion  the  uterine  cavity  may  not  be  safely 
closed  as  in  hysterotomy,  nor  completely  amputated  because  of 
adhesions.  A  portion  of  the  organ  may  then  be  excised  and  the 
margins  of  the  stump  securely  fixed  to  the  margins  of  the  ab- 
dominal incision,  thus  affording  exterior  drainage  for  the  sup- 
purating uterine  cavity. 

Progyiosis.  The  prognosis  of  hysterotomy  and  hysterectomy 
is  generally  unfavorable,  though  it  is  gradually  becoming  more 
successful  in  veterinary  practice,  as  veterinarians  become  better 
acquainted  with  anaesthesia  and  asepsis.  It  is  most  favorable 
in  small  domestic  animals,  in  which  incidentally  there  is  less 
susceptibility  to  infection,  although  perhaps  the  main  considera- 
tion is  that  of  the  size  of  the  animal  and  the  practicability  of 
proper  control  of  the  wound  after  the  operation.  Keller  re- 
cords the  operation  of  hysterotomy  in  10  bitches,  with  recovery 
of  8  of  the  mothers,  or  80  %.  In  8  out  of  these  10  cases,  some  or 
all  of  the  fetuses  were  saved.  In  the  other  cases  the  fetuses  were 
dead  at  the  time  when  the  operation  was  undertaken. 


C(£sarian  Section  671 

De  Bruin  records  23  hysterotomies  in  the  sow,  with  11  re- 
coveries and  12  deaths,  or  a  loss  of  60%,  but  he  accepted  all 
cases  of  dystokia  which  were  offered  and  which  it  seemed  impos- 
sible to  deliver  in  any  other  way.  Among  these  were  several 
sows  which  were  already  comatose  and  virtually  dying  when 
presented.  He  concludes  that,  when  the  fetuses  have  become 
emphysematous,  the  sow  has  a  high  temperature  accompanied 
by  loss  of  appetite  with  no  milk  in  the  teats,  or  is  in  a  comatose 
condition,  the  operation  will  most  probably  be  followed  by 
death.  He  submits  also  that,  according  to  the  statistics  of  the 
cases  which  he  publishes,  the  results  are  very  favorable  if  the 
patient  has  not  been  manipulated  prior  to  the  operation,  and 
there  is  no  extensive  necrosis  of  the  vaginal  walls  as  a  result  of 
the  forcible  extraction  of  one  or  more  fetuses  or  attempts  at  that 
operation  by  laymen.  De  Bruin  regards  the  operation  as  highly 
successful  in  those  cases  where  no  manipulation  of  the  genital 
tract  has  been  made,  except  by  the  veterinarian,  under  proper 
precautions,  for  purposes  of  diagnosis,  and  where  labor  has  not 
continued  for  more  than  24  hours. 

Kasselman  (D.  T.  W.,  1899)  operated  on  25  sows,  with  recov- 
eries in  19  cases.  In  his  statistics,  all  those  cases  in  which  the 
fetuses  were  putrid  perished. 

So  far  as  we  can  determine  by  the  available  literature,  the  op- 
eration is  somewhat  less  favorable  in  the  cat.  In  our  clinic,  in 
two  cases,  one  of  the  cats  died,  but  the  fetu.ses  were  saved  in  each 
in.stance. 

Hysterotomy  in  the  sheep  and  goat  has  not  been  largely  prac- 
ticed, so  far  as  indicated  by  our  literature,  although  a  few  suc- 
cessful operations  have  been  chronicled. 

It  has  been  clearly  shown  in  the  cow  that,  if  the  fetus  is  alive, 
Caesarian  section  is  highly  favorable  for  preserving  the  life  of  the 
calf.  Its  attachments  to  the  maternal  placenta  are  of  such  a  char- 
acter that  it  is  very  easy  to  perform  hysterotomy  and  preserve 
the  life  of  the  fetus  if  it  is  in  good,  vigorous  condition  at  the 
beginning  of  the  operation. 

Little  is  known  regarding  the  percentage  of  recoveries  of  the 
cow,  although  there  are  isolated  records  where  recovery  has  oc- 
curred. Franck  places  the  loss  in  cows  at  65%.  This  appears 
to  be  a  very  great  loss,  and  suggests  that  perhaps  many  of  the 
cases  were  in  a  very  serious  condition  before  the  operation  was 


672  Veteriiiary  Obstetrics 

undertaken,  and  were  virtually  hopeless.  The  cow  with- 
stands laparotomy  splendidly,  as  is  well  shown  by  the 
operation  of  spaying  through  the  flank.  She  is  quite  resist- 
ant to  lesions  of  the  uterine  walls,  and  so  it  would  appear  that 
she  could  withstand  hysterotomy  with  comparative  safety  if  we 
had,  to  begin  with,  an  aseptic  uterus  and  uterine  contents.  The 
difficulty  with  the  operation  is  largely  due  to  the  fact  that  the 
fetus  and  its  membranes  have  undergone  putrid  decomposition 
and  that  the  uterine  cavity  has  become  infected  before  the  ope- 
ration is  attempted.  Under  such  conditions,  success  can  scarcely 
be  hoped  for  in  a  reasonable  number  of  cases.  In  many  instances 
it  is  quite  impracticable  for  the  veterinarian  to  determine  early 
the  advisability  of  the  operation. 

Living  foals  have  been  repeatedly  removed  from  the  mare  by 
Caesarian  section,  but  we  have  been  unable  to  find  a  record  where 
the  life  of  the  mare  has  been  preserved.  We  do  not  believe  that 
this  total  want  of  success  is  necessary.  We  know  full  well  that, 
under  modern  surgical  methods,  we  can  perform  laparotomy  in 
the  horse  without  serious  danger.  Since  this  is  true,  there  is  no 
essential  reason  why  hysterotomy  should  not  succeed  in  some 
cases.  We  grant  that  it  never  can  be  made  as  successful  as  in 
the  cow.  There  are,  however,  some  cases,  especially  those  of 
tran.sverse  or  bi-cornual  development  of  the  fetus,  in  which  no 
successful  delivery  has  3^et  been  recorded,  where  the  prompt 
performance  of  hysterotomy  might  offer  some  hope  for  the 
life  of  the  mother.  The  foal  is  already  dead  when  the  veterin- 
arian is  called,  but  it  and  the  uterus  need  not  yet  be  infected  to 
any  great  degree. 


MATERNAL  DYSTOKIA. 

Maternal  dystokia  may  be  dependent  upon  a  great  variety  of 
causes.  Any  general  disease  or  disorder  which  may  unfavorably 
affect  the  maternal  system  may  render  the  pregnant  animal  in- 
competent to  expel  the  fetus  ;  that  is,  maternal  dystokia  may  be, 
and  frequently  is,  dependent  upon  constitutional  disturbances  of 
the  maternal  system. 

A  majority  of  the  cases  of  maternal  dystokia  are  due  to  some 
defect,  disease  or  displacement  of  the  genital  organs  or  to  disease 
of  the  maternal  pelvis.  Maternal  dystokia  may  consequently  be 
said  to  be  either  systemic  or  organic. 

I.   Inadequate  Expulsive  Powers. 

Systemic  causes  of  dystokia,  of  whatever  kind,  may  be  con- 
sidered in  a  single  group,  since  they  ultimately  induce  the  one 
phenomenon  of  inadequate  power,  on  the  part  of  the  mother,  to 
expel  a  normal  fetus,  in  normal  presentation  and  position, 
through  a  normal  birth  canal.  Anything  which  interferes  with 
the  general  health  of  the  animal  and  causes  extreme  emaciation 
or  weakness  may  at  the  same  time  induce  difficult  labor,  because 
of  the  feeble  contractions  of  the  uterine  walls,  as  well  as  insuf- 
ficiency of  the  contractile  powers  of  the  abdominal  muscles  and 
diaphragm.  It  is  consequently  not  rare  to  meet  with  cases  of 
ill-fed  animals,  especially  heifers  or  very  aged  cows,  in  which  the 
general  debility  of  the  system  .so  affects  the  expulsive  powers 
that  labor  becomes  more  or  less  tedious  or  difficult. 

During  some  seasons  in  certain  communities,  the  hay  or  other 
food  is  of  bad  quality,  the  weather  conditions  may  be  bad,  and 
other  unfavorable  conditions  arise  which  .serve  to  cause  great 
emaciation  of  entire  herds  or  all  the  cattle  of  a  district.  In  such 
instances  maternal  dystokia  may  become  well  nigh  enzootic,  es- 
pecially involving  immature  heifers  and  aged  cows. 

Such  maladies  as  osteomalacic,  page  423,  and  paraplegia, 
page  431,  are  frequently  accompanied  by  dy.stokia,  the  debility 
of  the  disease  being  accentuated  by  the  decubitis.  While  volun- 
tary recumbency  is  not  inimical  to  parturition,  involuntary 
decubitis  tends  to  cause  dj-stokia.  Hence  disabling  accidents, 
43  673 


674  Veterinary  Obstetrics 

such  as  serious  fractures  and  dislocations,  when  causing  decubitis, 
tend  strongly  to  induce  maternal  dystokia. 

Parturient  paresis,  in  those  rare  cases  where  it  attacks  a  cow 
prior  to,  or  during  parturition,  inhibits  the  expulsive  powers  and 
causes  dystokia.  The  fetus,  though  normal  in  size,  presenta- 
tion and  position,  is  not  expelled,  but  lies  in  the  inert  uterus 
throughout  the  course  of  the  disease,  unless  artifically  extracted. 

The  diagnosis  of  dystokia  due  to  deficient  expelling  powers  is 
to  be  based  primarily  upon  the  general  condition  of  the  animal, 
its  emaciation  and  weakness,  the  presence  of  decubitus,  and  with 
these  a  fetus  of  normal  size,  form,  presentation  and  position. 
The  maternal  passages  are  normal,  and  the  os  uteri  dilated  or 
dilatable,  but  there  is  an  absence  of  vigorous  expulsive  efforts. 

The  handling  of  dystokia  of  this  character  will  depend  upon 
the  cause.  If  the  feeble  labor  pains  are  referable  to  debility  and 
emaciation,  stimulants  are  indicated,  combined  with  judicious 
traction.  The  case  should  not  be  left  in  the  hope  of  a  natural 
delivery,  risking  the  exhaustion  of  the  patient. 

We  have  already  dealt  with  the  dystokia  of  the  ante-partum 
paralysis  in  the  cow,  and  shall  later  consider  the  question  of 
parturient  paresis. 

2.  Pelvic  Constriction. 

The  pelves  of  breeding  animals  may  depart  more  or  less  from 
the  normal,  in  such  a  way  as  to  render  parturition  difficult  or 
impossible.  Pelvic  constriction  may  be  due  to  disease  of  the 
general  system,  or  to  deformity  of  the  pelvis  as  the  result  of 
some  accident. 

a.  Rachitis.  Rachitis  is  not  at  all  rare  among  domestic  ani- 
mals, but  does  not  as  a  rule  result  in  serious  deformity  of  the 
pelvis,  as  is  so  frequently  observed  in  woman.  The  principal 
part  of  the  weight  of  the  quadrupedal  animal  falls  upon  the 
anterior  feet,  so  that  the  weight  upon  the  pelvis  is  comparatively 
slight  and  not  well  Calculated  to  cause  pelvic  deformity.  Be- 
sides, the  bones  of  most  species  of  domestic  animals  are  well 
advanced  in  ossification  at  the  time  of  birth,  and  in  rachitis  tend 
rather  to  break  than  bend.  This  is  especially  true  of  horses, 
cattle  and  sheep,  and  in  these  we  have  no  very  good  proof  of 
serious  rachitic  deformity  of  the  pelvis.  In  countries  where 
swine  are  kept  largely  in  styes,  and  upon  a  more  or  less  limited 


Pelvic  Constrictio7i 


675 


diet,  it  is  not  rare  to  meet  with  rachitic  deformity  of  the  pelvis 
which  leads  to  serious  dystokia  and  renders  it  wholly  impossible 
to  extract  the  fetus  through  the  pelvis.  In  a  series  of  cases  of 
dystokia  recorded  by  De  Bruin  in  the  sow,  (B.  T.  \\'.,  January 
3,  1907)  the  pelvis  was  so  constricted  from  rachitis  as  to  barely 
admit  two  fingers  to  pass  through  it.  Hysterotomy  became 
necessary. 

b.  Callus  from  Healed  Pelvic  Fractures.  We  occasionally 
meet  with  fractures  of  the  pelvis  in  which,  when  the  animal 
recovers,  there  remains  an  enlarged  callus,  with  perhaps  some 
additional  deformation  by  one  fractured  portion  of  the  pelvic 
girdle  pushing  inward,  so  that  it  may  greatly  narrow  and 
obstruct  the  pelvic  canal,  rendering  birth  through  it  exceedingly 
difficult  or  quite  impossible.  These  cases  are  not  very  common, 
but  occur  in  the  experience  of  most  veterinary  obstetrists,  and 
constantly  suggest  that  a  female  which  has  suffered  from  a 
fracture  of  the  pelvis  should  not  be  used  for  breeding  purposes, 
except  the  pelvis  has  first  been  examined  and  found  to  be  suf- 
ficiently wide  to  permit  of  safe  birth. 


Fig.  112.     Constricted  Pklvis  ok  Mark,  inducing  Irkemkdial  Dystokia. 
Dislocation  of  Right  Sacro-iliac  Articulation. 
Green-stick  Fracture  through  Right  Acetabulum. 
Non-union  of  Fracture  of  Left  Iliac  Shaft. 


676 


Veterinary  Obstetrics 


c.  Unhealed  Fractures  of  the  Pelvis.  We  observed  in 
one  case  a  fracture  of  the  pelvis  in  a  sucking  filly,  Fig.  112, 
which  was  broken  down  by  a  large  stallion.  There  was  a  dis- 
location of  the  sacro-iliac  articulation,  a  green-stick  fracture 
through  the  acetabulum,  and  a  fracture  through  the  shaft  of  the 
ilium.  The  latter  failed  to  heal,  but  the  filly  recovered  suffi- 
ciently to  get  about.  She  was  crippled,  but  in  good  flesh  and  vig- 
orous. Later  she  was  bred  without  the  pelvis  having  been  ex- 
amined. At  foaling  time  we  were  called,  because  of  severe 
dystokia,  and  found  the  fetus  presenting  normally  at  the  pelvic 
inlet ;  but  the  pelvic  canal  was  very  constricted,  and  whenever 
we  applied  traction  to  the  fetus  it  seemed  to  recede  instead  of 
advance.  The  foal'  could  not  possibly  be  extracted  by  traction 
because,  on  account  of   the  non-united   fracture  on   the  one  side 


Fig.  1 13  a.     Cai.ias  duk  to  Dislocation  of  the  Femur 
of  cow  through  the  foramen  ovale. 
A.   Acetabulium.     B.  Exostosis  froui  permanent  dislocation 
of  femur  through  foramen  ovale. 


Pelvic  Co7istriction 


677 


and  movable  sacro-iliac  articulation  on  the  other  side,  whenever 
traction  was  applied,  the  pubis  moved  toward  the  sacrum  and  the 
channel  closed  like  a  cam.  The  fetus  was  dead  and  the  mare 
was  worthless,  so  that  delivery  by  other  means  was  ignored  and 
the  animal  was  at  once  destroyed. 

d.  Exostosis,  as  a  result  of  dislocation  of  the  femur 
through  the  foramen  ovale.  Fig.  1 13A  illustrates  the  pelvis 
of  a  cow,  in  our  collection,  in  which  there  has  been  an  old  stand- 
ing dislocation  of  the  femur  through  the  foramen  ovale.  As  a 
result  of  the  constant  irritation  there  has  developed  a  large  ex- 
ostosis inside  the  pelvis,  which  would  naturally  cause  serious 
obstruction  in  case  of  parturition.  Exostoses  or  bone  tumors 
may  arise  in  the  pelvic  canal  from  various  causes,  and  offer  more 
or  less  serious  obstruction  to  birth. 

e.  Eminences  along  the  ischio-pubic  symphysis,  Fig. 
113  B,  are  not  rare  in  the  pehis  of  the   mare.     Their  cause   is 


E 

1 

i^R 

P*^:  ^-  H 

I^H 

i^E 

iflHBk 

i^^l 

Fig.  113B.    Pelvis  of  Mare. 

Showing  prominent  elevations.  A,  B  and  C  on  the  anteriormargin  of 

the  pelvic  inlet. 


678  Veterinary  Obstetrics 

unknown.  Usually  they  present  no  evidences  of  being  of  patho- 
logic origin,  but  seem  merely  a  deviation  from  the  normal  type 
of  development.  They  occur  chiefly  upon  the  median  line  of 
the  anterior  pubic  border,  within  the  area  of  insertion  of  the 
prepubian  tendon,  and  may  be  directed  more  or  less  forward  and 
upward.  At  other  times  they  are  located,  as  in  Fig.  113B, 
just  posterior  to  the  pubic  brim  along  the  symphysis,  and  project 
upwards  into  the  pelvic  cavity  as  a  sharp  cone.  They  more 
rarely  occur  along  the  ischial  symphysis  and  elsewhere. 

It  is  not  impossible  that  they  result  from  some  disturbance  of 
the  nutrition  of  the  general  osseous  system,  and  originate  in  a 
way  corresponding  to  spavin  and  similar  exostoses  in  other  parts 
of  the  body. 

Whatever  their  cause,  they  constitute  serious  pelvic  ob- 
structions when  the  time  for  parturition  arrives.  They  differ,  how- 
ever, in  their  significance,  from  the  preceding  classes.  Though 
they  offer  some  mechanical  impediment  to  the  passage  of  the 
fetus,  unless  the  projection  is  very  large  the  fetus  ma}'  pass 
over.  The  chief  danger  is  to  the  utero-vaginal  walls,  which,  be- 
coming impinged  between  the  conical  projection  and  the  fetal 
body,  become  contused,  lacerated  or  perforated,  to  end  finally 
in  septic  peritonitis. 

Handling.  In  the  handling  of  this  group  of  cases,  three  dis- 
tinct possibilities  offer  to  the  obstetrist. 

I.  Prophylaxis. 
Should  the  veterinarian  be  consulted  regarding  pelvic  in- 
juries to  a  female  which  might  be  used  for  breeding  purposes, 
he  should  always  consider  whether  the  animal  may  later  be 
safely  bred  or  not.  If  the  pelvis  has  been  fractured,  if  there 
has  been  a  coxo-femoral  dislocation  or  disease,  the  possibility  of 
changes  in  the  dimensions  of  the  pelvic  canal  should  be  con- 
sidered, the  parts  carefully  examined,  and,  if  necessary,  the 
owner  warned.  Should  the  veterinarian  be  asked  to  examine 
the  pelvis  of  a  female  with  reference  to  her  capability  as  a 
breeder,  the  various  impediments  should  be  carefully  estimated 
and  a  judicious  answer  given. 

2.  Artificial  Abortion. 
Pelvic   deformities   of    a    character  to  induce   dystokia    may 
occur  or  become  known  during  pregnancy,  at  a  time    when   the 


Pelvic  Constrictio7i  679 

fetus  is  so  small  that  it  might  safely  pass  the  pelvic  canal. 
In  such  instances,  if  it  is  clear  that  normal  birth  cannot  take 
place,  and  the  mother  is  prized  aside  from  her  power  to  breed, 
the  question  of  inducing  artificial  abortion  should  be  considered. 
If  it  seems  that  the  life  of  the  mother  can  thus  be  rendered  more 
safe  than  by  permitting  the  fetus  to  remain  and  develop  until  the 
normal  time  of  parturition,  then  the  operation  should  be  per- 
formed. 

Artificial  abortion  may  be  induced  in  a  variety  of  ways. 

a.  It  has  been  stated  that  artificial  abortion  may  be  brought 
about  by  the  administration  of  ergot,  savin  and  other  drugs.  So 
far  as  we  have  been  able  to  learn,  however,  this  plan  of  bringing 
about  the  expulsion  of  the  fetus  has  not  been  successful  in  domestic 
animals,  and  the  only  cases  recorded  which  have  apparently 
succeeded  are  those  where  the  life  of  the  mother  has  been  greatly 
imperiled  through  the  toxic  action  of  the  drug.  It  seems  that 
these  medicines  are  as  likely  to  kill  the  mother  as  the  fetus. 

b.  Irritation  and  Dilation  of  the  Cervix  Uteri.  The  hand 
may  be  introduced  into  the  vagina  and  one  or  more  fingers  or 
the  entire  hand  forced  through  the  os  uteri  into  the  cervix  of 
the  uterus,  thereby  producing  an  irritation  which  may  cause 
expulsive  efforts  and  expulsion  of  the  fetus.  It  seems,  how- 
ever, that  this  plan  possesses  no  reliability.  While  in  some  in- 
stances it  may  produce  the  expulsion  of  the  fetus,  in  others 
it  may  not. 

c.  In  the  larger  animals  we  may  readily  carry  the  preceding 
operation  further  and,  introducing  the  hand  through  the  cervix, 
separate  the  fetal  membranes  from  the  maternal  placenta,  thus 
inducing  uterine  contractions  with  considerable  certainty, 
especially  in  the  mare. 

We  may  render  this  still  more  certain  by  puncturing  the  fetal 
envelopes.  If  we  introduce  the  hand  through  the  cervix,  as 
already  described,  and  then  force  one  or  more  fingers  through 
the  fetal  envelopes  and  permit  the  fetal  fluids  to  escape,  the  fetus 
will  ordinarily  be  expelled  within  48  hours,  providing  the  uterus 
is  in  healthy  condition.  As  we  have  already  noted  on  page  424, 
rupture  of  the  fetal  membranes  and  escape  of  the  liquids  may 
fail  to  induce  expulsion  of  the  fetus  in  amniotic  dropsy. 

d.  Vaginal  irrigation  with  cold  water,  continued  for  15  minutes 
every  three  hours,   is  said  to  bring  about  expulsive  efforts  and 


68o  Veterinary  Obstetrics 

evacuation  of  the  uterine  cavity,  but  this  does  not  seem  to  be 
entirely  reliable.  According  to  Fleming  it  has  certain  dangers, 
especially  that  of  metritis  as  a  result  of  the  shock. 

e.  Dislodgementof  Corpus  Luteum.  Hess,  page  227,  claims  that 
the  safest  and  best  way  to  induce  artificial  abortion  in  the  cow  is  by 
dislodging  the  corpus  luteum  by  compression  and  then  applying 
massage  to  the  gravid  uterus  from  before  backward.  In  his 
hands  this  plan  of  inducing  expulsive  contractions  of  the  uterus 
has  proven  highly  efficient. 

3.  Overcoming  Dvstokia  duk  to  Pelvic  Constriction. 

When  gestation  has  passed  unheeded  until  the  time  for 
parturition  has  arrived,  and  the  veterinary  obstetri.st  faces  a 
case  of  dystokia  due  to  pelvic  constriction,  various  plans  for  the 
removal  of  the  fetus  present  themselves. 

a.  Forced  Extraction.  First  to  be  considered  as  affecting 
the  lives  of  both  mother  and  fetus  is  that  of  forced  extrac- 
tion through  the  narrowed  canal.  If  in  the  judgment  of  the 
veterinarian  it  is  practicable  to  force  the  fetus  through  the 
canal  without  serious  injury  to  the  mother,  this  should  be  done. 
If  forced  extraction  is  decided  upon,  the  operator  should  proper- 
ly secure  the  presenting  parts,  thoroughly  lubricate  the  passages 
by  means  of  a  warm  lysol  solution,  or  otherwise,  and  proceed 
with  the  extraction  under  the  general  rules  on  page  5S6. 

If  the  fetus  has  already  become  advanced  in  the  pelvic  canal 
and  is  firmly  impacted,  it  is  difficult  to  do  otherwise  than  to 
attempt  the  completion  of  delivery  by  means  of  traction.  The 
fact  that  it  has  been  forced  along  the  passage  for  a  considerable 
distance  should  be  considered  evidence  that  it  may  be  com- 
pletely extracted  without  very  great  danger. 

b.  Embryotomy  may  be  po.ssible  in  the  larger  animals,  but 
is  not  available  in  the  smaller  ones.  We  have  already  described, 
on  page  641,  the  technic  for  carrying  out  embryotomy  operations. 

e.  Caesarian  Section.  Finally,  when  other  means  for  saving 
the  life  of  the  mother  or  fetus  or  both  are  excluded  or 
rendered  very  doubtful  by  the  conditions  which  are  present, 
hysterotomy  should  be  employed,  under  the  general  plan  which 
has  been  suggested  on  page  663. 

This  constitutes  the  most   promising   method   for  overcoming 


Pelvic  Constriction  68 1 

pelvic  coustriction  in  the  sow,  bitch  and  cat.  When  dystokia 
occurs  in  these  animals  from  pelvic  constriction,  the  obstetrist 
should  definitely  decide  upon  the  course  to  pursue.  If  hyster- 
otomy is  performed  at  all,  it  should  be  done  at  once,  without 
first  attempting  forced  extraction  or  other  manipulations  in  the 
genital  canal,  since  the  inevitable  insult  to  these  parts  and  the 
exhaustion  of  the  patient  greatly  complicate  the  case  and  seriously 
reduce  the  prospects  for  recovery  should  hysterotomy  be  later 
decided  upon. 


RIGIDITY  OR  SPASM  OF  THE  CERVIX  UTERI. 

In  the  cow  a  condition  is  occasionally  met  with  which  is 
attributed  to  a  spasmodic  contraction  of  the  cervix  uteri,  of  such 
a  character  as  to  constitute  a  more  or  less  serious  obstacle  to 
parturition.  It  is  difficult  to  define  clearly  and  definitely  what 
constitutes  rigidity  or  spasm  of  the  cervix,  and  to  differentiate 
between  it  and  induration.  At  best  this  condition  is  largely  a 
comparative  one,  and  may  be  due  as  much  to  defective  uterine 
contractions  as  to  an  abnormal  contraction  or  spasm  of  the 
cervix. 

Symptoms.  The  symptoms  by  which,  it  is  claimed,  we  may 
recognize  rigidit}'  or  spasm  of  the  cervi.x  consist  largely  of  a  non- 
dilation  of  the  cervical  canal,  in  spite  of  the  fact  that  the  labor 
pains  are  apparently  normal  and  that  no  disease  of  the  cervix 
itself  can  be  detected  by  examination.  In  describing  the  cervix 
of  the  uterus  in  ruminants,  we  noted  its  elongated  and  narrow 
canal  the  abundance  of  circular  muscle  fibers  in  its  walls, 
with  the  large  amount  of  connective  tissue.  This  gives  a  very 
firm  and  rigid  character  to  the  normal  organ. 

In  one  instance  w^hich  came  under  our  observation,  the  keeper 
of  some  pedigreed  cows  had  one  morning  found,  projecting  from 
the  vulva  of  a  cow,  the  head  of  a  fetus.  The  cow  was  at  about 
the  6th  month  of  gestation.  The  head  of  the  fetus  was  re- 
moved by  the  attendant  ;  its  body  promptly  dropped  back  into 
the  uterine  cavity  ;  the  cervix  contracted,  and  the  canal  was 
closed.  The  attending  veterinarian  failed  to  introduce  his  hand 
through  the  constricted  cervical  canal,  and  the  fetus  was  allowed 
to  remain  in  the  uterus  until  thoroughly  decomposed,  when, 
some  lo  weeks  later,  the  remains  were  expelled.  Such  would 
seem  to  be  a  well-marked  case  of  rigidity  of  the  cervix,  because 
its  dilatability  had  been  proven  by  the  fact  that  the  head  of  the 
fetus  had  passed  through  it.  Its  rigidity  was  emphasized  by 
the  fact  that  the  attending  veterinarian  was  unable  to  introduce 
his  hand  through  the  cervix,  through  which  the  fetal  head  had 
passed  but  a  few  hours  before. 

As  one  of  the  prominent  symptoms,  we  must  consequently 
recognize  first  of  all  the  existence  of  expulsive  efforts  without 
corresponding  dilation  of  the  cervical  canal.  Upon  examining 
682 


Rigidity  of  Cervix  Uteri  683 

the  latter  with  the  hand,  no  actually  diseased  condition  of  it  can 
be  recognized. 

The  prognosis  of  rigidity  or  spasm  of  the  cervix  of  the  uterus 
is  usually  favorable.  Occurring  almost  wholly  in  the  cow,  where 
labor  is  frequently  prolonged,  and  where  the  fetus  may  live  for 
a  long  time,  the  rigidity  usually  gives  way  to  the  pressure  of  the 
fetal  membranes  or  of  the  advancing  portions  of  the  fetus,  in  the 
course  of  24  to  48  hours,  and  delivery  is  effected.  The  prognosis 
must  depend  to  a  great  extent  upon  the  position  of  the  fetus  in 
the  uterus.  If  it  chances  to  be  in  some  vicious  position,  by 
which  a  very  large  mass  presents  at  the  cervix,  it  may  have  little 
tendency  to  cause  its  dilation.  We  frequently  observe  great 
delay  in  the  dilation  of  the  cervical  canal,  when  the  fetus  presents 
by  its  breech  with  both  hind  legs  extended  forward  beneath  the 
abdomen,  because  in  such  a  case  the  buttocks  are  too  blunt  to 
act  as  a  wedge. 

There  are  other  cases  in  which  the  non-dilation  of  the  cervix 
may  be  primarily  due  to  debility  on  the  part  of  the  mother  or 
to  some  debility  or  disease  of  the  walls  of  the  uterus. 

Treatment.  In  the  handling  of  this  condition  it  should  be 
remembered  that  in  the  ruminant  the  process  of  parturition  is 
usually  deliberate  and  that,  if  the  fetus  is  presenting  normally 
and  the  mother  seems  to  be  well  and  strong,  the  veterinarian 
should  be  in  no  haste  until  some  hours  have  elapsed  after  ex- 
pulsive efforts  have  become  evident. 

When,  however,  labor  becomes  unduly  protracted,  and  there 
seems  to  not  be  satisfactorj-  progress,  intervention  upon  the  part 
of  the  obstetrist  is  advisable.  The  dilation  of  the  cervical  canal 
is  indicated.  He  should  resort  first  to  the  most  simple  means, 
such  as  the  injection  into  the  vagina,  and  if  practicable  also  into 
the  cervical  canal,  of  warm  emollient  liquids,  like  a  i  '/f  solution 
of  lysol  or  bi-carbonate  of  soda. 

Various  drugs  have  been  suggested  to  overcome  rigidity  of 
the  cervix.  Presumably,  any  drug  introduced  into  the  general 
system  acts  alike  upon  all  parts  of  the  uterus,  and  while  decreas- 
ing the  spasm  of  the  cervix,  also  decreases  the  expulsive  powers 
of  the  organ  as  a  whole.  The  chief  drugs  which  have  been  ad- 
vi.sed  for  this  purpose  are  opium,  chloral  hydrate  and  chloroform. 
Some  have  advised  the  application  of  extract  of  belladonna  to 


684  Veierifiarv  Obstetrics 

the  cervix  uteri,  while  others  contend  that  it  has  no  real  value. 
With  this  latter  opinion  we  are  in  full  accord. 

A  more  hopeful  class  of  drugs,  which  we  do  not  know  to  have 
yet  been  used,  are  the  local  anaesthetics.  Stovaine,  we  know, 
induces  marked  muscular  paralysis  when  injected  upon  a  motor 
nerve.  Cocaine  and  eucaine  would  probably  prove  serviceable 
but  must  be  used  with  caution,  lest  poisoning  follow.  These 
may  prove  highly  important  in  combination  with  mechanical 
dilation. 

The  mechanical  dilation  of  the  canal  is  that  to  which  final 
resort  must  be  made.  This  frequently  constitutes  a  very  trying 
ordeal,  which  may  require  much  labor  and  patience.  For  this 
purpose  the  vagina  and  vulva  should  be  well  disinfected  and  the 
hand  rendered  unctuous  by  means  of  an  aseptic  or  antiseptic  oil 
or  fat  or  by  keeping  it  well  moistened  by  means  of  a  warm  lysol 
solution.  By  passing  the  hand  through  the  vagina  to  the  os 
uteri,  one,  two  or  more  fingers  are  pressed  through  the  os.  As 
the  OS  becomes  somewhat  dilated,  the  fingers  are  held  in  the  form 
of  a  cone  and,  by  a  .somewhat  rotary  motion,  are  forced  further 
and  further  into  the  cervix,  until  finally  the  hand  is  pushed 
through  into  the  uterine  cavity,  when  a  portion  of  the  fetus  may 
be  grasped  and  secured,  and  the  dilation  completed  from  in  front 
by  drawing  upon  the  fetus  itself. 

It  should  be  constantly  remembered  that  the  mo.st  effective 
direction  for  the  application  of  the  force  is  from  in  front,  as  in 
normal  parturition,  and  consequently,  the  earlier  we  can  apply  it 
from  this  direction  the  better,  and  the  easier  the  task. 

In  one  instance  we  were  without  mechanical  appliances  for 
dilating  the  canal,  except  obstetric  instruments  which  were 
armed  with  olive-shaped  handles  tapering  from  the  butt  toward 
the  point.  After  dilating  the  canal  sufficiently  to  push  one  of 
these  instruments  through  until  the  handle  entered  the  uterus, 
we  then  introduced  a  second  handle  along  the  shank  of  the  first 
instrument  and  forced  it  through  also.  Drawing  simultaneou-sl}^ 
upon  the  two  instruments  brought  the  two  handles  together  at 
the  anterior  opening  of  the  cervix,  and  thus  forced  the  cervical 
walls  apart  and  dilated  the  canal  far  more  effectively  than  we 
could  have  done  by  force  applied  from  behind. 

Uterine  dilators  are  made,  which  in  our  experience  po.s.sess  high 
efficiency  and  greatly  lighten  the  labor  of  the  mechanical  dilation 


Indiiration  and  Atresia  of  the  Cervix   Uteri  685 

of  the  cervical  canal.  These  instruments  should  be  made  very 
strong.  Introduced  through  the  canal  closed,  they  are  to  be 
opened  by  means  of  a  screw  or  other  mechanism,  and  the  cervical 
walls  thus  forced  apart. 

Since  most  of  these  instruments  open  to  a  greater  extent  at 
the  apex  than  at  the  base,  they  imitate  the  natural  method  for 
bringing  about  the  dilation.  While  some  patterns  of  dilators 
have  their  jaws  open  along  parallel  lines,  those  which  are  di- 
vergent, so  that  thej'  open  wider  at  their  apex  than  at  their  base, 
are  to  be  preferred. 

Some  have  suggested  sponge-tents,  in  which  a  compressed 
piece  of  .sponge  is  introduced  into  the  narrow  cervical  canal,  left 
there  to  absorb  fluids,  thus  to  become  greatly  enlarged  and 
force  the  walls  apart.  Others  have  suggested  rubber  bags  of 
various  forms,  which  may  be  introduced  through  the  cervical 
canal  empt}'  and  then  dilated  by  having  warm  water  forced  into 
their  interior. 

In  our  experience,  however,  it  is  best  to  rely  upon  the  careful 
manual  or  instrumental  dilation.  This  should  be  accomplished 
verj'  gradually  and  with  much  care,  since  any  violence  may 
cause  serious  injury  to  the  parts. 

Induration  and  Atresia  of  the  Cervix  Uteri. 

In  the  cow,  and  more  rarely  in  other  domestic  animals,  there 
occurs  an  induration  of  the  cervix  uteri,  apparently  the  result  of 
some  injury  or  disease  which  has  established  a  chronic  inflamma- 
tion of  the  part  and  led  to  its  thickening  and  becoming  sclerotic, 
with  a  consequent  narrowing  or  even  closure  of  the  cervical 
canal.  In  dealing  with  the  anatomy  of  the  cervix  uteri,  we 
have  already  noted  in  ruminants,  and  especially  in  the  cow,  that 
the  cervix  is  usually  highly  developed  and  contains  numerous 
circular  muscle  fibers,  commingled  with  a  large  amount  of  con- 
nective ti.ssue,  which  gives  to  the  part  a  preeminently  rigid 
character. 

This  normal  character  of  the  cervix,  with  its  .slow  respon.se  to 
the  dilating  influence  of  labor,  tends  con.stantly  to  induce  injuries 
during  parturition,  which  may  later  lead  to  a  chronic  inflamma- 
tion and  thickening  of  the  part,  to  eventually  end  in  induration 
and  a  loss  of  dilatability.  It  is  generally  presumed  to  occur 
chiefly  in  cows  which  have   previously  given  birth,  and  suffered 


686  Veteriyiary  Obstetrics 

from  cervical  lacerations,  retained  afterbirth  or  other  forms  of 
local  irritation.  In  our  experience  it  has  been  confined  to 
heifers.  In  one  heifer  the  cervix  was  so  hard  and  unyielding 
that,  in  forcing  the  fetus  through  the  narrowed  cervical  canal, 
the  cervix  was  torn  asunder,  leaving  a  wide  rent  into  the  perito- 
neal cavity. 

The  induration  may  lead  to  a  condition  which  will  admit  of  a 
moderate  degree  of  dilation,  permitting  the  fetus  to  pass  with 
more  or  less  difficulty  ;  or  to  complete  atresia  of  the  canal.  Be- 
tween these  two  extremes  there  may  be  every  possible  variation. 

The  symptoms  of  induration  and  atresia  of  the  cervix  do  not 
appear  until  parturition  sets  in  and  expulsive  efforts  have  become 
established,  when  it  soon  becomes  evident  that  there  is  some 
serious  obstacle  to  birth.  Although  the  expulsive  efforts  may 
be  vigorous,  and  to  all  external  appearances  everything  may 
seem  normal,  there  is  nevertheless  little  or  no  progress. 

In  the  milder  cases  the  fetal  membranes  may  protrude  and 
rupture,  or  even  some  portion  of  the  fetus,  especially  one  or  two 
extremities,  may  advance  along  the  vaginal  canal  and  appear  at 
the  vulva  ;  but,  regardless  of  the  expulsive  efforts,  no  substantial 
progress  is  made.  The  constriction  continuing  day  after  day 
unless  relief  is  given,  the  placenta  may  finally  come  away,  leaving 
the  fetus  behind,  and  the  expulsive  efforts  may  cease,  while 
the  fetus  undergoes  putrid  decomposition.  The  cow  may 
apparently  recover  her  condition,  or  may  succumb  to  septicaemia, 
with    all   the  symptoms  attendant  thereon. 

The  diagnosis  of  induration  and  atresia  of  the  cervix  must  de- 
pend primarily  upon  the  revelation  of  the  condition  to  the  sense 
of  touch  upon  manual  exploration.  When  the  veterinarian  ex- 
amines the  genital  canal  he  finds  that  the  os  is  more  or  less  com- 
pletely closed,  that  the  cervical  canal  is  largely  undilatible, 
and  that  the  walls  of  the  cervix  are  hard,  tense  and  unyielding. 
In  some  cases  the  walls  of  the  cervix  are  evidently  greatly  thickened 
for  a  considerable  distance,  while  in  others  the  diseased  condition 
may  be  limited  to  the  vaginal  portion  of  the  cervix. 

Perhaps  one  or  more  fingers,  or  even  the  entire  hand,  may  be 
passed  through  the  cervical  canal,  but  beyond  this  degree  no 
dilation  may  seem  practical,  and  the  parts  are  exceedingly  dense 
and  rigid  to  the  touch. 


Induration  and  Atresia  of  the  Cervix  Uteri  687 

Induration  or  atresia  is  to  be  differentiated  from  spasm  of  the 
cervix,  which  is  purely  temporary  in  character  and  may  yield 
with  comparative  promptness  to  mechauicaldilation  or  somewhat 
later  to  the  natural  dilating  forces  of  the  expulsive  powers.  In- 
duration is  also  to  be  distinguished  from  malignant  or  other  new 
formations,  such  as  carcinom,  sarcom,  actinomycosis  or  tuber- 
culosis. These  diseases  usually  reveal  to  the  sense  of  touch  a 
diseased  state  of  the  tissues,  with  a  tendency  to  bleed  upon  be- 
ing handled. 

The  prognosis  of  induration  or  atresia  of  the  cervix  uteri  will 
depend  very  largely  upon  its  location  and  extent.  When  con- 
fined to  the  vaginal  portion  of  the  cervix  uteri,  the  prognosis  is 
distinctly  favorable,  because  this  portion  admits  of  the  freest 
possible  manipulation  and  operation  without  imperiling  the  in- 
tegrity of  the  walls  of  the  organ.  When  the  induration  is  more 
extensive,  and  involves  the  anterior  portion  of  the  cervix  or  its 
entire  length,  the  prognosis  becomes  more  serious  because  any 
extensive  operation  or  accidental  tear  during  the  extraction  of 
the  fetus  may  bring  about  a  perforating  wound  communicating 
with  the  peritoneal  cavity,  and  lead  to  the  death  of  the  animal. 

Handling.  Three  courses  of  handling  are  open  for  consider- 
ation ;  manual  or  mechanical  dilation,  followed  by  forced  extrac- 
tion of  the  fetus  ;  dilation  by  incision  or  vaginal  hysterotomy; 
and   gastro- hysterotomy  or  Caesarian  section. 

Forced  dilation  of  the  cervical  canal  and  extraction  of  the 
fetus  should  be  attempted  only  in  those  instances  where  the  vet- 
erinarian feels  confident  that  it  ma}-  be  accomplished  without 
serious  mutilation  of  the  cervix.  If  it  appears  that  forcing  the 
fetus  through  the  canal  would  probably  cause  extensive  tears, 
and  perhaps  penetrant  wounds  of  the  cervical  walls,  forced  ex- 
traction should  be  abandoned.  The  os  uteri  and  cervical  canal 
are  first  to  be  gradually  dilated  with  the  hand  or  uterine  dilator, 
until  the  operator  ma}'  introduce  his  hand  into  the  uterine  cavity. 
The  fetus  may  be  secured  by  the  presenting  extremities,  each 
carefully  arranged  in  its  proper  position,  and  the  cervical  canal 
thoroughly  lubricated,  after  which  traction  may  be  applied  slowly 
and  judiciously  and  the  fetus  forced  away.  The  general  direc- 
tions for  the  application  of  traction  have  been  given  on  page  586. 

Vaginal  Hysterectomy.  The  dilation  of  the  cervix  by  in- 
cision, or  vaginal  hysterotomy,  is  usually  to  be  preferred  to  forced 


688  Vete^inaiy  Obstetrics 

extraction  or  other  means  for  bringing  about  delivery.  If  it  is 
probable  that  forced  extraction  would  cause  more  or  less  exten- 
sive ruptures  in  the  cervix,  the  veterinarian  may  often  guide  and 
control  these  injuries  by  means  of  proper  incisions.  When  the 
induration  or  atresia  involves  only  the  vaginal  projection  of  the 
cervix,  and  the  anterior  portion  is  normal,  the  operation  is 
simple  and  readily  performed. 

In  such  a  case  the  operator  introduces  a  scalpel  or  bistoury 
and  makes  one,  two  or  three  incisions  in  an  upward  or  lateral 
direction,  sufficient  to  bring  about  the  required  dilation  of  the 
part.  The  depth,  number  and  direction  of  the  incisions  must  be 
based  upon  the  amount  of  dilation  required  and  upon  the  thick- 
ness of  the  muscular  walls.  The  direction  of  the  incisions 
should  usually  be  upward  or  to  the  right  or  left.  It  is  better 
that  they  should  be  numerous  rather  than  deep,  because,  if  a 
certain  degree  of  dilation  is  to  be  attained  and  but  one  incision  is 
made  and  the  fetus  is  then  forced  into  the  rigid  cervix,  the 
yielding  will  take  place  almost  exclusively  at  the  one  point 
weakened  by  the  incision,  while  the  other  portions  remain  un- 
dilated,  thus  leading  to  an  extensive  and  dangerous  rupture. 

After  the  incisions  have  been  completed,  the  presenting  ex- 
tremities of  the  fetus  should  be  secured  and  properly  placed, 
the  cervical  canal  freely  lubricated,  and  the  fetus  slowly  and 
cautiously  extracted. 

After  the  extraction  of  the  fetus,  careful  examination  of  the 
cervix  should  be  made  for  perforating  wounds  into  the  peritoneal 
cavity.  If  the  organ  is  intact  and  the  fetus  has  been  dead  and 
has  begun  to  decompose,  it  may  be  desirable  to  flush  out  the 
uterine  cavity  with  an  anti.septic  solution.  If  there  is  a  pene- 
trant wound  into  the  peritoneal  cavity,  the  introduction  of  an  anti- 
septic in  a  large  volume  is  exceedingly  dangerous  and  improper, 
and  other  means  should  be  taken  for  cleansing  the  uterus.  Any 
liquids  present  may  be  drawn  off  by  means  of  a  siphon.  The 
fetal  membranes  should  be  removed  as  promptly  as  is  practicable, 
and  if  they  cannot  be  removed  with  safety  they  should  be  kept 
as  nearly  antiseptic  or  aseptic  as  is  possible,  by  the  introduction 
of  liquid  disinfectants,  or  dry  antiseptics  such  as  powdered  boric 
acid  or  iodoform. 

Caesarian  Section.  Finally,  if  forced  extraction  and  the 
surgical  dilation  of  the  cervix  are  each  impracticable,   Caesarian 


Induration  a?id  Atresia  of  the  Cervix  Uteri  689 

section,  as  described  on  page  663,  should  be  performed  at  a 
sufficiently  early  period  to  give  the  best  opportunity  for  the 
saving  of  the  lives  of  the  mother  and  fetus.  The  operation  leaves 
the  animal  worthless  for  breeding  purposes,  the  common  fate  of 
induration  or  atresia  of  the  cervix,  however  handled.  It  is  only 
in  exceptional  instances  that  the  veterinarian  can  properly  advise 
an  owner  to  again  attempt  breeding  from  an  animal  which  has 
required  surgical  aid  in  parturition  as  a  result  of  cervical  atresia 
or  induration. 

Fleming  cites  a  number  of  recorded  instances  of  induration  and  atresia  of 
the  cervix  uteri.  We  have  met  with  two  noteworthy  instances,  both  in  the 
cow.  The  first  was  in  a  two-year-old  heifer,  in  which  case  the  os  uteri  was 
opened  suihciently  to  admit  the  passage  of  the  hand,  by  which  means  the 
two  anterior  feet  and  head  were  secured,  and  traction  cautiously  applied. 
The  extraction  of  the  fetus  was  very  gradual,  and  the  traction  applied  was 
not  severe,  consisting  of  the  combined  power  of  two  men.  The  progress 
was  very  slow.  The  two  anterior  limbs  were  easily  brought  through  the 
cervix  into  the  vagina  and  pelvic  canal.  Later  the  head  also  passed  through, 
but  when  the  chest  svas  reached  there  seemed  to  be  a  halt. 

Finally  during  a  vigorous  expulsive  effort,  while  traction  was  being 
applied,  there  was  a  loud  tearing  sound,  the  fetus  advanced  rapidly  without 
severe  traction  and  was  quickly  delivered.  The  calf  was  alive.  Upon  ex- 
amining the  uterine  cavity,  a  great  rent  was  found  in  the  cervical  canal, 
about  10  inches  long,  which  penetrated  the  peritoneal  cavity.  Fortunately 
it  was  directly  at  the  top  of  the  canal  and  consequently  was  advantageously 
situated  in  reference  to  escape  of  uterine  contents  into  the  peritoneal  cavity. 
The  heifer  recovered  without  incident. 

The  second  case  was  also  in  a  heifer,  but  in  this  instance  a  3-year-old  and 
of  the  Polled  Angus  breed.  The  pregnant  heifer  was  kept  at  pasture  in  a 
place  where  she  was  not  under  close  observation.  At  about  the  normal 
time  for  parturition,  the  owner  noted  the  fetal  membranes  protruding  from 
her  vulva  and  assumed  that  she  had  given  birth  to  a  calf.  The  heifer 
showed  some  slight  expulsive  efforts,  which  he  attributed  to  a  retention  of 
portions  of  the  afterbirth. 

In  a  general  way  she  recovered  from  the  ill-effects  of  fetal  retention,  and 
kept  in  good  condition.  She  was  taken  from  the  pasture  and  was  milked, 
yielding  about  two  gallons  per  day.  Her  appetite  and  general  health 
seemed  to  be  good,  except  that  at  intervals  she  was  affected  with  a  fetid 
diarrhea,  which  soon  passed  off.  Ten  weeks  later  we  were  called  in  con- 
sultation, and  upon  exploration  found  the  os  uteri  constricted,  permitting 
the  introduction  of  but  two  or  three  fingers,  while  through  it  protruded  a 
portion  of  the  tail  of  the  fetus.  The  constriction  was  confined  to  the  vaginal 
portion  of  the  cervix,  so  that  the  finger  or  fingers  entered  the  fully  dilated 
cavity. 

44 


690  Veterinary  Obstetrics 

With  an  ordinary  bistour}',  the  os  uteri  was  sufficiently  dilated,  by  cutting, 
to  allow  of  the  ready  insertion  of  the  hand.  Introducing  the  hand  into 
the  uterus,  we  encountered  the  remains  of  the  fetus  there  being  re- 
cognizable the  tail  and  a  small  fragment  of  the  skin  of  the  buttocks.  Be- 
yond lay  an  inextricable  mass  of  fetal  bones,  which  had  separated  into 
their  basic  parts,  the  shafts  and  epiphyses  being  separated  from  each  other. 
Deep  down  in  the  anterior  part  of  the  uterus  there  was  found  an  accumula- 
tion of  whole  grains  of  corn  and  other  foods.  Along  the  left  side  of  the 
uterus  there  were  two  openings,  which  would  admit  of  the  passage  of  one 
or  two  fingers  directed  toward  the  rumen.  Apparently  the  uterus  had  be- 
come adherent  to  the  rumen,  and  portions  of  the  fetus  had  sloughed  into 
that  organ  and,  passing  out  through  the  intestinal  canal,  had  caused  the 
fetid  diarrhea  which  the  owner  had  observed. 

The  walls  of  the  uterus  were  hard,  immensely  thickened,  and  wholly  de- 
void of  contractile  power.  Judging  from  the  sense  of  touch,  the  walls 
seemed  to  be  more  than  one  inch  thick. 

There  was  no  unfavorable  reaction  to  the  operation,  and  the  heifer  con- 
tinued her  usual  flow  of   milk.     Later  she  was  fatted  and  sent  to  market. 

Malignant  and  Other  Newgrowths  Involving  the 
Genital  Passages. 

Veterinary  literature  records  occasional  cases  of  malignant 
tumors  or  other  diseased  growths  in  the  cervix  uteri  and  other 
portions  of  the  genital  tract.  They  are  very  rare,  and  very  di- 
verse in  character.  The  symptoms  are  frequently  unlike  those 
of  induration  or  atresia  of  the  cervix  in  that  their  presence  may 
be  revealed  by  symptoms  before  the  end  of  gestation.  Naturally, 
they  probably  develop  chiefly  after  impregnation,  because,  were 
they  present  and  had  acquired  any  great  development  before 
breeding,  they  wotild  probabl)'  prevent  fertilization. 

They  may  be  of  the  nature  of  carcinom  or  sarcom  and,  more 
rarely,  of  actinomycosis  or  tuberculosis. 

During  pregnancy  their  presence  may  be  revealed  or  suggested 
by  the  existence  of  a  vaginal  discharge,  accompanied  possibly  by 
some  constitutional  symptoms  of  debility,  especially  in  cases  of 
malignant  tumors. 

If  not  revealed  by  the  presence  of  discharge  during  gestation, 
they  may  be  discovered  because  of  their  acting  as  an  impediment 
to  parturition.  When  the  veterinarian  is  called  because  of 
dystokia,  and  examines  the  patient,  he  recognizes  the  tumor  by 
touch. 


Malignant  and  other  Newgrowths  691 

The  prognosis  is  highly  unfavorable  if  the  tumor  is  malignant 
because,  although  it  may  be  possible  to  deliver  the  fetus,  the  life 
of  the  mother  cannot  usually  be  greatly  prolonged,  and  the  disease 
itself  is  generally  beyond  remedy.  The  disturbance  of  parturi- 
tion is  quite  inclined  to  arouse  the  disease  process  to  renewed 
activity. 

Should  the  tumor  be  of  a  benign  character,  and  its  anatomical 
relations  permit  removal,  the  prognosis  is  favorable. 

The  handling  of  the  dystokia  is  to  be  based  upon  the  char- 
acter of  the  tumor.  If  malignant,  the  chief  aim  should  be  the 
saving  of  the  life  of  the  fetus,  if  of  value.  Partial  or  complete 
removal  of  a  mahgnant  tumor  of  the  genital  canal  may  be  war- 
ranted in  order  to  remove  the  obstruction  to  birth,  and  the  fetus 
may  then  be  delivered  through  the  birth  canal.  If  the  tumor  is 
irremovable  and  offers  serious  obstacle  to  delivery,  gastro-hyster- 
otomy  may  be  performed  to  save  the  life  of  the  young. 

Benign  tumors  interfering  with  parturition  should  be  removed. 

Numerous  other  minor  impediments  to  parturition  occur  very 
rarely  in  the  genital  canal. 

Adhesions  and  constrictions  in  the  vulvo- vaginal  canal  offer 
at  times  more  or  less  serious  impediments  to  parturition,  which 
may  lead  to  important  lacerations  of  the  soft  parts. 

Persistent  hymen  is  occasionally  met  with  in  cases  of  dys- 
tokia, but,  so  far  as  we  have  observed,  consists  of  thin  bands, 
stretching  from  floor  to  roof  between  vulva  and  vagina  but  taking 
no  part  in  the  causation  of  the  dystokia.  They  are  easily 
ruptured  with  the  fingers. 


DYSTOKIA  DUE  TO  DISPLACEMENTS  OF  UTERUS. 

a.  Hernia  of  the  Uterus,  or  Hysterocele.  In  considering 
the  accidents  and  diseases  of  the  pregnant  female,  we  have  already 
had  occasion  to  refer  on  page  436  to  the  rupture  of  the  prepu- 
bian  tendon,  and  to  other  forms  of  uterine  hernia  by  which  the 
gravid  uterus  may  escape  through  an  opening  in  the  muscular 
walls  of  the  abdomen.  In  considering  those  accidents,  we  neces- 
sarily dealt  with  their  causes,  prevention,  and  method  of 
handling. 

b.  Deviation  of  the  Uterus.  Various  writers  describe  a  dis- 
placement of  the  uterus  obliquely  downward,  which  they  com- 
pare with  ante-version  of  the  gravid  uterus  of  woman.  The  ex- 
act condition  is  not  very  clear.  According  to  Fleming,  when  the 
hand  is  introduced  into  the  vagina  it  reaches  an  imperforate  cul- 
de-sac,  which  consists  of  the  floor  of  the  uterus  pushed  up  against 
the  floor  of  the  vagina,  thus  projecting  into  the  pelvic  cavity, 
while  the  os  uteri  is  situated  high  toward  the  sacrum  and  is  not 
much  dilated.  The  fetus  lies  beneath  the  vaginal  floor  and  cor- 
responds somewhat  in  its  position  to  what  we  describe  on  page  715 
as  bi-cornual  or  transverse  development  of  the  fetus. 

While  considering  the  location  and  attitude  of  the  fetus  in  preg- 
nant animals,  on  page  379,  we  have  recorded  occasionally  finding, 
during  the  later  stages  of  gestation,  an  extremity  of  the  fetus, 
usually  the  head  and  two  anterior  feet,  projecting  into  the  pelvis 
or  immediately  against  the  pelvic  inlet,  either  above  the  vagina 
or  alongside  of  it,  but  we  did  not  consider  that  this  was  abnormal. 

Fleming,  citing  Garreau,  relates  one  case  in  which,  in  this 
deviation,  the  os  uteri  was  closed  and  the  cervix  was  thickened 
and  indurated.  Later  it  became  necessary  to  perform  Caesarian 
section,  by  which  the  life  of  the  cow  was  saved.  This  seems 
rather  to  have  been  induration  of  the  cervix. 

In  another  case,  described  by  Schaack,  the  fetus  was  in  a 
normal  position  and  was  extracted,  but  the  cow  died  almost  im- 
mediately from  an  extensive  rupture  in  the  floor  of  the  uterus, 
which  led  to  a  fatal  hemorrhage,  in  a  similar  way,  apparently,  to 
what  we  record  as  a  common  consequence  of  forcible  extraction 
in  cases  of  bi-cornual  development  of  the  fetus. 
692 


Torsion  of  the   Uterus  693 

It  would  appear,  therefore,  that  under  this  head  veterinary  ob- 
stetrists  include  a  group  of  diverse  conditions. 

The  handling  of  such  cases  must  be  based  upon  the  actual 
character  of  the  obstacle  to  birth.  When  practicable,  the  fetus 
should  be  removed  by  traction. 

c.     TORSION  OF  THE  UTERUS. 

Torsion  of  the  gravid  uterus,  or  revolving  of  the  organ 
upon  its  long  axis,  is  an  accident  which  belongs  to  quad- 
rupedal animals.  The  displacement  occurs  most  frequently 
in  uniparous  animals,  and  especially  in  ruminants.  It  is 
most  frequently  diagnosed  in  the  cow.  It  is  common  in  the 
ewe.  In  the  cow  it  occurs  chiefly  in  dairying  districts  where 
the  animals  are  kept  confined  in  stanchions  and  where,  as  a  con- 
sequence, they  are  subjected  to  certain  violent  movements, 
especially  of  slipping  in  getting  up  on  a  wet  floor  or  in  making  a 
misstep  into  a  deep  gutter.  It  is  comparatively  rare  in  the 
mare,  and  even  more  so  in  the  small,  multiparous  domestic 
animals. 

Historically,  the  accident  has  been  recognized  for  more  than  a 
century,  and  has  been  well  known  and  studied  in  every  country 
where  much  attention  is  paid  to  dairying  and  the  breeding  of 
cattle. 

The  anatomical  relations  of  the  uterus  largely  determine  the 
probability  of  torsion.  The  ovaries  are  formed,  page  17,  near 
the  Wolffiah  bodies,  and  the  broad  ligaments  extend  from  these 
backward  to,  and  including,  the  vagina,  maintaining  the  geni- 
tal canal  in  its  position  in  the  abdominal  cavity.  In  all  animals 
the  ovaries  drop  more  or  less  into  the  abdominal  cavity,  and  tend 
to  move  backward  toward  the  inguinal  ring.  As  the  ovaries 
retreat  backward,  the  broad  ligaments  tend  to  follow  them,  so 
that  their  most  anterior  attachments  pass  back  toward  the 
inguinal  ring.  Consequently,  the  fixation  of  the  uterus  becomes 
more  and  more  posterior  as  the  ovary  moves  backward. 

This  migration  of  the  ovary,  and  the  consequent  moving  back- 
ward of  the  broad  ligament,  is  most  marked  in  the  ruminant,  and 
consequently  when  the  animal  becomes  pregnant  the  gravid 
uterus  soon  projects  far  anterior  to  its  ligamentous  attachments 
to  the  abdominal  walls.     There  is  little  to  prevent  the  projecting 


694  Veterinary  Obstetrics 

portion  of  the  gravid  uterus  from  revolving  upon  its  long  axis, 
and  once  it  has  thus  become  displaced  there  are  virtually  no 
natural  means  for  its  replacement. 

An  additional  factor  in  torsion  of  the  uterus,  which  has 
perhaps  been  over-emphasized  by  some  obstetrists,  is  that,  in  the 
uterus  of  the  cow,  the  cornua  curve  downward,  backward  and 
then  upward,  instead  of  curving  upward  and  forward  as  in  the 
mare  and  most  other  animals,  and  that  the  broad  ligament  is 
attached  at  first  to  the  inferior  side  of  the  uterine  cornua.  This 
in  itself  renders  the  organ  unstable  when  it  becomes  gravid,  and 
it  tends  to  make  a  partial  revolution  upon  its  long  axis  before  it 
can  come  to  rest  in  a  stable  position  upon  the  abdominal  floor. 
Some  writers  look  upon  this  peculiarity  in  the  conformation  of 
the  organ  itself  as  the  chief  factor  in  the  frequency  of  torsion  in 
the  cow,  but  it  probably  plays  a  very  minor  part. 

The  accident,  in  the  larger  animals,  consists  of  the  revolution 
of  the  gravid  uterus  upon  its  long  axis,  in  which  process  its 
broad  ligaments  must  become  involved.  The  torsion  shows  it- 
self chiefly  in  the  cervix  and  vagina.  When  the  organ  turns 
upon  its  long  axis,  the  broad  ligaments  are  necessarily  carried 
along  with  it,  and  more  or  less  incarcerate  the  organ,  as  if  they 
were  tense  cords  wound  spirally  about  it. 

In  the  smaller,  multiparous  animals,  torsion  usually  involves 
one  cornu  only. 

The  gravid  organ  in  torsion  behaves  very  much  the  same  as  a 
vStout  bag  filled  with  fluid  contents.  If  such  a  bag  is  attached  at 
one  end,  and  we  attempt  to  revolve  the  free  extremity  upon  its 
long  axis,  the  spiral  constriction  will  occur,  not  in  its  middle  but 
at  the  end  where  it  is  attached  and  constricted  by  its  mouth  be- 
ing tied  shut.  In  the  distended  uterus,  when  it  revolves  upon 
its  long  axis,  the  actual  twist  or  spiral  occurs  ordinarily,  not  in 
the  uterine  body  or  in  the  cornua,  but  in  the  constricted  neck  or 
in  the  empty  vagina  just  beyond.  The  method  by  which  this 
torsion  is  brought  about  is  well  demonstrated  in  Figs.  114-116. 
The  torsion  may  occur  with  equal  facility  to  the  right  or  to  the 
left.  If  the  upper  portion  of  the  uterus  turns  to  the  right,  while 
the  floor  passes  to  the  left,  it  is  known  as  right  torsion  ;  if  it 
revolves  in  the  opposite  direction,  it  is  known  as  left  torsion. 

The  torsion  may  be  of  any  degree  compatible  with  the  integ- 
rity of  the  organ.     As  a  general  rule,  it  is  scarcely  recognizable 


Torsiofi  of  the   Uterus 


695 


unless  the  revolution  has  reached  the  quadrant  of  a  circle,  90°,  or 
what  some  obstetrists  know  as  quarter  torsion.  If  the  torsion 
continues  until  the  uterus  has  made  a  complete  revolution  upon 
its  long  axis,  it  is  known  as  complete  torsion.  Some  writers 
would  have  us  believe  that  the  uterus  may  make  four  complete 
revolutions.  This  assumption  or  statement  is  open  to  question. 
It  cannot  well  go  very  far  beyond  a  complete  revolution,  until 
the  strain  upon  the  organ  becomes  too  great,  and  it  twists  oflF  or 
ruptures  transversely  and  drops,  an  inert  bag,  into  the  abdominal 
cavity. 


/ 


Fig.  114.     The  Mechanism  of  Torsion  of  the  Uterus  in  the  Cow. 
Gravid  Uterus  in  Normal  Position  at  about  the  7Th 
month  of  Pregnancy,  Seen  from  Below. 

P,  Pubis.     B,  Bladder.     L,  Broad  ligament. 
L',  Point  of  attachment  of  broad  ligament  to  abdominal  wall. 
O,  O,  Ovaries.     C,  Right  cornu.     Q.' ,  Left  (non-gravid)  cornu. 
A,  Corpus  luteum. 


696 


Veterinary  Obstetrics 


The  causes  of  torsion  have  not  been  fully  determined.  Any- 
thing which  may  violently  disturb  the  uterus  may  cause  it  to 
turn  upon  its  long  axis.  We  have  noted  the  peculiar  anatomical 
relations  of  the  uterus  of  the  cow.  Another  peculiarity  is 
that  when  she  gets  up  she  rises  first  upon  her  hind  feet, 
which  causes  the  gravid  uterus  to  hang  half  suspended  by  the 
vagina  in  the  abdominal  cavity.  When  thus  partially  suspended, 
any  slipping  upon  a  wet  floor  or  misstep  into  a  deep  gutter  may 


L 


C 


Fig.  115.    The  Mechanism  of  Torsion  of  the  Uterus  in  the  Cow. 

One-half  Revolution  of  the  Gravid  Uterus  on  its  Long 

Axis  at  about  the  7Th   month  ok  Pregnancy. 

Lettering  same  as  Fig.  114. 


Torsion  of  the   Uterus 


697 


cause  such  a  disturbance  of  the  semi-pendulous  organ  as  to  cause 
it  to  revolve  more  or  less  completely  upon  its  long  axis. 

Any  movement  of  the  animal  which  might  cause  a  sudden  im- 
pact upon  the  gravid  uterus,  such  as  a  fall,  a  severe  slip,  run- 
ning, jumping,  or  the  jostling  which  animals  get  in  transit  upon 
railway  trains,  may  accidentally  cause  the  gravid  uterus  to 
revolve  upon  its  long.axis. 

In  one  instance  observed  by  us,  a  mare  had  the  habit  of  climb- 
ing up  the  sides  of  a  large  stack  of  straw,  and  would  then  lie 
down  in  such  a  way  that  she  was  unable  to  get  up  except  by 
rolling  over  backward.  In  several  instances  the  owner  was  com- 
pelled to  turn  her  over  in  this  way  and  let  her  roll  down  the  side 
of  the  straw  stack  before  she  could  regain  her  feet.  When  foal- 
ing time  came  she  died  because  of  torsion  of  the  uterus. 


Fig.  116.     The  Mechanism  of    Torsion  of  the  Uterus  in  the  Cow, 
Complete  Revolution  of  the  Gravid  Uterus  at 
about  the  7th  month  of  pregnancy. 
Lettering  same  as  Fig.  114. 


698  Veteriiiary  Obstetrics 

The  belief  that  the  rolling  of  the  animal,  or  some  similar  move- 
ment, such  as  a  slip,  which  causes  the  body  to  very  quickly  re- 
volve to  a  slight  degree,  is  the  cause  of  torsion,  is  borne  out  by 
the  results  of  our  most  common  form  of  handling  of  this  diffi- 
culty, the  rolling  of  the  animal. 

Some  believe  that  violent  movements  of  the  fetus  exert  an 
influence  in  the  production  of  torsion,  but  this  cannot  be  deter- 
mined. The  fetus  may  move  violently  because  of  partial  as- 
phyxia after  the  torsion  has  occurred,  and  this  fact  may  be 
mistaken  for  the  cause  of  the  torsion. 

Symptoms.  The  symptoms  of  torsion  of  the  uterus  are  not 
diagnostic  without  the  aid  of  an  examination  of  the  organ  itself. 
Soon  after  the  torsion  occurs,  there  is  more  or  less  pain  caused 
by  the  displacement  of  the  organ,  which  may  be  expressed  in  a 
variety  of  ways,  according  to  the  degree  of  torsion  and  the 
period  of  gestation  at  which  it  occurs.  In  the  simpler  cases  the 
pain  is  expressed  by  kicking  at  the  belly,  lying  down  and 
quickly  getting  up  again,  looking  at  the  side,  switching  the  tail, 
with  other  symptoms  which  might  be  regarded  as  those  of  colic. 
In  addition  to  these  colicky  symptoms,  there  may  be  present 
more  or  less  marked  expulsive  efforts,  which  may  .somewhat 
closely  resemble  normal  labor  pains,  or  may  partake  rather  of 
the  character  of  straining  to  defecate. 

The  general  condition  of  the  animal  is  variable.  There  may 
be  a  well  marked  loss  of  appetite,  accompanied  by  more  or  less 
constipation  of  the  bowels.  When  the  torsion  becomes  more 
complete,  and  the  blood  supply  to  the  uterus  is  largely  or  wholly 
interrupted,  the  fetus  usually  undergoes  death  and  decomposi- 
tion, followed  by  great  weakness  of  the  animal.  There  are  then 
such  symptoms  as  would  be  caused  by  the  presence  of  an  emphy- 
sematous fetus  and  an  inflamed  or  gangrenous  uterus,  with  the 
resulting  extensive  peritonitis  combined  with  .septicaemia.  When 
the  septicaemia  and  peritonitis  do  not  result  fatally,  the  contents 
of  the  uterus,  undergoing  putrid  decomposition,  act  as  an  abscess, 
which  eventually  ruptures  through  the  abdominal  walls  or  into 
the  digestive  tract,  and  the  fetal  remains  escape  in  this  way.  In 
other  ca.ses  the  fetus  is  .said  to  undergo  mummification,  followed 
by  recovery  of  the  patient.  This  must  be  extremely  rare.  We 
have  observed  no  such  case,  or  authentic  record  of  such. 

Frequently  the  owner  or  caretaker  fails  to  observe  any  signs 


Torsion  of  the   Uterus  699 

which  would  lead  him  to  suspect  serious  accident.  The  animal 
simply  becomes  dull,  or  if  colic  is  present  it  passes  unobserved, 
and  it  is  not  until  the  torsion  has  existed  for  days  or  even  weeks 
that  it  has  caused  a  sufficient  disturbance  to  finally  attract  his 
attention.  This  is  especially  true  of  those  who  keep  but  a  few 
cows  and  are  about  them  but  little.  Cows  at  pasture  are  often 
scarcely  seen  at  all,  or  merely  are  noticed  for  a  few  minutes  each 
day,  so  that,  unless  there  are  very  evident  symptoms  of  disease, 
they  pass  unseen.  In  this  way,  it  has  been  our  experience  that 
torsion  of  the  uterus  frequently  passes  unnoticed  for  a  week  or 
two,  except  that  the  owner  may  have  recognized  the  fact  that 
there  was  something  amiss  with  the  animal,  though  not  in  his 
judgment  of  a  sufficiently  serious  character  to  call  for  veterinary 
attendance.  In  some  cases  of  uterine  torsion,  the  vulva  seems 
smaller  and  drawn  inward. 

The  diagnosis  of  the  accident  in  the  larger  animals  is  com- 
paratively ea.sy  by  either  vaginal  or  rectal  exploration.  Ex- 
amined per  rectum,  the  anterior  part  of  the  vagina  and  the  cer- 
vix of  the  uterus  appear  as  a  more  or  less  tense,  spiral  cord,  in 
which  the  spiral  folds  of  the  organ  can  be  somewhat  readily  felt 
and  the  direction  in  which  the  torsion  has  taken  place  may  be 
determined. 

When  the  hand  is  introduced  into  the  vulva,  it  does  not  ad- 
vance far  until  it  comes  in  contact  with  the  spiral  folds  in  the 
vaginal  walls,  which  pass  in  a  spiral  manner,  either  to  the  right 
or  left,  obliquely  toward  the  os  uteri.  In  some  cases  these  spiral 
folds  are  not  very  prominent  and  the  vagina  is  not  closed,  so 
that  the  veterinarian  may,  without  serious  difficulty,  advance 
his  hand  to  the  os  uteri  ;  sometimes  he  may  be  able  to  pass  the 
cervical  canal  and  reach  the  cavity  of  the  uterus. 

In  severe  cases  of  torsion  this  cannot  be  done,  but  the  hand, 
after  following  the  folds  of  the  vaginal  wall  in  a  spiral  manner 
for  a  time,  can  be  advanced  no  further.  In  some  cases  the  hand 
can  barely  be  introduced  to  the  os  uteri,  and  in  others  it  stops 
before  the  mouth  of  the  uterus  is  reached. 

This  condition  of  the  vagina  is  sufficient  in  itself  to  clearly 
identify  the  torsion,  and  renders  the  diagnosis  definite. 

Pathology.  The  changes  taking  place  in  the  uterus  and  its 
contents,  in  cases  of  torsion,  must  depend  very  largely  upon  the 
extent  of  the  displacement  of  the  organ.     In  mild  cases,  where 


700 


Veterinary  Obstetrics 


the  torsion  is  but  slight,  it  does  not  interfere  seriously  with  the 
circulation  of  the  uterus  and  the  nutrition  of  the  fetus.  The  con- 
tractile power  of  the  uterine  walls  remains  essentially  intact,  and 
the  life  of  the  fetus  may  not  be  threatened  except  by  delay  in  its 
expulsion,  caused  by  the  narrowing  of  the  birth  canal,  owing  to 
the  partial  revolution  of  the  organ.  In  such  slight  cases  the 
torsion  merely  constitutes  a  mechanical  impediment  to  partu- 
rition, which,  if  not  relieved,  may  finally  end  in  the  death  of  the 
fetus,  to  be  followed  by  the  ordinary  consequences  of  fetal  death 
and  decomposition.  Such  mild  cases  are  recorded,  but  have  not 
been  seen  by  us. 

When  the  torsion  is  extensive,  it  directly  interferes  with  the 
circulation  in  the  uterus,  and  secondarily  with  the  nutrition  of 
the  fetus.  As  shown  in  Figs.  114-116,  whenever  the  uterus  re- 
volves upon  its  long  axis  all  the  blood  vessels  become  more  or 
less  incarcerated,  so  that  the  circulation  is  very  promptly  dis- 
turbed or  may  be  completely  cut  off.  This  applies  equally  to 
vessels  arising  from  the  pudic  or  ovarian  vessels.  As  soon  as  the 
circulation  is  disturbed,  the  effect  upon  the  uterus  is  more  or  less 

01 


Fk;.  117.     T..KhH)x   -I 

V,  Vagina.     OE,  Os  uteri  externum. 
BL,  Broad  ligament.      C.  Cotyledon. 


01,  Os  uteri  internum. 
U,  Uterine  cavity. 


Torsion  of  the   Uterus 


701 


profound,  according  to  the  degree  of  obstruction.  Moderate  ob- 
struction to  the  circulation  tends  to  cause  congestion  of  the 
uterine  walls  and  placenta,  accompanied  b}'  pain  and  sj^mptoms  of 
colic,  with  possibly  more  or  less  evident  expulsive  efforts.  This 
obstruction,  affecting  first  the  venous  circulation,  tends  to  cause 
asphyxiation  of  the  fetus.  As  a  result  of  this  disturbance  of  the 
circulation,  the  fetus  may  show  more  or  less  violent  movements, 
which  may  sometimes  be  misinterpreted  and  believed  to  be  the 
cause  of  the  displacement,  whereas  in  fact  they  are  the  result  of 
it.  The  disturbance  in  the  circulation  and  the  non-seration  of  the 
blood  of  the  fetus  tend  finally  to  bring  about  its  death,  and  this 
usually  occurs  after  a  comparatively  short  time  if  the  torsion  is 
at  all  extreme. 

The  interference  with  the  circulation  affects  first  the  return  of 
the  venous  blood  from  the  placenta,  and  as  a  consequence  there 
is  a  constant  tendency  to  an  extensive  transudation  of  serum 
and   blood,    into  the  uterine   cavitv  and   the    fetal  membranes. 


V_ 


uc 

Fig.  118.     Sagitt.\i.  Section  ok  Fig.  117. 
OE,  Os  uteri  externum.     OI,  Os  uteri  internum. 
BL,  BL,  Broad  ligament. 

V,  V,  V,  Veins  distended  with  coagulated  blood. 
U,  Uterus.     U,  C,  Ulerine  comu. 


702  I'^eterinary  Obstetrics 

The  transudation  involves  the  uterine  walls  also,  causing  them  to 
become  immensely  thickened,  injected  and  black  ;  the  maternal 
and  fetal  placentae  undergo  analogous  changes;  the  fetal  mem- 
branes become  involved  ;  and  extensive  exudation  of  bloody 
serum  occurs  in  the  uterine,  allantoic  and  amniotic  cavities,  in- 
creasing enormously  the  volume  and  weight  of  the  gravid  organ. 

It  is  said  that  in  some  cases  the  fetus  undergoes  mummifica- 
tion, but  if  this  occurs  it  must  be  very  rare.  The  tendency  is 
rather  for  infection  of  the  uterus  and  its  contents  to  take  place 
and  lead  to  putrid  decomposition.  Under  normal  conditions, 
the  cervix  uteri  acts  as  an  efficient  guard  against  infection.  The 
cervical  canal  is  hermetically  sealed  with  a  mucous  plug.  When 
torsion  occurs,  the  tissues  of  the  vagina  and  cervix  at  once  lose 
their  normal  function  and,  wh'en  the  torsion  is  extreme  and  the 
vitality  of  the  walls  becomes  depressed  or  destroyed,  their 
bactericidal  power  declines  or  ceases,  and  they  serve  rather  as  a 
favorable  culture  ground  for  bacteria,  which  consequently  ad- 
vance to  the  uterus  and  its  contents,  either  along  the  cervical 
canal  or  through  the  tissues,  and  thus  cause  fetal  decomposition 
and  septic  metritis. 

It  has  been  stated  by  some  veterinary  obstetrists  that  the 
torsion  of  the  uterus  may  take  place  at  any  point,  or  nearly  so, 
in  the  entire  organ  in  the  vagina,  the  cervix  or  body  of  the 
uterus,  or  in  the  cornu.  A  study  of  the  figures  presented  will 
answer  this  question.  If  we  examine  the  gravid  uterus,  as  shown 
in  Figure  114,  and  revolve  it  upon  its  long  axis,  as  has  been 
done  in  115  and  116,  we  find  that  we  are  dealing  essentially  with 
a  large  bag,  containing  solid  (fetus)  and  liquid  contents,  in 
which  the  fundus  of  the  uterus  or  the  gravid  cornu  represents 
the  bottom  of  the  sac,  while  the  cervix  and  vagina  represent  the 
closed  mouth,  which  is  fixed  to  the  immovable  vulva. 

Attempting  to  revolve  this  bag  upon  its  long  axis,  we  at  once 
find  that  it  will  twist  only  at  or  near  its  point  of  fixation,  where 
its  mouth 'has  been  closed.  If  the  uterus  were  empty,  it  could 
admittedly  twist  at  any  point  throughout  its  entire  extent,  but 
when  completely  filled  this  cannot  occur.  Instead,  if  it  were 
forcibly  revolved  and  forced  to  begin  to  twist  in  this  part,  it 
would  be  torn  asunder  because  the  contents  do  not  permit  of 
any  decrease  in  volume.     Therefore,  in   cases  of   uterine  torsion 


Torsion  of  the   Uterus  703 

in  unipara,  the  twist  must  occur  in  the  cervix  and  vagina  and 
not  elsewhere. 

The  suggestion  that  the  gravid  cornumay  possibly  be  the  only 
part  involved  in  a  twist  is  untenable,  in  so  far  as  it  relates  to  uni- 
parous  animals,  where  a  portion  of  the  fetus  has  developed  and 
lies  within  the  uterine  body.  In  multipara,  like  the  sow,  bitch 
and  cat,  torsion  of  one  of  the  cornua  may  and  does  occur,  and  is 
more  probable  than  the  torsion  of  the  entire  uterus. 

De  Bruin  suggests  that,  in  a  large  proportion  of  the  cases  of 
torsion,  the  accident  occurs  after  the  os  uteri  has  become  dilated, 
and  that  it  is  favored  by  this  fact.  He  bases  his  belief  upon  the 
clinical  fact,  that,  in  a  large  proportion  of  cases  of  uterine  tor- 
sion, when  it  is  reduced,  the  cervical  canal  is  found  dilated  and 
ready  for  the  passage  of  the  fetus.  We  are  not  wholly  ready  to 
accept  his  conclusion.  We  have  likened  the  gravid  uterus  to  a 
bag  filled  with  fluid.  If  we  leave  the  mouth  of  the  bag  open, 
retaining  its  contents,  attach  it  to  an  immovable  object  and 
attempt  to  turn  it  upon  its  long  axis,  we  find  this  very  difficult 
or  even  impossible. 

De  Bruin  reasons  that,  because  the  uterus  is  contracted,  there 
is  more  room  for  it  to  twist,  but  the  uterus  is  certainly  just  as 
thoroughly  filled,  if  not  more  so,  than  before  it  began  to  con- 
tract, unless  the  waters  have  escaped.  The  common  clinical 
fact,  that  the  cervical  canal  is  found  dilated  in  .some  cases  im- 
mediately after  torsion  is  reduced,  may  readily  be  explained  by 
the  torsion  itself.  In  torsion,  the  cervix  becomes  very  much 
stretched  longitudinally,  and  this  is  one  of  the  greatest  elements 
in  the  dilation  of  the  cervical  canal.  The  torsion,  by  involving 
chiefly  the  cervix,  would  destroy  first  of  all  its  contractile  power, 
very  greatly  weaken  its  muscles  and  tend  to  favor  dilation  as 
soon  as  the  torsion  is  reduced.  De  Bruin  admits  this  weakness 
of  the  cervical  walls,  and  cautions  the  obstetrist  against  applying 
great  force  upon  the  fetus  after  reduction  of  the  torsion,  lest  the 
cervix  rupture  transversely,  but  this  would  scarcely  occur  ex- 
cept the  muscles  had   been  seriously  damaged  by  over-tension. 

When  the  fetus  becomes  emphysematous  or  undergoes  putrid 
decomposition,  and  the  uterine  cavity  becomes  filled  with  tran- 
suded liquids,  the  disease  processes  are  not  confined  to  the  inner 
surface  of  the  uterus  and  to  its  contents,  but  extend  to  and  beyond 
the  peritoneal  covering  of  the  organ.     The  peritoneal  covering 


704 


Veterinary   Obstetrics 


of  the  uterus  becomes  inflamed,  and  fiuallj-  tends  to  adhere  to 
other  portions  of  the  peritoneum  with  which  it  comes  in  contact, 
so  that  in  one  case  observed  by  us,  almost  the  entire  peritoneal 
surface  of  the  uterus  was  very  firmly  adherent  to  the  intestines, 
rumen,  bladder  and  abdominal  walls.  In  addition  to  these  ad- 
hesions, in  severe  cases,  the  peritoneal  cavity  contains  an  abnor- 
mal amount  of  a  reddish-colored  serum. 

Not  only  does  the  uterus  become  adherent  to  surrounding 
organs  and  tissues,  but  one  part  of  the  organ  becomes  firmly  ad- 
herent to  another  part  of  it  or  to  its  broad  ligaments,  especially 
about  the  cervix,  so  that  even  if  the  rest  of  the  organ  is  free  from 
adhesions  it  may  be  difficult  to  untwist  it  because  of  adhesions 
existing  between  the  coils  in  the  twisted  portion  it.self. 

When  the  torsion  continues  to  an  extreme  degree,  the  organ 
and  its  broad  ligaments  give  way,  and  the  uterus,  with  its  con- 
tents, becomes  almost  or  wholly  detached   and  lies  free  within 


Followed  by  transverse  rupture  of  the  vagina  and  sloughing  of  the 
putrid  fetus  through  the  abdominal  floor. 

A,  Vulva.  E.  Ovary. 

B,  Vaginal  stump.  F,  Uterine  cornu. 

C,  Broad  ligament.  G,  Intestine. 

D,  Cord-like  cervix,  entwined  by  broad  ligament. 


Torsion  of  the   Uterus  705 

the  peritoneal  cavity.  Just  how  far  uterine  torsion  can  advance 
in  the  living  animal  is  a  question  not  readily  determined.  Flem- 
ing, in  his  Veterinary  Obstetrics,  Edition  1887,  page  299,  states 
that  the  uterus  may  make  as  many  as  four  complete  revolutions, 
but  cites  no  cases  which  clearly  demonstrate  the  correctness  of 
such  a  conclusion.  In  our  own  experience,  the  constant  tend- 
ency has  been  for  the  organ  to  rupture  transversely  whenever 
the  torsion  extends  to  an  extreme  degree.  In  Fig.  119,  trans- 
verse rupture  of  the  uterus  in  the  ewe  is  shown.  In  this 
case  the  fetus  and  other  uterine  contents  sloughed  out 
through  the  abdominal  floor  in  the  region  of  the  umbilicus. 
How  many  times  this  uterus  had  revolved  before  it  had  torn  in 
two  cannot  be  determined,  but  apparently  not  much,  if  any, 
beyond  one  complete  revolution.  We  question  Very  much  if, 
under  ordinary  conditions,  the  pregnant  uterus,  when  near  the 
close  of  gestation,  will  turn  more  than  once  or  once  and  a  half 
around  without  .serious  danger  of  a  transverse  rupture. 

In  one  instance,  in  the  cow,  which  came  under  our  observa- 
tion, it  would  seem  that  the  torsion  did  not  exceed  one  complete 
turn  because  it  was  verj-  promptly  reduced  by  rolling  the  cow 
once  over.  Yet,  when  the  fetus  had  been  removed,  a  large  trans- 
verse rupture  was  found,  which  later  ended  in  the  death  of  the 
animal.  We  do  not  believe  that  we  caused  this  rupture  in  deliv- 
ering the  calf,  as  this  was  accomplished  very  gently  and    easily. 

Some  authors  state  that  occasionally  the  broad  ligaments  of  the 
uterus  also  become  ruptured,  and  make  their  statement  in  such  a 
way  as  to  carry  the  impression  that  the  ligaments  rupture  inde- 
pendently of  the  transverse  rupture  of  the  organ  itself.  How 
true  this  may  be,  is  not  quite  clear  to  us.  When  the  organ  rup- 
tures transversely,  as  in  Fig.  119,  it  is  v^xy  evident  that  the  broad 
ligaments  must  give  way  also,  as  they  are  firmly  incarcerated  in 
the  part  which  ruptures,  and  the  immense  weight  of  the  gravid 
organ,  after  it  has  become  detached  from  the  vagina,  is  such  that 
the  ligaments  must  necessarily  be  torn.  Yet,  we  do  not  under- 
stand, from  a  study  of  Figs.  114  and  115,  how  any  serious 
rupture  of  these  ligaments  could  take  place  without  the  organ 
itself  having  first  given  way. 

Prognosis.  The  prognosis  of  torsion  of  the  uterus  must  neces- 
sarily be  grave.  The  probability  of  recovery  must  be  based 
45 


7o6  Veter7tary  Obstetrics 

largely  upon  the  duration  and  extent  of  the  lesion.  When  a  re- 
cent torsion,  to  the  extent  of  %  lo  }i  oi  o.  revolution,  exists,  it  is 
ordinarily  not  to  be  regarded  as  serious,  because  it  may  not 
greatly  imperil  the  life  of  the  fetus,  or  render  its  extraction  a  for- 
midable matter.  It  may  not  interfere  very  greatly  with  the  cir- 
culation in  the  uterus  or  with  the  nutrition  of  the  uterus  and 
fetus.  When,  however,  the  torsion  becomes  complete,  as  in  Fig. 
ii6,  or  there  is  almost  a  complete  turn  upon  its  long  axis,  the 
circulation  of  the  organ  is  at  once  seriously  interrupted.  Unless 
prompt  relief  is  afforded,  the  fetus  must  perish,  and  almost  cer- 
tainly undergo  decomposition  with  all  its  consequences,  and  the 
uterus  must  become  seriously  diseased.  If  the  twist  proceeds  a 
step  further,  a  rupture  of  the  uterus  results,  which  must  almost 
inevitably  lead  to  the  death  of  the  animal  ;  or  should  she  survive, 
her  value  is  usually  destroyed  because  of  the  very  .slow,  uncertain, 
and  imperfect  recovery,  by  the  .sloughing  of  the  fetus  through 
the  abdominal  walls  or  into  the  alimentary  canal. 

The  prognosis  must  therefore  always  be  very  cautiously  made. 

1.  The  torsion  may  be  reducible  or  irreducible. 

2.  The  fetus  may  be  alive,  or  dead  and  emphysematous,  ac- 
cording to  the  duration  and  extent  of  the  torsion. 

3.  The  putrid  decomposition  of  the  fetus  and  the  serious  dis- 
turbances in  the  circulation  may  have  led  to  uterine  paralysis, 
inflammation  or  gangrene  from  which  it  is  impossible  for  the 
animal  to  recover. 

4.  The  uterus  may  have  suffered  a  fatal  transverse  rupture, 
which  may  not  reveal  itself  until  after  the  torsion  has  been 
reduced  and  the  fetus  extracted. 

Treatment.  The  handling  of  torsion  of  the  uterus  must  be 
based  upon  the  extent  and  duration  of  the  condition  and  the 
character  of  the  pathologic  changes  which  have  occurred. 

I.  In  slight  torsion,  where  the  uterus  has  not  made  a  complete 
revolution  upon  its  long  axis,  it  may  be  possible  to  advance  the 
hand  through  the  vagina  and  cervical  canal  into  the  uterus, 
rupture  the  fetal  membranes,  seize  the  presenting  limbs,  and, 
by  exerting  force  upon  the  fetus  itself,  cause  the  uterus  to 
turn  back  to  its  normal  position.  In  such  a  case  the  force 
is  to  be  exerted  in  the  direction  opposite  to  the  twist, 
turning  the  organ  back  to  its  original  position.  If  the  tor- 
sion has  taken  place  to  the   right,    the  force,   exerted  indirectly 


Torsion  of  the   Uterus  707 

upon  the  uterus  through  the  fetus,  should  be  to  the  left.  If  the 
birth  canal  is  sufficiently  open  to  permit  the  feet  to  pass  through 
and  beyond  the  vulva,  the  correction  of  the  position  of  the  uterus 
is  rendered  much  more  simple,  because  greater  power  is  given  to 
effect  rotation  of  the  fetal  body  by  grasping  the  limbs.  Having 
flexed  the  foot  at  the  fetlock,  the  pastern  may  be  used  as  a  lever 
to  exert  power.  Various  machines  and  appliances  have  been 
suggested  to  aid  the  operator  in  these  cases,  but,  as  a  general 
rule,  where  the  torsion  is  so  slight  its  correction  constitutes  a 
rather  simple  procedure,  and  not  much  equipment  is  necessary 
for  the  purpose.  In  correcting  this  slight  torsion,  the  animal 
should  be  in  the  standing  posi-tion,  if  practicable,  and  with  the 
hind-feet  much  higher  than  the  fore-feet.  We  have  not  observed 
such  slight  torsion  though  it  has  been  reported  by  others. 

When  the  torsion  has  advanced  to  such  a  degree  that  the  hand 
cannot  be  inserted  into  the  uterine  cavity,  it  is  impossible  to  turn 
the  uterus  by  the  application  of  force  to  the  vagina. 

2.  In  severe  torsion  we  may  attempt  either  to  turn  the  uterus 
within  the  abdomen  of  the  patient  or  to  turn  the  body  of  the 
patient  and  keep  the  uterus  fixed. 

The  method  most  frequently  employed  for  bringing  about  the 
reduction  of  the  torsion  is  that  of  turning  or  rolling  the  patient. 
The  operation  is  best  performed  in  the  open  field  if  weather  and 
other  conditions  permit.  Otherwise  a  commodious  room  is  se- 
lected. The  patient  is  to  be  cast  with  her  hind  parts  elevated,  so 
that  the  uterus  may  tend  to  drop  away  from  the  pelvis  and  hang 
attached  by  the  vagina,  much  like  a  bag  freely  suspended  from  a 
fixed  support.  If  the  torsion  is  to  the  right,  the  patient  should  be 
cast  upon  the  right  side.  The  two  forefeet  should  be  firmly 
bound  to  each  other  and  the  two  hind  feet  to  each  other.  The 
forefeet  should  not  be  attached  to  the  hind  feet,  becau.se  this 
would  exert  compre.s.sion  upon  the  abdomen,  which  would  in- 
terfere with  the  rotation  of  the  uterus  upon  its  long  axis,  and 
consequently  with  the  replacement  of  the  organ. 

The  operator  should  be  careful  to  keep  the  posterior  parts  of  the 
patient  well  elevated.  He  should  kneel  or  lie  behind  the  patient 
and  insert  his  hand  as  far  as  possible,  to  hold  the  vagina  or  uterus 
as  firmly  as  may  be  and  also  to  determine  the  result  of  the  oper- 
ation of  rolling.  The  operation  proceeds  upon  the  assumption 
that,  in  rolling  the  body  of   the  animal,  the  gravid  uterus  shall 


yoS  Veterinary  Obstetrics 

remain  static,  and  consequent!}'  the  normal  relationship  shall  be 
restored  by  the  patient's  body  revolving  around  the  gravid  uterus 
in  the  same  direction  in  which  the  latter  had  previously  turned. 
The  operator  remains  in  the  position  named,  and  assistants  turn 
the  animal  upon  her  right  side,  thence  upon  her  back  and  over 
onto  her  left  side.  Folding  the  feet  beneath  the  patient's  body, 
she  is  rolled  up  on  her  chest,  over  onto  her  right  side,  and  the 
rolling  continued  as  before. 

In  discussing  the  cause  of  torsion,  we  suggested  that  the  acci- 
dent probably  results  from  a  very  sudden  slip  or  turn  of  the  ani- 
mal. In  attempting  to  overcome  the  displacement  of  the  organ, 
it  may  be  advisable  to  imitate  those  conditions  which  we  assume 
to  have  caused  the  displacement.  Consequently,  the  rolling 
process,  at  a  critical  point,  should  be  more  or  less  sudden,  in  the 
hope  that  the  body  of  the  patient,  by  being  moved  quickly,  does 
not  cause  the  gravid  uterus  to  move  with  it,  but  leaves  it  stand- 
ing still.  To  this  end,  then,  when  the  rolling  process  is  begun 
it  may  be  done  rather  quickly,  in  order,  if  possible,  to  bring  about 
the  revolution  of  the  body  of  the  mother,  without  having  the 
gravid  uterus  follow  its  motion. 

3.  Others  favor  a  modified  rolling  process  by  causing  a  partial 
revolution  of  the  body  of  the  mother  with  an  attempt  to  turn  the 
gravid  uterus  in  the  opposite  direction  or  to  hold  it  from  turning 
with  the  maternal  body  by  means  of  external  force  applied  to  the 
fetus  through  the  abdominal  walls.  The  patient  is  turned  .slowly 
and  gently  upon  her  back,  while  the  operator  or  an  assistant 
identifies  the  fetus  by  palpating  the  abdominal  floor.  If  the 
torsion  is  to  the  right,  the  operator  pushes  against  the  fetus  from 
the  right  to  the  left  and  attempts  to  cau.se  the  gravid  organ  to 
revolve  toward  the  left,  or  at  least  to  aid  materially  in  holding 
and  preventing  it  from  rotating  to  the  right  as  the  body  of  the 
patient  is  suddenly  brought  down  on  her  left  side. 

This  plan  of  operating  is  based  upon  the  assumption  that, 
when  an  animal  suflfering  from  uterine  torsion  is  slowly  and  care- 
fully rolled  over,  the  gravid  uterus  revolves  to  the  same  degree, 
but  that  an  abrupt  roll  of  the  maternal  body  may  change  the 
relations  of  the  gravid  organ.  This  influence  can  be  aided  by 
external  manipulation. 

Assuming  that  the  operation  has  been  successful,  when  the  cow 
has  been  turned  completely  to  her  left  side  the  ropes  are  removed 


Torsio7i  of  the   Uterus  709 

and  she  is  allowed  to  stand.  If  the  operation  has  been  successful, 
the  spiral  folds  of  the  vagina  have  disappeared,  the  hand  can  be 
advanced  without  difficulty  to  the  os  uteri,  and,  if  the  cervical 
canal  is  dilated,  the  hand  may  be  passed  on  into  the  uterine 
cavity  and  the  fetus  grasped. 

It  is  highly  important,  in  this  operation,  that  the  veterinarian 
should  constantly  keep,  or  frequently  insert  his  hand  into  the 
vagina  in  order  to  determine  the  progress  which  is  being  made. 
Sometimes  the  operator  becomes  confused  in  reference  to  the  di- 
rection of  the  twist,  and  consequently  in  reference  to  the  direc- 
tion in  which  the  animal  should  be  rolled.  If  his  hand  is  intro- 
duced into  the  birth  canal  and  the  rolling  process  is  begun  in  the 
wrong  direction,  he  at  once  recognizes  the  fact  by  the  increased 
pressure  upon  his  hand  as  the  twist  becomes  aggravated.  If  the 
turning  is  in  the  right  direction,  and  the  torsion  is  reducible,  the 
vagina  becomes  more  open  and  commodious,  and  the  hand  can 
be  advanced  further  into  it. 

In  some  instances  the  torsion  is  not  promptly  reduced,  al- 
though it  may  eventually  be  accomplished  by  perseverance,  so 
that,  if  turning  the  animal  once  does  not  completely  accomplish 
the  object,  we  should  not  despair,  but  should  resort  to  several 
turns  and  watch  closely  the  result. 

4.  When  the  rolling  process,  or  the  partial  rolling  with  external 
manipulation,  fails  to  bring  about  a  reduction  of  the  torsion,  it 
has  been  recommended  to  perform  laparotomy,  reach  into  the 
abdominal  cavity  with  the  hand,  grasp  the  gravid  uterus,  and 
reduce  the  torsion  by  acting  directly  upon  the  organ.  In  the 
cow  it  would  be  preferable  to  operate  upon  the  standing  animal, 
making  the  incision  somewhat  high  in  the  right  flank.  If  the 
torsion  is  to  the  right,  the  operator  reaches  down  between  the 
right  abdominal  wall  and  the  gravid  uterus  ;  inserting  the  hand 
as  far  as  possible  alongside  and  beneath  the  organ,  lifts  up- 
ward ;  and,  drawing  somewhat  to  the  right,  attempts  to  cause  it 
to  revolve  to  the  left.  If  the  twist  is  to  the  left,  the  operator 
passes  his  hand  over  the  top  of  the  organ  to  the  left  side,  and 
downward  as  far  as  possible,  and,  grasping  some  projecting  por- 
tion, draws  the  organ  upward  and  to  the  right.  How  often  this 
process  succeeds,  where  rolling  or  external  palpation  fails,  we 
are    unable    to   determine.       Probably    not    often.     The    gravid 


7IO  Veterinary  Obstetrics 

uterus  is  so  voluminous  and  heavy,  its  exterior  so  even  and 
smooth,  and  it  is  so  closely  imprisoned  in  the  abdomen  that 
grasping  the  organ  with  the  hand  and  exerting  efficient  force  is 
not  so  easy.  The  force  must  be  largely  exerted  by  placing  the 
palm  of  the  hand  at  a  favorable  point  and  pressing  against  the 
uterine  walls  in  an  advantageous  direction  to  induce  rotation. 
We  have  attempted  the  operation  twice  after  rolling  had  failed, 
each  time  without  result. 

When  the  torsion  has  been  reduced  by  one  of  the  foregoing 
plans,  the  question  of  delivery  arises.  If  the  torsion  has  occurred 
earlj'  in  pregnancy,  and  has  been  promptly  discovered  and  rem- 
edied, it  may  not  be  advisable  to  encourage  the  immediate  expul- 
sion of  the  fetus.  Cases  have  been  recorded  in  the  cow,  six  to 
seven  months  pregnant,  in  which  the  torsion  has  been  reduced, 
the  pregnancy  continued  to  its  normal  close,  and  a  living  calf 
born.  These  constitute  very  exceptional  instances.  In  many 
cases  the  torsion  is  not  discovered  at  this  period. 

Torsion  is  liable  to  occur  at  any  time  during  the  last  third  of 
gestation,  and  consequently,  when  the  veterinarian  is  called  to 
attend  a  pregnant  animal  during  this  period,  and  finds  it  suffer- 
ing from  some  disease,  the  character  of  which  is  not  very  clear 
upon  external  examination,  he  should  not  fail  to  investigate 
carefully  the  condition  of  the  gravid  uterus,  in  the  course  of 
which  examination  he  would  naturally  discover  uterine  torsion 
if  it  existed. 

When  uterine  torsion  has  been  reduced,  and  has  not  caused  path- 
ologic changes  which  have  destroyed  the  functions  of  the  uterus, 
labor  generally  begins  very  shortly  afterward,  and  the  fetus  is  ex- 
pelled. De  Bruin  and  others  recommend  that  we  should  as  a 
rule  leave  the  expulsion  of  the  fetus  to  the  natural  forces  of  the 
mother,  unless  there  are  conditions  present  which  suggest  other- 
wise. If  the  cervical  canal  is  not  yet  dilated,  time  should  be 
allowed  for  this  to  occur  normally.  If  the  canal  is  dilated,  it  is 
usually  observed  that  the  fetus  is  quite  promptly  expelled,  so 
that  very  little  assistance,  if  any,  is  required.  If  it  seems  ad- 
visable to  apply  traction  to  the  fetus,  it  should  be  done  very 
cautiously,  and  abundant  time  should  be  given  for  the  passage  of 
the  fetus  through  the  birth  canal.  It  is  needless  to  state  that,  if 
the  fetus  presents  abnormally,  it  should  be  adjusted. 


Torsioyi  of  the   Uterus  711 

Before  applying  traction  or  carrying  out  other  manipulations, 
after  the  organ  has  been  replaced,  we  would  advise  the  practitioner 
to  search  carefully  in  every  part  for  transverse  rupture  of  the 
cervix  uteri  or  other  important  injuries,  because,  if  such  rupture 
has  occurred  during  the  torsion  of  the  organ,  it  should  be  discov- 
ered promptly  and  the  owner  of  the  animal  advised  of  the  condi- 
tions, that  he  may  relieve  the  veterinarian  from  any  responsibil- 
ity which  might  rest  upon  him  otherwise  because  of  the  later 
discovery  of  the  condition. 

De  Bruin  aptly  remarks  that,  in  these  cases,  examination  should 
be  made  before  any  operation  is  begun,  with  a  view  to  deter- 
mining whether  the  case  has  already  been  handled  by  empirics  or 
others,  and  in  this  way  the  outcome  rendered  more  doubtful. 

Torsion  of  the  uterus  is  frequently  irreducible.  In  one 
case  which  we  attended,  the  torsion  had  apparently  existed  for 
about  two  weeks,  and  the  spiral  folds  of  the  cervix  and  vagina 
had  become  so  firmly  adherent  to  each  other.  Figs.  1 17  and  118, 
that  the  organ  could  not  very  well  have  been  untwisted. 

Reduction  was  also  made  virtually  impossible  by  the  fact  that 
the  fetus  was  dead,  emphysematous,  and  swollen  to  thrice  its 
normal  volume,  and  so  great  a  volume  of  fluid  had  transuded 
into  the  uterine  cavity  as  to  increase  the  weight  and  volume  of 
the  organ  to  such  a  degree  that  there  was  neither  room  within  the 
abdominal  cavity  to  turn  the  organ  nor  power  enough  in  the  arms 
of  a  man  to  bring  about  its  rotation.  In  addition,  the  uterus  was 
so  firmly  adherent  over  its  entire  surface  to  the  surrounding  or- 
gans and  abdominal  walls  that  a  replacement  of  it  was  impossi- 
ble, until  it  had  first  been  dissected  loose. 

In  another  of  our  cases,  the  organ  was  free  from  adhesions, 
the  torsion  had  existed  for  some  days,  the  emphysematous 
fetus  and  the  transuded  liquid  had  so  thoroughly  distended  the 
uterus,  and  its  walls  were  so  voluminous,  that  it  occupied  vir- 
tually the  whole  abdominal  cavity,  and  there  was  simply  a  want 
of  room  in  which  to  turn  the  organ,  and  its  weight  was  entirely 
too  great  for  a  man  to  lift. 

In  those  cases  where  the  torsion  has  ended  in  a  complete  trans- 
verse rupture  through  the  cervix  or  vagina,  reduction  is  evi- 
dently impossible.  When  gangrene  of  the  uterus  has  occurred, 
reduction,  if  possible,  is  useless. 

When  torsion   is   irreducible,   there  is    virtually  no    hope  for 


712  Veterinary  Obstetrics 

the  life  of  the  fetus,  because  in  almost,  if  not  all  cases,  it  has 
perished  before  the  condition  has  been  realized,  and  consequently 
its  life  or  value  is  excluded  from  consideration. 

If  irreducible  torsion  has  occurred  early  in  pregnancy,  it  is 
possible,  according  to  some  writers,  that  infection  may  not  reach 
the  uterus  and  its  contents,  and  that  as  a  result  the  fetus  may 
undergo  mummification,  in  which  instance  the  animal,  if  a  meat- 
producing  one,  may  be  fatted  for  the  butcher  and  disposed  of  in 
that  way. 

In  some  instances,  the  fetus  may  undergo  putrid  decomposi- 
tion and  slough  out  through  the  abdominal  floor  or  into  the  di- 
gestive tract,  and  by  a  long  and  tedious  process  the  animal  may 
eventually  recover.  But  the  economic  loss  is  well-nigh  total,  be- 
cause of  the  total  loss  of  breeding  power  and  the  long  time  re- 
quired for  recovery. 

5.  Caesarian  Section.  The  chief  hope  in  cases  of  irreduci- 
ble torsion  is  Caesarian  section,  and  the  value  of  this  should  al- 
ways be  judiciously  considered.  Usually  there  can  be  no  hope 
for  the  life  of  the  fetus,  and  the  fertility  of  the  mother  is  at  an 
end.  We  have  left  for  consideration  the  question  of  the  eco- 
nomic value  of  the  animal  for  meat,  wool  or  labor  ;  or  the  .sen- 
timental value  of  the  saving  of  the  life  of  the  animal.  Whether 
we  operate  or  not  should  be  determined  after  considering  all  these 
factors.     The  operation  has  already  been  described  on  page  663. 

Should  gastro-hysterotomy  be  performed  in  torsion  of  the 
uterus,  it  is  to  be  remembered  that  the  evacuated  uterus  must 
not  be  completely  closed  and  returned  into  the  peritoneal  cavity 
unless  the  torsion  has  been  reduced.  If  the  torsion  remains  and 
the  uterine  incision  is  closed,  the  escape  of  uterine  excretions 
is  barred.  The  margins  of  the  uterine  incision  may  be  .securely 
sutured  to  the  margins  of  the  abdominal  incision,  thus  providing 
an  avenue  for  the  escape  of  uterine  discharges  externally. 
Usually  it  would  be  preferable  to  amputate  the  di.seased  cornua 
and  body  of  the  organ,  and  secure  the  cervix  to  the  margins  of 
the  abdominal  incision.  In  other  cases  the  entire  organ  may  be 
amputated,  with  a  portion  of  the  vagina,  the  latter  ligated  and 
returned  into  the  pelvic  cavity,  and  the  abdominal  incision  com- 
pletely closed. 

In  the  smaller  animals,  where  one  of  the  cornua  undergoes 
torsion,  reduction  is  practically  out  of  the  question,  and  only 
gastro-hysterotomy  remains. 


FETAL  DYSTOKIA. 

In  veterinary  obstetrics,  abnormalities  in  the  form  or  attitude 
of  the  fetus  furnish  by  far  the  most  numerous  instances  of  dys- 
tokia.  The  ways  in  which  the  fetus  may  serve  as  an  obstacle  to 
its  own  expulsion  from  the  uterus  are  exceedingly  varied,  and 
may  be  dependent  upon  something  abnormal  in  the  fetus  itself, 
due  to  arrest  in  development,  to  disease  during  its  intra-uterine 
life,  or  to  its  death  and  decomposition  ;  or  it  may  be  due  to 
some  deviation  in  its  attitude  when  approaching  the  birth  canal, 
which  may  render  its  passage  difficult  or  impossible. 

It  is  convenient  for  the  proper  study  of  these  difficulties  that 
they  be  divided  into  groups  dependent  somewhat  upon  their 
character.     These  may  be  synoptically  outlined  as  follows  : 


714 


m 


>      ^  w 

Q         <«        i_  C        en. 


he  Head, 
e  Elbows 
e  Carpus. 
X.etained 

"  .    s 

M  -"2  >, 

«  ^=03^ 

a  S2     0,5 


?  .^    o  $  S;  °  =  .^^^.i-         g     -  «•   ^  ^  ^  ^ 
M'n.    ii  i  «  =«  'X  u  o  »-^         5      ?i  .4^   -S  s  s  fl 


!    Ji.S.S.H     S  S  S  Sli 


O     5  "3     .   •   •   •  '^  g 

H     n-    ■ It^tl    -— .=  : 


a       -^   C      ►-  P)  <^  't  lo  -■  rj 


o  — '  2  O 

en  ^  "^  ^ 


pu    -^  jj  o  5  s  s       Q       3  y  '^ 


o     §  7. 


o 


«>     IZ  "h    3^-s         h  -non 

n       "    -2 


W  fe    Q    << 


o  jj  g 


=  ii        a 


j^       saxaauv  sji  puB  sn;^^  ^^^  sn^aj  aqi  10  suomsod 

.       p  inamdop-vaci  3tn  ai  S9U  puB  snonB;u3S9Jd   iBmioaqv 

<{     -ilBuuonqv  JO  'jo  sasBasxQ  'a 


A.  DEVELOPMENT  OF  THE  FETUS  IN  AN  ABNORMAL 
POSITION    IN    THE    UTERUS. 
BICORNUAL    PREGNANCY    OR  TRANSVERSE    DE- 
VELOPMENT OF  THE  FETUS. 

The  uteri  of  domestic  animals  are  so  definite  and  characteristic 
in  their  form  that  the}'  usually  admit  of  the  development  of  the 
fetus  in  but  one  position,  in  which  the  long  axes  of  the  uterine 
cornu  and  the  fetus  must  be  parallel.  In  uniparous  animals  the 
two  cornua  usually  leave  the  rather  ample  body  at  an  acute 
angle,  and  the  single  fetus  is  almost  inevitably  developed  in  a 
longitudinal  position,  somewhat  equally  in  one  of  the  cornua  and 
in  the  uterine  body. 

In  multiparous  animals  the  inconspicuous  uterine  body  is  usu- 
ally empty,  and  the  fetuses  are  developed  almost  wholly  in  the 
extensive  cornu,  in  a  longitudinal  position. 

In  the  mare,  however,  the  form  of  the  uterus  is  such  that  it 
may  lead,  as  we  have  already  stated  on  pages  28  and  379,  to  a 
bicornual  or  transverse  development  of  the  fetus. 

The  earliest  account  we  have  found  of  this  abnormality  is  by 
PauH,  who,  in  Gurlt  and  Hertwig's  Mag.,  1842,  Vol.  8,  p.  196, 
records  attending  in  1837,  with  two  colleagues,  a  mare  which 
they  could  not  deliver.  Autopsy  revealed  a  transverse  fetus, 
dorsal  presentation,  head,  neck  and  anterior  limbs  in  right 
horn,  hind  feet  in  left  horn,  abdomen  and  chest  occupying  the 
uterine  body. 

So  far  as  we  are  aware,  definite  attention  was  first  drawn  to 
this  anomaly  by  us,  in  an  article  entitled  ' '  Transverse  Develop- 
ment of  the  Fetus  in  the  Uterus  of  the  Mare  "  in  the  American 
Veterinary  Review,  Vol.  13,  page  298.  Later  occurred  a  de- 
scription of  apparently  the  same  anomaly  by  Anton  Tapken, 
Official  Veterinarian  in  Varel,  in  the  Monatshefte  fiir  Praktische 
Tierheilkunde,  Vol.  18,  page  148,  of  which  a  translation  by  us 
appeared,  with  added  comments,  in  the  Veterinary  Journal,  Vol. 
XLIII,  page  148. 

Bicornual  development  of  the  fetus  is  made  possible    in   the 

mare  because  of  the  unique  direction  in  which  the  two  uterine 

cornua  are  given  off  from  its    body.     Instead    of    leaving    the 

uterus  at  an  acute  angle,   as  in  ruminants  and  carnivora.   they 

716 


Bicornual  Preg?mncy  'jl'j 

depart  from  the  body  at  right  angles,  or  slightly  recurved  so  as 
to  give  the  entire  organ,  consisting  of  the  body  and  cornua,  a 
crucial  form.  It  thus  becomes  possible  for  the  fetus  to  develop 
in  such  a  position  that  the  long  axis  of  its  body  corresponds  to 
the  combined  long  axes  of  the  two  uterine  cornua  ;  that  is,  the 
fetus  develops  partly  in  each  of  the  two  cornua.  with  its  body 
crossing  the  uterine  body  at  its  anterior  extremity,  so  that  the 
fetus  fundamentally  occupies  a  position  with  its  long  axis  trans- 
verse to  that  of  the  mare. 

How  often  this  may  occur  in  the  mare,  we  do  not  know.  In 
our  contribution  above  quoted,  we  recorded  four  ca.ses,  to  which 
we  may  add  the  four  case  reports  of  Tapken  and  one  of  Pauli. 

It  is  a  well  known  fact,  to  all  who  have  had  extensive  obstetric 
practice  in  mares,  that  it  is  not  rare  for  the  foal  to  present  trans- 
versely. This  is  in  sharp  contrast  to  cattle  obstetrics,  where 
transverse  presentation  is  very  rare.  Among  these  presentations, 
except  those  cases  which  we  now  have  definitely  under  con- 
sideration, it  is  impossible  to  determine  how  many  of  them  may 
have  developed  transversely,  and  consequently  at  the  time  of 
birth  presented  transversely.  While  veterinary  obstetrists  may 
deny  the  posssibility  of  bicornual  development,  our  cases,  fully 
verified  by  post  mortem  examination,  show  that  it  actually  occurs, 
and  not  very  infrequently.  The  established  facts  do  not  forbid 
our  assuming  that  some  of  the  other  fetuses  which  present  trans- 
versely may  have  been  developed  in  the  transverse  position. 

In  the  cases  now  under  consideration,  the  embr3'o  apparently 
forms  in  each  case  in  the  transverse  presentation,  with  its  ventral 
surface  presenting  toward  the  os  uteri,  and  later  revolves  upon 
its  long  axis,  so  that  it  finally  rests  in  a  dorsal  tran.sverse  presen- 
tation instead. 

In  its  earlier  stages,  the  embrj'O  curves  very  markedly  ven- 
tralwards,  and  this  ventral  curvature  continues  to  a  consider- 
able degree  throughout  gestation.  Since  the  cornua  of  the  uterus 
leave  the  body  at  fight  angles  or  slightly  recurved,  the  embryo 
may  well  develop  with  either  its  dorsal  or  ventral  surface  facing 
the  OS  uteri,  although,  so  far  as  investigations  upon  this  point 
carry  us,  only  those  cases  have  been  recognized  as  bicornual 
development  which  have  begun  their  development  with  their 
ventral  surface  presenting  toward  the  pelvis. 


7i8  Veterbiarv  Obstetrics 

If  the  embryo  commences  to  form  in  the  uterine  cornua,  with 
its  ventral  surface  directed  toward  the  os  uteri,  and  the  fetus 
curv^es  ventrally,  it  would  naturally  follow  that,  as  it  attains 
weight,  the  central  portion  of  its  body  would  tend  to  drop 
downward,  while  its  two  extremities  would  point  upward  toward 
the  oviducts.  Later  the  fetus  would  tend  to  descend  until  the 
convex  dorsal  surface  would  come  in  contact  with  the  abdominal 
floor  and  thereby  assume  an  unstable  position.  Since  the  anatom- 
ical conditions  prevent  its  revolving  upon  its  long  axis  in  the  di- 
rection of  the  pelvis,  it  may  acquire  .stability  only  by  its  ex- 
tremities passing  forward  and  downward  to  come  to  rest  upon 
the  abdominal  floor.  In  accomplishing  this  movement,  the  fetus 
revolves  upon  its  long  axis  ;  and  in  doing  so  its  dorsal  surface 
turns  toward  the  birth  canal,  pushing  the  uterine  floor  back- 
ward beneath  the  vaginal  floor,  and  stretching  the  roof  of  the 
vagina  forward.  In  this  transverse  position,  the  fetus  must 
necessarily  drop  well  forward  and  remain  wholly  in  front  of  the 
pubis,  thus  stretching  and  elongating  the  vagina  to  a  remarkable 
degree.  We  have  attempted  to  indicate  this  change  in  the 
position  of  the  fetus  in  Figs.  120  and  121. 

Symptoms.  This  anomaly  in  development  naturally  passes 
unobserved  during  the  entire  period  of  gestation,  and  is  not  dis- 
covered until  an  examination  is  made  in  order  to  determine  the 
cause  of  dj^stokia.  The  symptoms  are  then  unique  and  diagnos- 
tic. Before  the  obstetrist  is  called,  the  os  uteri  has  become 
dilated,  the  water-bag  has  appeared  and  ruptured,  and  probably 
some  of  the  fetal  membranes  lie  in  the  vagina  or  protrude  from 
the  vulva.  The  labor  pains  are  weak  in  character.  The  fact 
that  no  portion  of  the  fetus,  or  at  least  no  considerable  portion 
of  it,  can  usually  be  forced  into  the  vagina,  tends  to  inhibit  any 
well  marked  expulsive  efforts.  Such  would  necessarily  prove 
futile,  and  dangerous  to  the  integrity  of  the  uterus. 

When  the  obstetrist  inserts  his  hand,  he  is  first  struck  by  the 
extremely  elongated  and  narrowed  vaginal  passage,  which  is 
nearly  twice  its  ordinary  length,  although  very  much  decreased 
in  its  transverse  diameter.  No  os  uteri  or  cervix  is  distinguish- 
able as  such.  If  the  obstetrist  follows  the  roof  of  the  vagina, 
the  hand  glides  along  it  almost  as  far  as  the  arm  can  reach  ;  or 
perhaps  he  cannot  reach  the  anterior  end   of  the  roof,  where   it 


Bicornual  Pregyiancy 


719 


finally  turns  down  in  a  gradual  curve,  without  any  recognizable 
line  of  demarcation  between  it  and  the  uterus. 

If  he  follows  the  floor  of  the  vagina  and  palpates  carefully  as 
his  hand  passes  along,  he  will  discover  to  his  astonishment  a 
hard  body  lying  beneath  it,  which  upon  careful  manipulation 
he  may  recognize  as  portions  of  the  fetus,  lying  directly  against 
the  vaginal  floot,  and  impressing  him  very  strongly  at  first  with 
the  idea  of  extra-uterine  pregnancy.  If  he  will  follow  the 
uterine  floor  further,  to  the  extent  of  nearly  the  entire  length  of 
his  arm,  his  hand  suddenly  passes  downward  into  the  uterine 
cavity,  and  he  finds  that  the  floor  which  he  has  been  following 
bends  abruptly  backward  to  constitute  the  roof  of  the  uterus, 
immediately  beneath  which  the  fetus  lies  transversely  with  its 
■dorsal  surface  presenting  toward  the  pelvic  inlet. 


-uc 


Fig.  120.  Transverse 
OR  Bicornual  Devel- 
opment OF  THE  Fetus 
IN  THE  Mare. 

V,  Vagina.  U,  Uterine 
cavity,  which  is  later  to 
blend  with  the  vagina  to 
constitute  an  elongated 
tube.    UC,  Uterine  cornu. 


^-.^-^ 


t 


720 


Veterin  a  ry  Obstetrics 


lu  some  cases  the  obstetrist  may  find  one  or  more  feet  project- 
ing from  the  uterus  into  the  vagina,  which  may  be  readily 
reached  and  grasped.  In  a  large  proportion  of  cases,  however, 
no  portion  of  the  fetus  projects  into  the  vagina,  and  before  the 
operator  can  bring  his  hand  into  immediate  contact  with  any  por- 
tion of  the  fetus  he  must  reach  far  forward  and  then,  bending 
the  hand  downward  and  backward,  touch  the  ventral  portion  of 
the  fetus  or  some  of  the  extremities  which  are  folded  along  it. 
In  order  to  accomplish  this,  he  reaches  clear  over  the  body  of 
the  fetus,  passes  beyond  its  ventral  line  and  then,  after  pa.ssing 
the  point  of  version  where  the  floor  of  the  vagina  ends,  turns  the 
hand  downward,  and  more  or  less  backward,  into  the  uterine 
cavity.  These  peculiarities  serve  to  differentiate  this  condition 
from  any  other  known  in  veterinary-  obstetrics. 


--f^-->s-^j(5, 


Fig.  121.     BicoRNU.'VL  Prf,gn.\ncy.     Second  stage,  the  fetu.s  having  made 
one-half  revohition  on  its  long  axis.     (Schematic). 
V,  Elongated  vagina  and  uterine  body. 
UF,  Floor  of  uterine  cornua,  now  become  the  roof. 
UR,  Roof  of  uterine  cornua,  now  become  anterior  wall. 
RL,  Broad  ligament. 


Bicornual  Pregnancy  721 

Prognosis.  The  prognosis  in  this  condition  is  always  highly 
unfavorable.  We  have  no  record  of  any  case  in  which  the  life 
of  either  mother  or  fetus  has  been  .saved.  Tapken  says,  "De- 
livery is  always  difficult.  If  no  part  of  the  fetus  can  be  reached, 
delivery  is  evidently  impossible.  In  each  of  the  four  cases  which 
I  append,  the  result  was  fatal  for  both  mother  and  foal,  and  such 
was  also  the  result  in  another  case,  which,  owing  to  oversight, 
was  not  included  in  the  foregoing  table.  In  the  latter  case  of 
dystokia,  two  experienced  colleagues  had  already  tried  in  vain  to 
deliver  the  mare  before  I  had  been  called.  It  was  barely  possible 
to  touch  the  metacarpus  of  one  leg  with  the  finger  tips,  when 
the  arm  had  been  introduced  completely  to  the  shoulder."  The 
case  of  Pauli  also  ended  fatally  for  both  mare  and  foal,  despite 
the  efforts  of  three  veterinarians. 

In  our  own  experience  we  have  been  equally  unsucce.ssful,  and 
have  encountered  great  and  even  insurmountable  difficulties  in 
delivery.  In  one  of  our  cases  the  mare  survived  the  operation 
some  days,  but  finally  succumbed  to  metritis.  In  that  one  ca-se 
it  would  seem  possible  that,  had  we  had  a  better  understanding 
of  the  conditions  and  given  closer  attention  afterward,  she  might 
have  been  saved.  We  would  not,  therefore,  advise  the  veterin- 
ary obstetrist  to  refrain  from  attempting  to  deliver  a  mare  in  this 
condition.  However,  in  undertaking  it,  it  would  be  well  in  our 
judgment  to  advise  the  owner  of  the  highly  unfavorable  prog- 
nosis of  the  case,  so  that  he  may  be  forewarned  of  the  probable 
outcome. 

Method  of  Handling.  Each  case  must  be  dealt  with,  in 
detail,  according  to  circumstances.  In  general,  it  is  well  to  se- 
cure any  of  the  extremities  which  may  lie  within  reach  and  cord 
them,  so  that  force  may  be  exerted  upon  them  at  any  time  that, 
it  may  become  desirable.  If  all  four  feet  can  be  reached,  it  is 
usually  advisable  to  amputate  the  two  anterior  limbs,  either 
subcutaneously  or  at  the  humero-radial  articulation,  and  then 
attempt  to  convert  the  presentation  into  a  posterior  one  by 
drawing  carefully  upon  the  hind  legs. 

The  position  of  the  animal  is  important.     Fig.  121  suggests 

that,  if  we  turn  the  mare  upon  her  back,  the  version  of  the  uterus 

will  tend  to  disappear  and  the  fetus  will  be  brought  nearer  to  the 

operator,  so  that  parts  which  previously  had  not  been    in    reach 

46 


722  Veterinary  Obstetrics 

may  now  be  grasped.  Placing  the  mare  upon  her  back  also  re- 
laxes the  projecting  floor  of  the  vagina  and,  by  tending  to  over- 
come the  version  of  the  organ,  renders  traction  upon  the  fetus  less 
dangerous  to  the  floor  of  the  vagina  and  the  roof  of  the  uterus. 

Various  positions  of  the  mare  may  be  tried  in  an  effort  to 
overcome  the  difficulty.  It  must  be  remembered  that  it  is  ex- 
ceedingly exhausting  to  the  mare  to  remain  for  a  long  period  of 
time  upon  her  back,  and  this  position  should  not  be  continued 
beyond  the  absolute  necessities  of  the  case.  If  the  work  can 
be  done  nearly  as  well  with  her  standing  upon  her  feet,  this 
position  .should  be  preferred  until  the  critical  time  arrives  for 
extracting  the  fetus  by  force,  when  we  believe  it  would  be  best 
in  all  cases  to  turn  the  mare  upon  her  back  for  this  brief  period 
and  thereby  relieve  the  vaginal  floor  and  uterine  roof. 

The  position  of  the  fetus  and  its  relation  to  the  uterus  render 
most  forms  of  embryotomy  exceedingly  difficult  or  impossible. 
In  our  experience,  we  have  been  limited  to  the  possibility  of  the 
amputation  of  the  limbs.  The  decrease  in  the  size  of  the  fetus, 
were  we  able  to  bring  about  embryotomy,  especially  evisceration, 
would  favor  its  delivery. 

After  the  extraction  of  the  fetus,  if  the  obstetrist  has  been  so 
fortunate  as  to  accomplish  this  without  fatally  injuring  the 
uterus,  unusual  care  should  be  taken  to  guard  against  sepsis. 
Fig.  121  shows  that  the  form  of  the  uterine  cavity  is  extremely 
unfavorable  for  adequate  drainage,  and  suggests  that  this  be  over- 
come as  far  as  possible  by  careful  and  repeated  irrigation  of  the 
uterus  and  siphoning  out  of  the  contents. 

In  view  of  the  fact  that  we  have  been  unable  to  save  the  life 
of  either  mare  or  foal  in  any  case,  and,  so  far  as  we  have  been 
able  to  determine  from  recorded  cases,  no  mare  or  foal  has  been 
saved  by  other  practitioners,  it  would  seem  to  us  that  the 
veterinary  obstetrist  is  fully  warranted  in  early  resorting  to 
gastro-hysterotomy  in  a  way  to  possibly  save  the  life  of  his 
patient.  While  we  have  not  attempted  this  operation  in  the 
mare,  we  believe  that  it  offers  the  greatest  hope  for  success  in 
the.se  cases.  Evidently  there  is  nothing  to  lose.  In  one  of  my 
cases,  as  in  one  of  those  recorded  by  Tapken,  delivery  through 
the  birth  canal  was  wholly  impossible,  and  under  such  conditions 
clearly  the  only  plan  remaining  is  hysterotomy. 

Presumably  there  is  never  an  opportunity  to   save  the   life  of 


Bicor7iual  Pregnancy  723 

the  foal  ;  it  is  ordinarily   dead    before   the    obstetrist    is   called. 
We  have  outlined  the  technic  of  hysterotomy  on  page  663. 

The  following  cases  illustrate  the  variations  and  difficulties  to 
be  overcome,  and  suggest,  more  forcibly  than  anything  else  well 
can,  the  seriousness  of  the  anomaly.  Cases  i  to  3  are  quoted 
from  the  contribution  by  Tapken ;  cases  4  to  6  are  from  our 
personal  experience. 

1.  An  old  mare,  which  had  alread}^  foaled  regularly  a  number  of  times, 
showed  symptoms  of  colic  in  the  evening  after  the  normal  duration  of  preg- 
nancy. Later,  mild  labor  pains  appeared  and  some  of  the  fetal  waters  were 
expelled.  Upon  examination,  at  8:30  A.  M.,  the  mare  was  comfortable,  ate 
some,  no  labor  pains  recognizable.  At  times  there  was  a  discharge  of  fetal 
fluids.  The  cervix  uteri  was  dilated.  Portions  of  the  ruptured  chorion  ex- 
tended into  the  vagina.  The  uterine  walls  were  stretched  and  thrown  into 
folds  sunilar  to  torsion  of  the  uterus,  but  nearer  to  the  body  of  the  uterus- 
The  fetus  could  barely  be  reached  with  the  fingertips,  after  the  arm  had  been 
introduced  up  to  the  shoulder.  During  the  exploration  there  were  only 
feeble  labor  pains. 

An  attempt  to  modify  the  position  of  the  uterus,  by  rolling  the  mare, 
failed.  While  in  the  recumbent  position,  however,  strong  labor  pains  ap- 
peared. As  a  consequence  of  these  violent  pains,  the  tightly  stretched  uter- 
ine wall  was  pressed  into  the  pelvis  to  such  an  extent  as  to  threaten  rupture. 
The  neck  of  the  bladder  was  also  dilated  to  such  a  degree  that  four  fingers 
could  be  introduced  into  it.  During  the  violent  pains,  the  urinary  bladder 
was  from  time  to  time  forced  out  into  the  vulva,  where  it  was  visible  as  a 
whitish  mass  about  the  size  of  a  man's  fist. 

A  second  veterinarian  was  called  in  consultation.  At  4  P.  M.  the  further 
handling  of  the  case  was  undertaken  by  T.,  in  company  with  his  colleague 
K.  After  a  prolonged  effort,  the  lower  end  of  the  tibia  was  grasped,  and  a 
cord  attached  above  the  hock. 

By  means  of  a  vigorous  pull  by  four  persons,  the  tarsus  was  brought  to 
the  pelvic  inlet,  and  the  tendo-Achilles  divided,  partly  with  a  knife  and 
partly  with  shears.  Both  arms  were  inserted  in  the  genital  canal,  and 
finally  the  leg  was  drawn  out  so  far  that  it  could  be  amputated  at  the  hock. 
The  second  leg  could  not  be  grasped.  Traction  was  applied  to  the  tibia  of 
the  amputated  leg,  and,  with  the  force  of  six  persons,  the  skin  and  muscles 
torn  asunder  without  any  incisions  having  been  made,  and  the  leg  tore  away 
at  the  hip  joint  and  was  drawn  out.  The  other  tarsus  could  then  be  grasped, 
and  was  handled  in  the  same  way.  Upon  the  application  of  powerful  traction 
by  six  persons,  the  fetus  was  extracted.     It  was  large,  but  normally  formed. 

In  the  uterus,  near  the  neck,  there  existed  a  perforation.  The  mare  died 
a  few  hours  later. 

2.  An  eight-year-old  mare,  which  had  repeatedly  foaled  in  a  normal 
manner,  showed,  after  eleven  months  pregnancy,  weak  labor  pains  and  un- 
rest for  a  period  of  two  and  one-half  hours.  An  examination  revealed  one 
fore-leg,  presenting  in  the  normal  position  and  direction,  in  the  pelvis.     Be- 


724  Veterinary  Obstetrics 

neath  the  advanced  limb,  the  uterus  and  vagina  formed  a  projection,  under 
which  one  could  distinguish  parts  of  the  fetus,  especially  the  head.  These 
parts  were  time  and  again  forced  to  the  middle  of  the  pelvic  cavity  during 
the  labor  pains.  Beneath  the  presented  foreleg  one  could  feel,  through  the 
uterine  wall,  other  parts  of  the  foal,  which  later  were  found  to  be  the  second 
anterior  limb  flexed  at  the  carpus. 

After  mounting  a  stool,  so  that  the  arm  could  be  inserted  as  far  as 
possible,  he  succeeded  in  reaching  the  point  of  flexure  of  the  uterus.  It  was 
not  possible  to  grasp  any  other  part  of  the  fetus.  The  anterior  limb  was 
corded  and  drawn  out  by  three  persons,  until  the  forearm  was  visible.  The 
other  anterior  limb  was  then  released  from  the  folds  in  the  uterus  and 
brought  into  the  genital  canal,  but  it  could  not  be  extended.  In  order  to 
secure  room,  the  extended  limb  was  detached.  The  division  of  the  skin 
was  incomplete,  and  could  only  be  extended  to  the  elbow  joint.  As  a  re- 
sult of  this,  it  required  the  combined  power  of  six  or  seven  persons  to  draw 
the  limb  away. 

The  head,  which  was  clearly  recognizable  at  the  beginning  of  the  opera- 
tion, became  displaced  in  such  a  way  that  it  could  no  longer  be  reached. 
There  remained,  consequently,  no  other  recourse  than  a  forcible  extraction 
of  the  fetus,  which  was  accomplished  by  the  traction  of  six  or  seven  persons. 

The  mare  lay  exhausted  and  listless.  After  half  an  hour  the  pulse  was 
60,  strong  and  regular,  which  indicated  that  no  great  amount  of  internal 
hemorrhage  was  occuring.  A  small  amount  of  blood  flowed  from  the  vulva. 
By  a  manual  exploration  of  the  uterus,  no  labor  pains  were  induced. 
After  three  and  one-half  hours  the  mare  arose,  staggered  somewhat  at  first, 
but  soon  partook  of  food.  In  the  following  days  the  appetite  was  fairly 
good,  then  failed. 

Four  days  later  the  mare  was  again  examined.  The  pulse  was  70,  the 
appetite  poor,  and  now  and  then  there  were  expulsive  efforts.  Upon  ex- 
amination of  the  parts,  there  was  found  a  great  gaping  rent  in  the  superior 
wall  of  the  uterus,  so  that  it  was  easy  to  introduce  the  hand  directly  into 
the  peritoneal  cavity.  The  animal  died  on  the  sixth  day.  The  autopsy 
revealed  a  rent  in  the  uterus  about  25  cm.  long,  also  diffuse  peritonitis. 

3.  A  young  mare,  at  full  term,  had  shown  labor  pains  for  several  hours. 
Fetal  water.s  had  appeared.  Upon  inserting  the  hand  as  far  as  possible, 
only  fetal  membranes  and  the  uterine  wall  could  be  felt  ;  through  these 
walls,  however,  in  the  reflexed  uterus,  parts  of  the  fetus  could  be  recognized. 
An  empiric,  with  the  consent  of  the  owner,  had  made  an  examination  and 
had  torn  through  the  wall  of  the  uterus,  which  he  had  mistaken  for  the 
fetal  membranes.     The  mare  was  destroyed. 

4.  In  1SS7  the  writer  was  called  to  attend  an  imported  Percheron  mare, 
because  the  keeper  believed  her  to  be  in  labor,  although  in  some  way  the 
symptoms  appeared  to  him  unusual. 

Upon  examination  no  expulsive  efforts  could  be  observed,  and  when 
manual  exploration  of  the  vagina  was  made  there  was  marked  narrowness 
of  the  passage  at  the  usual  location  of  the  os  uteri,  which  was  mistaken  for 
it.  Lying  beneath  the  vagina,  a  fetus  was  felt,  apparently  with  all  its 
membranes  intact.     Non-interference,  with  clo.se  watching,  was  advised. 


Bicor7iual  Pregnancy  725 

The  mare  continued  fairly  well  and  quiet  for  about  48  hours,  when  we 
were  recalled  and,  upon  making  a  second  examination,  found  the  fetal  mem- 
branes protruding  from  the  vulva.  Upon  careful  examination  it  was 
found  that  the  part,  which  was  previously  supposed  to  be  the  os  uteri,  was 
merely  the  narrow  vagina,  beneath  which  the  fetus  lay.  The  presence  of 
the  membranes  permitted  us  to  follow  them  along  their  course  until  the 
opening  into  the  uterus  was  reached,  when  it  was  found  that  nothing  resem- 
bling the  normal  os  uteri  was  present. 

The  vagina  was  extremely  long  and  narrow.  Far  to  the  anterior,  barely 
within  reach,  the  canal  opened  abruptl)-  downwards  and  backwards  into 
the  uterus.  Posterior  to  this  openmg,  and  beneath  the  vagina,  lay  the 
body  of  the  foal,  in  a  transverse  position,  readily  felt  through  the  vaginal 
and  uterine  walls.  Though  beyond  reach  through  the  os  uteri  so  long  as 
the  mare  was  standing,  when  she  was  recumbent  the  hind  limbs  could  with 
difficulty  be  reached. 

After  patient  and  exhausting  work,  the  hind  legs  were  secured  at  the 
tarsus  by  means  of  cords,  but  it  was  impossible  to  bring  them  into  the 
passage  until  the  feet  were  amputated  through  the  lower  tarsal  articulation. 
We  then  had  the  two  hocks  presenting  with  the  ossa  calces  directed  up- 
wards, while  beneath  the  vagina  could  still  be  felt  the  main  volume  of  the 
fetus.  Firm  traction  applied  to  the  hind  limbs  finally  brought  the  fetus  into 
a  posterior  presentation,  and  accomplished  its  extraction  after  about  five 
hours  of  very  tr}  ing  labor. 

Examination  immediately  after  delivery  revealed  an  enormous  rupture  of 
the  uterus  and  inferior  wall  of  the  vagina.  The  animal  was  destro5'ed,  but 
no  autopsy  made. 

5.  A  large  French  draft  mare  in  excellent  condition,  which  had  pre- 
viously bred  successfully.  The  fetal  membranes  were  found  protruding,  but 
no  well-marked  labor  pains  Exploration  revealed  an  exceedingly  long, 
narrow  vagina,  which,  at  its  anterior  extremity,  barely  within  reach,  opened 
abruptly  downwards  and  backwards.  The  usual  conformation  of  the  os 
uteri  was  wanting.  While  the  mare  was  standing,  no  portion  of  the  fetus 
could  be  touched  by  passing  the  hand  into  the  uterus.  There  seemed  to  be 
a  great  cavity  to  the  right  and  left  and  posteriorly.  By  following  the  supe- 
rior walls  of  the  vagina  up  to  the  uterus,  we  found  this  bent  abruptly  down- 
ward to  become  the  anterior  wall,  which  could  be  followed  as  far  as  the 
hand  could  reach  without  coming  in  contact  with  any  portion  of  the  foal. 
Posterior  to  this  opening  and  beneath  the  floor  of  the  vagina,  the  fetus  could 
be  plainly  felt.  By  passing  the  hand  through  the  uterine  opening, 
drawing  its  posterior  margin  firmly  backwards,  and  then  reaching  down- 
ward and  backward  as  far  as  possible,  a  portion  of  the  fetus  could  be  barely 
touched,  but  not  grasped. 

After  casting  the  mare  and  placing  her  upon  her  back,  one  hock  was  se- 
cured, corded,  and  with  great  difficulty  brought  into  the  passage.  Then  one 
anterior  limb  was  secured  and  amputated.  Later  the  other  hind  leg  was 
secured,  and  with  strong  traction  the  fetus  was  brought  away  after  eight 
hours  of  exhausting  labor.  The  mare  succumbed  24  hours  later,  and  no 
autopsy  was  made. 

6.  The  writer  was  called  in  consultation,  in   case  of  dvstokia  in  a  large 


726  Veterinary  Obstetrics 

draft  mare  which  had  bred  repeatedly  before  without  difficulty.  The  vagina 
was  abnormally  elongated  and  narrow,  and  its  anterior  end  Opened  abruptly 
downward  and  backward  without  resemblance  to  the  usual  os  uteri.  The 
fetus  could  be  plainly  felt  through  the  floor  of  the  vagina,  posterior  to  the 
opening  into  the  uterus.  It  lay  with  its  back  against  the  pubis  of  the  mare. 
By  passing  the  hand  through  the  opening  into  the  uterus,  and  then  down- 
wards and  backwards,  the  elbow  of  one  fore-leg  could  be  touched  with 
difficulty.  After  long  and  arduous  labor  this  one  limb  was  secured  and 
brought  into  the  passage,  but  we  were  wholly  unable  to  secure  any  other 
limbs  or  parts  of  the  foal,  either  by  raising  the  abdomen  with  a  sling  or  by 
casting  the  mare  and  turning  her  upon  her  back.  Though  my  colleague 
was  an  experienced  obstetrist  and  a  large  and  powerful  man  with  very  long 
arms,  it  was  impossible  for  either  of  us  to  secure  other  parts  of  the  fetus. 
The  one  limb  which  we  had  succeeded  in  cording  was  in  such  a  position,  in 
relation  to  the  uterus  and  vagina,  that  traction  could  not  be  applied  with  any 
safety  or  efficiency.  After  a  long  and  fruitless  effort,  the  mare  was  destroyed, 
and  a  post-mortem  examination  immediatel}'  made. 

The  foal,  very  large  and  well  matured  in  every  respect  was  lying  upon 
its  right  side  with  its  dorsum  against  the  pubis  of  the  mare.  The  head  was 
located  in  the  right  uterine  cornu,  and  the  hind  legs  and  buttocks  in  the 
left.  The  body  lay  in  a  thoroughly  transverse  position  across  the  abdominal 
cavity,  posterior  to  the  opening  between  the  vagina  and  uterus.  One  fore- 
leg was  flexed  at  the  carpus,  and  the  other,  which  we  had  secured,  was 
drawn  backward  over  the  neck  of  the  fetus,  into  the  vagina.  The  two 
comua  were  developed  equally,  and  their  long  axes  were  perpendicular  to 
that  of  the  mare.  The  vagina,  because  of  the  transverse  position  of  the 
fetus  and  the  peculiar  version  of  the  uterus,  was  much  elongated  and 
narrow.  The  opening  from  the  vagina  into  the  uterus  was  abruptly  down- 
wards, the  superior  vaginal  wall  suddenly  losing  itself  by  turning  abruptly 
downwards  to  become  the  anterior  uterine  wall.  Thus  that  portion  of  the 
uterus  which  had  originally  constituted  the  roof  or  superior  wall  had  now- 
become  its  anterior  wall.  The  inferior  wall  of  the  vagina,  or  floor, 
terminated  anteriorly  abruptly,  in  a  thin  margin  ;  what  had  previously 
been  \.\i^  floor  of  the  uterus  was  turned  abruptly  backwards  against  the 
vagina,  thus  becoming  the  superior  uterine  wall. 

-)(.  ;i<  ^^  ;1;  ^;  ^  ^ 

While  the  bicornual  development  of  the  fetus  seems  to  be 
naturally  limited  almost  wholly  to  the  mare,  because  of  the 
peculiar  conformation  of  her  uterus,  rare  exceptions  are  recorded. 
Cuille,  Revue  Vet.  1905,  records  a  case  of  bicornual  pregnancy 
in  the  bitch,  which  caused  insurmountable  d5'Stokia.  The 
autopsy  showed  a  fetus,  lying  with  its  head  and  fore  legs  in  the 
right  horn  and  its  croup  and  hind  legs  in  the  left.  In  another 
case  of  dystokia,  in  the  bitch,  C.  extracted  the  fetus  by  traction 
on  one  fore  foot,  and  believed  that  this  also  was  a  case  of  bi- 
cornual pregnancy. 


B.    ABNORMALITIES   IN  THE  DEVELOPMENT, 
OR  DISEASES  OF  THE  FETUS. 

a.  Excess  of  Volume  of  the  Fetus. 

Excess  in  the  volume  of  the  fetus  is  a  comparative  term.  It 
is  the  relation  existing  between  the  size  of  the  fetus  and  the  di- 
mensions of  the  birth  canal  of  th  emother,  rather  than  definite 
abnormality  in  volume.  Such  comparative  excess  in  size  is  not 
rare  in  domestic  animals,  and  is  frequently  a  more  or  less  serious 
obstacle  to  the  expulsion  of    the  fetus. 

The  causes  of  this  comparative  excess  in  fetal  volume  are 
not  clear.  The  excess  maj^  be  confined  to  one  part  of  the  body, 
or  may  apply  to  the  entire  body. 

Prolonged  gestation  is  sometimes  believed  to  increase  the 
volume  of  the  fetus.  In  the  cow  and  mare  there  are  great 
variations  in  the  duration  of  gestation,  ranging  from  30  to  90 
days  or  even  more.  During  this  period  the  fetus  is  presumably 
constantl}^  growing,  and,  if  carried  for  30  to  60  days  bej'ond  the 
briefest  duration  of  pregnancy,  it  would  be  but  reasonable  to  ex- 
pect that  it  may  be  larger  because  of  this  longer  period  of  intra- 
uterine development. 

Nev^ertheless  it  has  not  been  possible  to  verify  this  suggestion 
by  clinical  observation.  Prolonged  gestation  does  not  commonly 
result  in  such  a  growth  of  the  fetus  as  to  cause  any  serious  ob- 
stacle to  its  deliver}'.  It  is  true  that  those  fetuses  which  are 
born  after  a  comparatively  short  duration  of  gestation,  prema- 
ture births,  are  usually  very  small,  but  they  are  also  correspond- 
ingly immature.  When  they  reach  the  average  duration  of 
intra-uterine  development  they  seem  to  be  as  large  as  though 
carried  for  a  much  greater  length  of  time.  In  one  instance 
which  we  noted,  where  the  duration  of  gestation  in  a  mare  ex- 
ceeded 12  months,  the  foal  to  which  she  gave  birth  was  a  pigmy 
about  half  the  size  which  would  naturally  have  been  expected 
in  harmony  with  the  size  of  the  sire  and  dam. 

Neuman  (B.  T.  W.,  1909,  p. 702)  records  delivering  a  cow,  413 

days  pregnant,  of  a  putrid,  emphysematous  calf,  weight  110  lbs. 

long  hair,   female,   form   of  male.       The    impression    is    given 

that  the  large  size  was  due  to  prolonged  gestation.     The  fact 

727 


728  Veterinary  Obstetrics 

that  the  fetus  was  dead  and  emphysematous  destroys  all  evi- 
dence of  prolonged  gestation.  The  fetus  may  have  perished  at 
280  days.  In  1908,  Frost,  instructor  in  the  N.  Y.  State  Veteri- 
nary College,  delivered  a  Holstein-Fresian  cow  of  a  calf  weigh- 
ing 147  lbs.  The  duration  of  pregnancy  was  normal,  the  calf 
was  normal,  and  was  alive,  but  died  during  delivery.  Calves 
weighing  over  100  lbs.  are  not  rare  in  this  breed.  It  is  con- 
sequently unwarranted  to  conclude  that,  because  a  fetus  is  un- 
usually large,  the  duration  of  pregnancy  has  been  excessive  ;  or 
that,  because  pregnancy  is  being  prolonged,  dystokia  from  ex- 
cessive volume  of  the  fetus  must  occur.  While  rare  exceptions 
may  occur,  according  to  our  observations  the  largest  fetuses  are 
usually  encountered  in  those  cases  where  the  full  duration  of 
what  we  regard  as  normal  pregnancy  has  merely  been  reached. 

It  appears,  from  all  that  we  can  learn  of  the  subject  from  a 
clinical  standpoint,  that  the  retention  of  the  fetus  in  the  uterus, 
beyond  the  average  duration  of  time,  is  not  dangerous  from  the 
standpoint  of  causing  dystokia  by  excess  of  volume,  but  rather 
that  other  complications  may  arise  which  may  be  more  or  less 
dangerous  for  the  well-being  of  the  mother  and  fetus. 

In  multiparous  animals,  like  the  bitch  and  sow,  it  is  frequent- 
ly noted  that  when  the  number  of  fetuses  is  below  the  average 
they  tend  to  grow  larger  because  of  the  increased  nutritive 
supply,  and  in  this  way  tend  to  cause  difficult  labor. 

Excessive  size  of  the  male  animal,  as  compared  with  that  of  the 
female,  has  been  alleged  to  cause  an  excessive  size  of  the  fetus, 
but  this  we  have  not  been  able  to  verify  clinically.  We  have 
had  occasion  to  observe  the  results  of  crossing  small  mares  of 
700  to  1000  pounds  with  large  draft  stallions  weighing  from  1800 
to  2500  pounds,  or  approximately  three  times  the  weight  of  the 
mare.  Yet  we  did  not  observe  a  case  of  dystokia,  in  such  mares, 
attributable  to  excessive  volume  of  the  fetus. 

Fleming  cites  several  authors  to  show  that  such  crosses  do  re- 
sult in  difficult  labor,  especially  in  the  ewe  and  bitch.  On  the 
other  hand,  Saint-Cyr  states,  in  harmony  with  our  personal  ex- 
perience, that  he  has  repeatedly  seen  large  Percheron  stallions 
crossed  with  small  mares,  without  any  resulting  difficulty  in 
foaling,  because  of  size. 

It  appears  from  clinical  observation  that  the  size  of  the  female, 
not  that  of  the  male,  chiefly   fixes  the  size  of  the   fetus,  and 


Excess  of  Volume  of  the  Fetus  729 

that  the  variation  in  the  size  of  animals  because  of  cross-breed- 
ing occurs  during  extra-uterine  life,  and  not  during  gestation. 

On  the  other  hand,  our  observations  indicate  that  the  male  in- 
fluences the  form  of  the  fetus  and  the  comparative  volume  of 
certain  portions  of  its  body.  This  variation  is  noticed  chiefly  in 
the  size  of  the  head.  It  has  been  observed  that  the  crossing  of 
ewes  with  rams  of  certain  breeds  having  larger  heads  may  lead 
to  dystokia  because  of  the  comparatively  large  size  of  the  lambs' 
heads.  In  one  instance  we  observed  that  many  of  the  cows  bred 
to  a  certain  bull,  which  had  a  very  heavy  head  and  neck,  re- 
quired assistance  because  of  the  voluminous  heads  and  necks  of 
the  calves. 

When  the  domestic  cow  is  crossed  with  the  buffalo  or  American 
bi.son,  with  his  very  heavy  head  and  neck,  there  is  very  liable  to 
be  difficulty  in  giving  birth  to  the  young,  because  of  the  large  head 
and  chest  of  the  hybrid  fetus. 

The  breeding  of  immature  females  constantly  tends  to  produce 
dystokia  because  of  the  comparatively  large  size  of  the  fetus.  The 
fetus  itself  is  actually  smaller  as  a  rule  than  the  same  female  would 
produce  later  in  life,  but  the  birth  canal,  and  especially  the  pelvis 
of  the  very  young  female,  is  not  yet  developed  to  a  degree  which 
will  render  birth  easy  or  practicable.  It  is  a  common  experience, 
therefore,  that  young  heifers,  which  give  birth  to  calves  when 
only  I  y2  years  old  or  even  younger,  may  require  some  degree  of 
assistance  in  order  to  expel  the  fetus.  The  same  is  noted  in 
immature  sows,  and  to  some  extent  in  other  animals. 

In  one  instance  which  we  noted,  the  owner  of  a  number  of 
fillies  allowed  a  stallion  colt  to  run  with  them  at  pasture,  and 
several  yearlings  became  pregnant.  Before  the  end  of  gestation 
contagious  abortion  broke  out,  so  that  they  all  aborted,  and  sev- 
eral of  them  required  assistance  in  order  to  get  rid  of  the  verj^  im- 
mature fetuses.  Judging  from  these  observations,  it  would  seem 
probable  that,  had  they  carried  their  fetuses  to  the  normal  close 
of  gestation,  there  might  have  been  dijBSculty  in  expelling  them. 

Clinical  observations  apparently  show  that  the  fetuses  are  larger 
if  the  mother  has  been  well  fed.  But  this  does  not  seem  to  in- 
terfere greatly  with  birth,  because,  while  the  fetus  is  compara- 
tively larger,  the  expulsive  powers  of  the  mother  are  also  greater 
and  the  birth  as  a  rule  is  easier.     If,  however,  an  animal  is  very 


73©  Veterhiary  Obstetrics 

fat,  her  young  is  not  as  a  rule  so  large  as  the  young  of  an  animal 
which  is  simply  well  nourished. 

Diagnosis.  Exce.s.sive  volume  of  the  fetus  is  difficult  of  accu- 
rate determination,  prior  to  its  entrance  into  the  pelvic  canal. 
Various  means  have  been  suggested  for  determining  this  excess 
in  volume,  but  they  are  necessarily  unreliable.  Some  have  sug- 
gested an  unusual  size  of  the  abdomen,  but  this  maj' depend  upon 
twin  pregnanc3^  an  excessive  number  of  fetuses,  qr  hydramnios 
or  other  cystic  disease.  In  many  animals  we  note  an  enormous 
abdomen  as  the  result  of  the  character  of  the  food  or  of  individual 
peculiarity. 

Along  similar  lines,  some  veterinarians  have  suggested  that 
the  excess  in  size  may  be  anticipated  owing  to  increased  weight 
of  the  animal. 

Its  final  determination  must  occur  when,  with  a  normally  di- 
lated cervix  and  normal  genital  canal,  labor  sets  in  and  the  ex- 
pulsive efforts  are  vigorous,  and,  although  the  fetus  is  normal 
in  form  and  position,  little  or  no  progress  is  made  in  its  expul- 
sion. If,  under  these  conditions,  the  veterinarian  examines  the 
patient,  he  is  enabled  to  judge  that  comparatively  the  size  of  the 
fetus  is  too  great  to  pass  readily  through  the  birth  canal.  How- 
ever, this  opinion  does  not  depend  upon  anj^  definite  measure- 
ment which  he  is  able  to  make  of  the  dimensions  of  the  pelvis. 

The  principal  obstacles  to  birth,  in  most  of  these  cases,  are  the 
head  and  chest.  The  obstruction  caused  by  the  head  is  especially 
notable  in  the  bitch  and  cow.  In  the  bitch  the  difficulty  most  fre- 
quently occurs  in  those  breeds,  like  the  bull-dog,  which  have 
short  muzzles  and  consequently  present  a  blunt  extremity  to 
pass  through  the  undilated  canal. 

In  the  mare,  the  head  of  the  foal  is  small  and  elongated  and 
rarely  offers  any  serious  obstacle  to  birth.  Generally  it  is  only 
when  the  chest  or  croup  arrives  at  the  pelvic  inlet  that  serious 
difficulty  arises  because  of  volume. 

We  have  already  noted  in  the  preceding  pages  that  the  dimen- 
sions of  the  chest  of  the  foal  are  greater  than  those  of  the  pelvis 
of  the  mother,  and  that  it  is  only  by  some  displacement  of  the 
parts,  especially  of  the  shoulders,  that  the  chest  of  the  foal  is 
capable  of  passing  through  the  birth  canal.  When  the  dimen- 
sions of  the  fetus  are  such  that  it  is  impracticable  for  the  diminu- 
tion by  displacement   to  be  sufficiently  great    to    permit   it    to 


Excess  of  Volume  of  the  Fetus  731 

pass  through,  we  meet  with  a  more  or  less  serious  obstacle  to 
parturition. 

Prognosis.  The  prognosis  in  case  of  excessive  volume  of  the 
fetus  must  depend  largely  upon  the  degree  of  excess,  and  still 
more  upon  the  duration  of  the  dj^stokia. 

In  the  mare  the  outlook  for  the  foal  is  always  bad,  because  the 
delivery  cannot  be  greatly  hurried  with  safety  to  the  mother  and 
cannot  be  delayed  with  safety  to  the  fetus.  In  fact,  as  already 
repeatedly  stated,  the  foal  is  usually  dead  when  the  obstetrist  is 
called.  The  prospects  for  the  mare  may  be  said  to  be  usually 
good,  but  it  should  be  remarked  that  dystokia  in  the  mare,  refer- 
able to  excess  in  the  volume  of  a  living  fetus,  is  exceedingly 
rare  and  does  not  constitute  a  formidable  question. 

In  the  cow  the  outlook  is  usually  good  for  the  mother,  and  if 
the  excess  of  volume  of  the  fetus  is  not  too  great  to  permit  of 
delivery  by  forced  extraction  the  prognosis  for  the  calf  is  also 
favorable.  Unfortunately,  however,  we  have  met  with  cases  in 
the  cow  where  embryotomy  was  necessary  because  of  the  excess 
of  volume. 

The  comparative  excess  in  volume  of  the  fetus  in  multiparous 
animals  where  embryotomy  is  possible,  is  in  many  respects  more 
serious  than  in  the  larger  species.  In  a  large  proportion  of 
these  the  head  of  the  fetus  does  not  enter  the  pelvis,  and  conse- 
quently traction  cannot  be  applied  because  the  head  cannot  be 
secured.  As  a  result,  the  veterinarian  is  forced  to  resort  to  Cae- 
sarian section  in  order  to  bring  about  delivery,  and  this  operation, 
while  not  necessarily  fatal  to  either  mother  or  fetus,  must  con- 
stantly be  considered  as  grave. 

Handling,  i.  Forced  extraction  of  the  fetus  should  be  car- 
ried out  in  all  those  cases  where,  in  the  judgment  of  the  veterin- 
arian, it  can  be  accomplished  with  reasonable  safety  to  the  mother. 
Prior  to  its  application,  it  should  be  determined  that  the  fetus  is 
in  a  correct  position,  after  which  the  genital  canal  should  be 
thoroughly  lubricated  with  warm  lysol  solution  or  fat,  and  the 
traction  then  applied.  In  the  mare  and  cow,  and  to  a  less  extent 
in  the  ewe  and  goat,  the  traction  may  be  exerted  by  means  of 
cords  applied  to  the  presenting  parts,  as  described  on  page  586. 

In  the  sow,  bitch  and  cat,  traction  is  usually  best  applied  by 
means  of  forceps  such  as  Fig.  93  on  page  585,  or  the  obstetric 
noose  such  as  f  and  g,  Fig.  91,  page  578.     Very  largely,  forced 


732  Veterinary  Obstetrics 

extraction  is  not  possible  or  desirable  in  small  animals,  and  Caesar- 
ian section  must  be  employed. 

2.  Embryotomy.  In  all  instances,  in  the  larger  animals, 
where  forced  extraction  is  impossible  or  imprudent,  the  veterin- 
arian should  diminish  the  size  of  the  fetus  by  embryotomy,  un- 
less the  fetus  is  still  living  and  possesses  a  very  high  value  as 
compared  with  that  of  the  mother.  This  operation  is  necessarily 
limited  in  practice  to  the  larger  species  of  animals,  and  is  virtu- 
ally excluded  in  the  sow,  bitch  and  cat  because  the  size  of  the 
genital  canal  does  not  permit  of  carrying  out  the  necessary 
operations. 

In  the  ewe  and  goat  embryotomy  is  at  times  practicable,  de- 
pending chiefly  upon  the  comparative  dimensions  of  the  genital 
canal  of  the  patient  and  the  hand  of  the  operator. 

In  the  cow  we  have  occasionally  found  that  the  head  presented 
the  chief  obstacle  to  labor,  and  it  was  only  necessary  to  perform 
cephalotomy,  as  described  on  page  643,  in  order  to  accomplish 
delivery.  If  this  does  not  suffice,  the  diminution  in  the  size  of 
the  fetus  may  be  continued  to  any  further  degree  required,  as 
suggested  under  d,  page  645  ;  g,  page  649  ;  and  c,  page  658. 

3.  Caesarian  section  will  be  found  necessary  or  advisable  in 
many  cases  of  dystokia  in  the  sow  and  carnivora  due  to  excessive 
volume  of  the  fetus.  Forced  extraction  is  difficult  because  of 
the  smallness  of  the  genital  passages,  and  frequently  unwise 
because  the  force  which  would  be  required  for  the  extraction 
of  the  fetus  would  produce  injuries  to  the  soft  parts,  of  a 
more  serious  character  than  would  result  from  gastro-hysterotomy. 
For  the  same  reason  embryotomy  cannot  be  applied,  and  the 
obstetrist   must  turn  to  Caesarian  section  as  his  last  resort. 

It  is  unfortunate  in  these  cases  to  postpone  the  operation  too 
long.  The  obstetrist  .should  determine  the  necessity  for  Caesarian 
section  early,  and  carry  it  out  as  promptly  as  possible.  If  there 
is  delay  in  operating,  and  one  or  more  fetuses  have  perished  and 
become  emphysematous  and  putrid,  the  operation  becomes  very 
grave  ;  whereas  in  these  animals  Caesarian  section,  when  carried 
out  upon  a  uterus  which  has  not  suffered  from  any  previous  insult 
and  in  which  the  fetuses  are  yet  alive,  is  not  highly  dangerous. 
The  operation  has  already  been  discussed  on  page  663. 


Death    of  the  Fetus.  733 

b.   Death  of  the  Fetus.  Fetal  Emphysema. 

Simple  death  of  the  fetus  prior  to  or  during  labor  does  not  con- 
stitute a  very  important  cause  of  dystokia,  though  the  move- 
ments of  the  living  fetus  probably  tend  to  favor  easy  labor  by 
overcoming  any  tendency  to  a  false  presentation.  The  dead  fetus 
may  undergo  rigor  mortis,  as  in  extra-uterine  death,  and  this  may 
tend  to  complicate  its  expulsion. 

When  the  fetus  has  been  long  dead,  and  emphysema  or  gaseous 
distension  of  the  tissues  occurs  as  a  result  of  its  decomposition, 
the  fetal  cadaver  becomes  very  greatly  increased  in  volume,  and 
this  may  render  its  expulsion  exceedingly  difficult  or  impossible. 
Not  only  is  there  an  increased  fetal  volume  in  such  instances,  but 
the  fluids  escape  and  the  hair  of  the  fetus  becomes  dry  and  ad- 
heres closely  to  the  uterine  walls,  .so  that  it  is  difficult  for  the  fetal 
cadaver  to  glide  along  the  passages.  The  emphysema  intensifies 
dystokia  by  distending  the  uterine  cavity  and  causing  paralysis 
of  the  uterine  walls,  from  fatigue  ;  or  it  leads  to  infection  of  the 
uterine  walls,  with  paralysis  of  function.  The  advent  of 
emphysema  occurring  durijig  dystokia  is  verj-  prompt.  If  the 
cervical  canal  is  well  dilated,  and  the  membranes  are  ruptured, 
emphysema  may  be  quite  pronounced  within  24  hours,  the  fetal 
cadaver  greatly  enlarged,  and  the  hair  and  epidermis  readily  de- 
tached. Within  48  hours  the  skeleton  may  begin  to  lose  its 
integrity,  the  epiphyses  of  the  bones  readily  separating. 

The  diagnosis  of  emphysema  of  the  fetus  is  readily  made  by 
the  fetid  odor,  the  enlarged  puffy  condition  of  the  fetal  cadaver, 
and  the  crepitus  when  the  skin  is  pressed  by  the  hand. 

The  cause  of  fetal  emphysema,  fundamentally,  is  the  death  of 
the  fetus,  followed  by  putrefaction  dependent  upon  the  presence 
of  gas-producing  organisms.  It  is  essential,  ordinarily,  that  the 
OS  uteri  is  open  or  the  tissues  of  the  cervix  are  seriously  dis- 
eased, as  in  torsion,  and  hence  incompetent  to  ward  off  the  exten- 
sion of  the  infection  through  the  cervical  canal  to  the  fetus. 
Under  other  conditions,  mummification  of  the  fetus  may  occur 
instead. 

Clinically,  fetal  emph^-sema  may  be  divided  into  two  classes — 
primary  and  secondar^^  In  the  first,  the  infection  and  death  of 
the  fetus  in  utero  occurs  prior  to  the  advent  of  labor  or  expulsive 


734  Veterinary  Obstetrics 

efforts.  In  some  cases  almost  no  labor  pains  are  observed  through- 
ont  their  clinical  history,  and  the  presence  of  the  emphysematous 
cadaver  is  made  manifest  chiefly  by  the  protrusion  of  the  putrid 
fetal  membranes  and  the  advent  of  fetid  vaginal  discharges. 

In  the  second  class,  or  secondary  emphysema,  are  included 
those  cases  in  which  the  fetus  was  alive,  or  at  least  not  em- 
physematous, at  the  beginning  of  labor,  and  in  which  the  em- 
physema follows  the  expulsive  efforts  because  of  some  delay 
in  the  expulsion  of  the  fetus  as  a  consequence  of  dystokia.  The 
first  class  might  be  termed  the  dystokia  of  emphysema  ;  the 
second  the  emphysema  of  dystokia. 

Whatever  the  cause  of  emphysema,  in  addition  to  the  decom- 
position of  the  fetal  cadaver,  metritis,  metro-peritonitis,  pyaemia 
and  septicaemia  are  more  or  less  frequent  and  intense.  The  uter- 
ine walls  become  thickened,  hard  and  unyielding.  vSometimes 
the  walls  are  one  inch  or  more  thick,  dark  colored,  black,  or 
necrotic-green.  The  uterine  expulsive  powers  are  absent  or 
greatly  enfeebled. 

The  prognosis  is  grave.  In  the  cow,  the  extraction  of  the 
fetus  after  two  or  three  days,  or  even  its  complete  decomposition 
and  sloughing  out  through  the  abdominal  walls  or  into  the  ali- 
mentary tract,  .sometimes  occurs.  In  fact,  after  emphysematous 
decomposition  of  the  fetus  has  continued  for  a  few  days,  the  uterus 
and  system  acquire  marked  powers  of  resistance. 

It  is  the  recent  case  of  emphysema  which  offers  the  grave 
prognosis.  We  have  seen  death  from  septicaemia  and  uterine 
gangrene,  in  the  cow,  within  24  hours  after  the  owner  had  first 
observed  signs  of  labor  or  disease.  In  these  cases,  apparently,  the 
emphysema  antedated  any  expulsive  efforts,  and  the  uterus  quickly 
lost  its  expulsive  powers. 

Handling,  i.  Forced  Extraction.  In  many  cases  it  is  ad- 
visable to  bring  about  delivery  by  forced  extraction,  pages  586 
and  640.  When  forced  extraction  is  to  be  attempted,  we  should 
first  correct  any  deviation  or  abnormal  condition  of  the  presentitig 
parts  and  then,  lubricating  the  passages  thoroughly  with  warm 
lysol  solution  or  fat,  apply  traction,  as  already  directed.  The 
traction  should  be  judiciously  applied,  but  may  be  quite  powerful, 
because,  in  the  emphysematous  state,  the  pressure  is  very  evenly 
distributed  over  every  part  of  the  genital  canal.  It  should  be 
remembered  also  that  the  operation  should  not  be  hastened  be- 


Death  of  the  Fetus  735 

cause  the  gases  tend  to  become  gradually  forced  out  when  pressure 
is  applied  to  the  cadaver,  so  that  those  parts  which  are  under 
greatest  pressure  become  slowly  but  markedly  decreased  in  size, 
because  of  the  shifting  or  escape  of  the  emphysema,  and  thus  favor 
extraction. 

2.  Embryotomy,  page  641,  should  always  be  preferred  to 
forced  extraction  if  the  latter  involves  any  serious  degree  of  force. 
Embryotomy  is  easier  than  in  an  undecomposed  fetus,  because  the 
tissues  are  so  soft  and  friable  that  they  are  very  readily  separated. 
In  the  performance  of  embryotomy  it  should  be  remembered  that 
extensive  punctures  and  incisions  of  the  skin  will  allow  the  escape 
of  large  volumes  of  gas,  by  which  the  size  may  be  reduced.  A 
much  greater  reduction  in  size  can  be  had  by  evisceration,  p.  658, 
because  not  only  do  the  viscera  and  the  body  cavity  contain  large 
quantities  of  gas,  but  also  those  gases  which  are  in  the  tissues 
elsewhere  may  largely  escape  from  the  open  body  cavity,  thus 
greatly  reducing  the  volume. 

Fleming  cites  Bosetto  as  having  had  a  unique  experience  in 
one  of  these  cases  of  emphj-sema,  in  which,  upon  withdrawing 
his  hand  after  some  manipulation,  there  was  a  rush  of  gas  from 
the  vulva  of  the  cow,  which  was  inflammable  and,  becoming  ig- 
nited owing  to  the  presence  of  a  candle,  caused  a  considerable 
flame,  which  burned  for  some  time,  but  which  produced  no  ill 
consequences. 

3.  Caesarian  Section,  page  663,  is  usually  indicated  in  the 
sow,  bitch  and  cat  ;  almost  never,  if  ever,  in  the  cow  and  mare. 
In  many  of  these  cases,  in  the  sow,  bitch  and  cat,  the  handling 
becomes  safer  if  the  more  radical  operation  of  hysterectomy,  page 
669,  is  substituted.     The  prognosis  is  unfavorable. 


C   DISEASES  OF  THE  FETUS. 

During  intra-uterine  life  the  fetus  is  subject  to  various  diseases, 
either  of  the  entire  body  or  of  parts,  which,  at  the  time  of  partu- 
rition, may  cause  more  or  less  serious  dystokia.  These  consist 
largely  of  dropsy  of  cavities  or  organs,  by  which  means  a  portion 
of  the  fetus  becomes  greatly  increased  in  size  ;  or  a  general 
dropsy  of  the  entire  body,  anasarca,  occurs. 

I.  Hydrocephalus. 

Hydrocephalus  consists  essentially  of  a  distension  of  the  lateral 
ventricles  of  the  brain  with  lymph.  The  fluid  may  be  of  any 
amount,  and  upon   its  volume  depends  the  degree  of  dystokia 


Fig.  122.     Hvi)K()ci:i'HAi.rs.    Cai.f.     (Harms). 

which  it  may  produce.  In  the  calf  and  foal  it  reaches,  in  many 
cases,  the  amount  of  4  to  5  gallons,  and  then  constitutes  a  rather 
serious  impediment  to  the  expulsion  of  the  young. 

The  cerebral  hemispheres  are  virtually  absent,  while  the  cere- 
bellum and  medulla  oblongata  are  usually  present  in  an  appar- 
ently normal  condition.  The  enormous  distension  of  the  lateral 
ventricles,  with    the    prevention    of   the  formation    of   cerebral 


Hydrocephalus  iy] 

matter,  leads  ordinarily  to  the  death  of  the  fetus  as  soon  as  the 
umbilic  circulation  is  suspended. 

The  effect  upon  the  skull  is  interesting,  and  has  an  important 
relation  to  the  question  of  delivery.  The  bony  skull  is  usually 
incomplete,  and  the  principal  portion  of  the  tumor  or  enlargement 
is  wholly  devoid  of  any  osseous  covering,  and  consists  merely  of 
the  skin  and  vestiges  of  the  meninges  of  the  brain.  At  the  base 
of  the  tumor,  the  bones  of  the  skull  spread  outward  and  then 
upward  to  constitute  a  chalice-like  cavity  with  irregular  borders. 

The  cause  of  hodrocephalus  in  the  fetus  is  unknown.  It  is 
observed  in  all  animals,  but  is  most  frequently  seen  in  the  calf 
and  somewhat  rarely  in  the  foal. 

The  diagnosis  is  comparatively  easy  when  the  fetus  presents 
anteriorly,  but  may  become  somewhat  difficult  in  the  posterior 
presentation.  When  the  fetus  presents  anteriorly,  the  obstetrist 
usually  finds  upon  inserting  his  hand  that  the  cranium  is  abnor- 


FiG.  123.  Hydrocephalus.  Calf.  Skull  from  Fig.  122.  (Harms). 
mally  enlarged  and  soft  or  fluctuating.  Somewhat  rarely  the 
hydrocephalic  cranium  is  complete,  the  osseous  walls  completely 
enclosing  the  abnormal  brain.  At  first  there  may  be  difficulty 
in  identifying  the  head,  because  of  the  great  disproportion  and 
its  soft,  fluctuating  character.  The  actual  diagnosis  can  be  made 
only  by  identifying  some  definite  parts  of  the  head,  such  as  the 
mouth,  nostrils,  ears  or  eyes,  and  determining  that  the  enlarge- 
ment has  a  definite  relation  to  these. 
47 


738  Veteri7iary  Obstetrics 

In  the  posterior  presentation,  the  presence  of  hydrocephalus  is 
not  likely  to  be  suspected  until  the  entire  fetus,  except  the  head, 
has  been  extracted,  when  suddenly  its  progress  is  checked  or 
completely  stopped,  and  it  becomes  necessary  to  make  an  ex- 
amination in  order  to  determine  the  cause. 

Handling.  The  indications  in  hydrocephalus  are  the  destruc- 
tion of  the  tumor  by  opening  the  sac  and  permitting  the  liquid 
to  escape  and  then  diminishing  the  size  of  the  osseous  portion 
by  dividing  the  bone  with  the  obstetric  chisel.  The  incision 
into  the  tumor  is  easily  made  with  the  scalpel  or  ring  knife,  and 
the  cranial  bones  are  so  thin  and  weak  that  they  are  easily 
broken  down  by  means  of  the  chisel,  as  described  on  page  643. 
In  one  case,  in  the  mare,  where  the  anterior  limbs  had  not  yet 
advanced  into  the  canal,  we  opened  the  sac  and  allowed  its  con- 


FiG.  124.  Hydrocephalus.     Calf,   (.■\fter  photograph). 


tents  to  escape,  broke  down  the  bones,  drew  the  head  through 
the  birth  canal  and  amputated  it,  after  which  we  repelled  the 
neck,  secured  the  two  anterior  limbs  and  extracted  the  headless 
fetus. 

When  the  fetus  presents  posteriorly,  and  hydrocephalus  has 
been  diagnosed,  the  handling  is  analogous  to  that  for  the  an- 
terior presentation. 

As  a  general  rule,  it  is  not  essential  to  decrease  the  size  of  the 
head  very  greatly,  or,  in  some  cases,  to  decrease  it  at  all  by  arti- 
ficial means.  Fig.  124  represents  a  hydrocephahc  calf,  which 
was  expelled  without  aid,  the  head-sac  of  which  had  a  capacity 
of  about  5  gallons.  We  had  been  called  because  of  the  dys- 
tokia,  but,  pending  our  arrival,  the  calf  had  been  expelled. 
Upon  examination,  it  appeared  that  the  expulsive  efforts  had 
compressed  the  sac  to  such  a  degree  that  it  ruptured  through  the 


Ascites  of  the  Fehis  739 

cribriform  plates  of   the  ethmoid  bone,  which  allowed  the  escape 
of  the  fluid  through  the  mouth,  and  the  collapse  of  the  pouch. 

2.  Ascites  and   Hydrothorax. 

The  peritoneal  cavity  of  the  fetus  is  occasionally  the  seat  of 
very  extensive  effusions.  It  is  .said  that  in  some  rare  cases  the 
pleural  cavity  may  suffer  similarly.  The  causes  of  fetal  ascites 
are  unknown.  Possibly  some  cases  designated  as  ascites  are  due  to 
cystic  distension  of  the  fetal  kidneys,  ovaries  or  other  organs. 

The  symptoms  of  ascites,  and  similarly  of  hydrothorax,  are 
confined  to  the  resultant  dystokia.  It  occurs  almost  wholly  in 
the  calf.  Upon  examination  it  maybe  found  that  the  fetus  is  pre- 
senting normally,  and  the  advancing  parts  are  of  normal  form 
and  volume.  If  presenting  anteriorly,  there  is  no  apparent  ob- 
stacle to  expulsion  until  the  head  and  neck  have  passed  the 
vulva,  when  progress  ceases,  and,  although  considerable  traction 
may  be  applied,  the  fetus  appears  immovable. 

Upon  examination  the  veterinarian  finds  that  the  abdomen  is 
enormously  enlarged,  tense  and  fluctuating,  and  alone  consti- 
tutes the  obstacle  to  parturition. 

When  the  fetus  presents  posteriorly  the  symptoms  are  quite 
analogous  ;  the  fetus  in  normal  attitude  advances  until  the  hips 
enter  the  pelvic  canal,  where  it  stops.  Inserting  the  hand  along- 
side the  fetal  body,  the  distended  abdomen  may  be  felt  and 
recognized. 

The  handling  of  the  dystokia  con.sists  fundamentall}^  of  re- 
leasing the  fluid  from  the  abdominal  cavity.  This  may  be  done 
in  a  variety  of  ways.  The  operator  may  carry  a  finger-knife  or 
concealed  scalpel  into  the  uterine  cavity,  and  incise  the  abdomen 
of  the  fetus  from  without,  thus  allowing  the  fluid  to  escape  into 
the  uterine  cavity  of  the  mother. 

From  the  standpoint  of  safety  to  the  mother  and  convenience 
to  the  operator,  we  prefer  liberating  the  fluid  through  the  chest 
cavity  externally.  The  head  and  neck  have  already  passed  the 
vulva ;  it  is  the  work  of  but  a  few  minutes  to  remove  one  an- 
terior limb  subcutaneously,  as  described  on  page  645;  after 
which  one  or  two  of  the  exposed  fetal  ribs  may  be  severed.  The 
operator  can  then  eviscerate,  page  658,  pass  his  hand  through 
the  chest  cavity,  and  rupture   the  diaphragm,  when   the   ascitic 


740  Veterinary  Obstetrics 

fluid   promptly    rushes   out  and  escapes   externally.       Delivery 
readily  follows. 

In  the  posterior  presentation  the  fluid  may  be  caused  to  escape 
through  the  fetal  pelvis  by  an  incision  through  the  perineum. 

3.  Anasarca. 

Somewhat  rarely  in  practice  the  veterinarian  meets  with  a 
fetus,  the  entire  body  of  which  is  edematous,  so  that  its  diameter 
is  greatl}^  increased  and  it  appears  as  a  somewhat  rounded,  soft 
mass  with  its  tissues  filled  everywhere  with  fluid.  Like  ascites, 
anasarca  is  seen  almost,  if  not  quite  exclusively,  in  the  calf.  In 
Germany  this  disease  has  acquired  the  designation  wasserkalbe 
or  speckkalbe.  The  fetus  affected  with  anasarca  usually  perishes 
at  the  sixth  to  seventh  month,  and  is  expelled.  Upon  expulsion 
it  appears  as  a  rounded  mass  ;  the  skin  is  hairless  and  looks 
somewhat  leathery  ;  the  limbs  and  neck  seem  excessively  short 
because  of  the  increased  transverse  diameter  of  the  fetus  ;  and 
everywhere  through  its  tissues  there  is  a  vast  amount  of  liquid, 
which  freely  exudes  when  the  parts  are  incised. 

The  causes  of  anasarca  are  not  known,  but  some  investigators 
have  attributed  the  condition  to  an  absence  of  the  thoracic  duct. 

Anasarca  rarely  offers  any  serious  obstacle  to  parturition,  and 
when  it  does  so  the  dystokia  is  referable  solely  to  the  excessive 
volume  of  the  fetus,  which  we  have  already  discussed  on  page 
726,  and  should  be  handled  in  the  same  wa}-. 

4.  Cysts  and  Cystic  Degeneration  of  Fetal  Organs. 

Cysts  in  various  internal  organs  or  in  the  subcutaneous  con- 
nective tissue,  which  may  .so  increase  the  size  of  a  particular 
region  of  the  fetus  as  to  induce  dystokia,  are  very  rarely  recorded. 
Among  the  internal  organs,  the  liver  and  kidneys  have  been 
found  affected  with  cysts  of  such  dimensions  as  to  constitute  an 
obstacle  to  the  expulsion  of  the  fetus.  Naturally  these  cysts 
cannot  be  differentiated  clinically  from  ascites,  and  it  is  only 
upon  post  partum  examination  that  the  character  of  the  diffi- 
culty may  be  fully  recognized.  The  method  of  handling  is  the 
same  as  we  have  already  suggested  for  ascites. 

Fleming,  citing  Ludke,  records  a  cyst,  in  the  subcutaneous 
connective  tissue  below  the  ear  of  a  calf,  which  was  more  than  a 
foot  in  diameter  and  contained  36  pounds  of  fluid.     This  had   to 


Tjimors  of  the  Fehcs  -         741 

be  punctured  in  order  to  permit  the  extraction  of  the  fetus,  but 
the  exact  nature  of  the  disease  was  not  determined.  Was  it  a 
cystic  thj-roid  or  salivary  gland  ? 

Fleming  cites  Pfiug,  who  was  called  to  attend  a  goat  in  difficult 
labor  and  found  a  large  cyst  upon  each  side  of  the  head  of  the 
kid,  in  the  region  of  the  parotid  gland,  which  offered  considerable 
impediment  to  the  extraction  of  the  fetus,  which,  however,  was 
finall^^  accomplished  without  puncturing  the  cysts. 

The  same  author  describes  the  case  of  a  foal  with  a  cystic 
distension  of  the  guttural  pouch. 

The  indications  in  this  rare  group  of  anomalies  will  depend 
somewhat  upon  the  location  and  volume  of  the  cyst.  When  very 
large  they  may  generally  be  easily  destroj-ed  by  puncture,  which 
allows  the  contents  to  escape;  or  the  tumor  maybe  so  adjusted  in 
position  that  the  fetus  may  be  extracted  without  the  destruction 
of  the  cyst. 

D.    TUMORS  OF  THE  FETUS. 

It  must  be  very  rare  that  a  fetus  suffers  from  a  tumor  in  the 
true  meaning  of  that  term.  Fleming  speaks  of  tumors  of  the 
fetus,  but  includes  under  this  heading  those  which  we  have  con- 
sidered in  the  preceding  section  as  cysts.  Among  his  citations 
there  is  only  one  which  might  possibly  be  regarded  as  a  tumor 
in  the  common  acceptance  of  that  term.  Citing  Rossignol,  Flem- 
ing alludes  to  a  fetus  which  had,  in  the  neighborhood  of  the  um- 
bilicus, a  tumor  which  weighed  1 1  pounds  and  was  composed  of 
fibro- adipose  tissue.  The  description  of  the  tumor  is  very  incom- 
plete, and  its  nature  is  not  revealed. 


E.    ANOMALIES  AND  DISEASES  OF  THE  FETAL  MEM- 
BRANES AND  OF  THE  UMBILIC  CORD. 

1.  Dense  Chorion.  It  has  been  asserted  that  the  fetal  mem- 
branes may  be  abnormally  thick  and  resistant  in  one  case  or 
abnormally  thin  and  weak  in  another,  and  that  these  may  result 
in  more  or  less  danger  to  the  mother  or  fetus.  As  a  .source  of 
dystokia,  onlj-  the  abnormally  thick  and  resistant  membranes, 
the  chorion,  can  produce  any  serious  results.  How  frequently 
these  abnormalties  occur  in  veterinary  obstetrics  cannot  be  de- 
termined. We  have  found  no  records  of  cases  where  such  a  condi- 
tion was  clearly  proven.  The  toughness  of  the  chorion  or  other 
membrane  must  be  merely  comparative,  and  its  existence  will 
largely  depend  upon  the  interpetration  of  the  obstetrist  in  attend- 
ance.    Should  it  occur,  artificial  rupture  or  incision  is  demanded. 

2.  Adhesions  of  the  Fetal  Membranes  to  the  Fetus. 
Very  rarely  in  veterinary  obstetrics  there  are  found  adhesions 
between  the  fetal  membranes  and  the  fetus,  which  tend  to  in- 
terfere with  birth.  There  is  no  part  of  the  fetus  upon  which 
such  adhesions  may  not  occur.  All  the  membranes  may  be  in- 
volved— amnion,  allantois  and  chorion — and  cause  more  or  less 
firm  adhesions  with  the  fetus,  and  may  also  extend  to  and  involve 
the  uterine  walls.  Fleming  cites  one  instance  where  the  adhe- 
sion took  place  upon  the  frontal  region,  and  interfered  with  the 
expulsion  of  the  calf.  In  other  cases  the  adhesion  has  occurred 
upon  the  skin  of  the  pastern  and  elsewhere.  When  such  adhe- 
sions exist,  and  result  in  dystokia,  they  must  be  divided  in  order 
to  bring  about  prompt  delivery. 

3.  Hydramnois  and  hydrallantois.  On  page  424  we  have 
already  described  the  dropsies  of  the  fetal  membranes  as  causing 
more  or  less  serious  interference  with  the  well-being  of  the 
mother  during  gestation,  and  have  there  discussed  the  action 
necessary  to  be  taken  in  these  cases. 

4.  Abnormalities  of  the  Umbilic  Cord.  The  umbilic  cord 
of  domestic  animals  is  very  rarely  of  an  abnormal  character, 
either  in  dimensions  or  in  its  tissue.  It  varies  greatly,  as  we  have 
already  noted  on  page  364,  in  its  length  in  various  domestic  ani- 
mals, but  we  are  unaware  that  these  variations  in  length  have 
any  special  significance  to  the  obstetrist.  If  very  short,  it  natur- 
ally must  rupture  very  early,  perhaps  before  the  fetus  is  completely 

742 


Diseases  of  the  Fetal  Membranes  and  Unibilic  Cord  743 

expelled.  In  the  cow,  the  umbilic  cord  habitually  ruptures 
while  the  calf  is  passing  through  the  pelvic  canal,  and  yet  it  is 
born  as  safely  as  is  the  foal,  in  which  the  cord  usually  does  not 
rupture  until  after  the  complete  expulsion  of  the  fetus. 

As  compared  with  the  child,  the  umbilic  cord  in  all  domestic 
animals  is  short,  and  consequentl)^  does  not  tend  to  protrude 
through  the  vagina  in  advance  of  the  fetus  or  to  become  en- 
tangled about  the  fetal  neck  or  extremities.  In  very  rare  cases 
the  cord  has  been  found  entangled  about  the  neck,  limbs  or 
body  of  the  fetus,  but  this  has  apparently  never  acquired  any 
great  significance. 

Even  if  the  cord  should  become  entangled  about  the  fetus,  it 
usually  offers  no  important  impediment  to  parturition,  because 
it  is  comparatively  easily  ruptured  in  au)^  of  the  domestic  ani- 
mals, so  that  any  powerful  expulsive  effort  would  quickly  cause 
it  to  part.  The  chief  danger  is  the  strangling  of  the  fetus 
through  compression  of  the  cord.  When  the  cord  is  found  en- 
circling a  part  in  a  manner  to  cause  its  compression,  the  ob- 
stetrist  should  obviate  the  danger  as  far  as  possible,  by  disen- 
tangling it  or  hastening  delivery,  according  to  the  circumstances. 


F.  ABERRATIONS  AND  ANOMALIES  IN  THE  DEVEL- 
OPMENT OF  THE  FETUS. 

I.   Campylorrhachis. 

We  have  met,  in  one  case  in  the  cow,  a  form  of  contracture, 
consisting  of  an  abrupt  lateral  curvature  of  the  spine  in  the 
dorsal  region,  by  which  the  body  was  doubled  upon  itself  in  the 
middle  in  such  a  way  that  the  two  posterior  feet  lay  with  their 
ventral  surfaces  upward,  alongside  the  two  anterior  feet,  with 
their  soles  turned  downward  and   the   head   resting   upon  them. 

The  symptoms  of  this  anomaly  are  peculiar  and  confusing. 
The  head  end  of  the  fetus  offers  in  the  typical  anterior  presen- 
tation, dorso-sacral  position,  the  anterior  feet  extended  and  the 
nose  resting  upon  them,  while  alongside  them,  to  the  right  or 
left,  are  the  two  hind  feet  with  their  plantar  surfaces  turned  up- 
ward and  the  Jiocks  and  buttocks  readily  reached.  The  condi- 
tion at  once  gives  the  obstetrist  the  impression  of  twins,  and  the 
chief  point  in  diagnosis  is  to  determine  whether  the  symptoms 
are  due  to  twins  or  to  deformity.  In  case  of  twins,  one  of  the  fe- 
tuses may  be  repelled  while  the  other  is  advanced,  but  in  this 
anomaly  both  the  anterior  and  posterior  portions  must  advance 
or  recede  simultaneously.  It  may  be  possible  to  reach  and  iden- 
tify the  .spinal  curvature. 

The  remedy  is  embryotomy.  The  most  efficient  plan  is  the 
subcutaneous  removal  of  the  two  anterior  limbs,  by  the  method 
described  on  page  645,  and  evisceration  of  the  fetus,  as  described 
on  page  658,  after  which  the  head  and  neck  are  to  be  repelled, 
the  now  flaccid  body  of  the  fetus  converted  into  a  posterior 
presentation  by  traction  upon  the  posterior  limbs,  and  its  ex- 
traction accomplished.  The  repulsion  of  the  anterior  portion  of 
the  fetus  should  be  quite  complete,  and  the  operator  should 
continue  the  process  with  his  hand  as  long  as  it  is  possible  to 
keep  his  arm  in  the  vaginal  canal  alongside  the  advancing 
po.sterior  portion. 

2.    SCHISTOCORMUvS     REFLEXUS. 

On  page  351,  while  discussing  the  development  of  the  embryo, 
we  have  stated  that  under  certain  conditions  the  amniotic  fold 
contracts  in  such  a   manner   that   the  spinal   column   is  forced 
744 


Schistocorvuis  Refiexiis 


745 


down  through  the  abnormally  wide  vitelline  duct,  and  the 
somatopleur  of  the  embrj^o  is  reflected  so  that  it  is  virtually 
everted,  as  indicated  in  Figs.  71,  72  and  125.  This  anomaly 
occurs  almost  wholly  in  the  cow,  though  a  few  cases  have  occurred 
in  other  ruminants.  The  viscera  lie  naked,  in  the  absence  of  a 
fetal  body  cavity,  while  the  other  portions  of  the  fetus  constitute 
an  irregular  mass,  presenting  the  pleuro-peritoneal  membrane  ex- 
ternally in  the  form  of  an  inverted  pouch,  open  at  one  end, 
through  which  all  four  limbs  and  the  nose  may  more  or  less  pro- 
sed 


Fig.  125.  ScHisTocoRMUS  REFI.EXUS.  (de  Bruin. 
trude.  The  four  legs  and  the  head  and  neck  lie  in  an  inextri- 
cable mass,  as  in  a  pouch  of  skin.  The  .skin,  with  its  coat  of  hair, 
constitutes  the  lining  of  the  pouch,  and  lies  in  contact  with  the 
contained  limbs  and  head  and  neck. 

The  diagnosis  of  this  anomaly  depends  upon  the  anatomical  re- 
lations above-mentioned.     Usually  the  monster  presents  by  its 


746  Veterinary  Obstetrics 

four  feet  and  head,  and  consequently  the  operator  at  once  comes 
in  contact  with  several,  or  all  four  feet  and  the  head.  Following 
along  the  fetal  extremities,  the  hand  passes  into  a  closely  envel- 
oping pouch,  lined  with  hair.  Examining  more  externally,  the 
operator's  hand  passes  over  the  fetal  mass  and  comes  in  contact 
with  the  fetal  viscera  lying  loose  within  the  uterine  cavity. 

If  presenting  by  the  reverse  end,  the  operator  should  recognize 
the  viscera  lying  free,  and  the  exposed,  bent  spinal  column  and 
ribs,  covered  only  by  peritoneum. 

Usually  the  condition  offers  rather  serious  dystokia.  In  the 
cases  observed  by  us,  fetal  death,  putrefaction  and  emphysema 
preceded  the  symptoms  of  dystokia,  so  that  upon  our  arrival  the 
fetus  has  been  found  putrid. 

Forced  extraction  and  embryotomy  offer  the  chief  suggestions 
in  delivery.  The  conglomerate,  irregular  outline  of  the  fetal 
ma.ss,  with  projecting  ribs  and  other  bones,  renders  forced  extrac- 
tion too  dangerous  in  most  cases.  Unless  the  pelvis  of  the  cow  is 
very  roomy  and  the  fetal  mass  very  small,  embryotomy  is  to  be 
preferred. 

In  performing  embryotomy,  the  operator  should  have  in  mind 
the  anatomical  relations  of  the  parts,  and  should  first  of  all  make 
a  longitudinal  incision  through  the  skin  pouch,  so  as  to  lay  it 
freely  open  and  render  the  limbs  available  for  operation.  He 
should  then  proceed  to  diminish  the  mass  to  a  sufficient  degree, 
preferably  first  by  the  subcutaneous  amputation  of  the  two  an- 
terior limbs,  page  645.  This  may  be  followed  by  the  amputation 
of  one  or  both  hind  limbs  or  of  the  head,  as  circumstances  may 
suggest,  until  the  remaining  portion  may  be  extracted  without 
serious  difficulty  or  injury  to  the  soft  parts. 

3.  Contractures  of  the  Extremities.  Wry-Neck. 

Various  fetal  articulations  undergo  deformation  during  intra- 
uterine life,  and  present  at  birth  obstacles  of  a  more  or  less  im. 
portant  character.  The  campylorrhachis,  mentioned  on  page 
744,  may  be  regarded  as  belonging  to  this  class.  Abnormal 
flexion  of  certain  joints  of  the  limbs  is  not  rare.  The  indica- 
tions, in  case  of  dystokia  due  to  flexures  or  contractures  of  the 
limbs,  are  to  overcome  such  obstacles  by  forcible  extension,  or, 
if  this  fails,  to  amputate  the  offending  part  or  relieve  the  con- 


Wry-neck  in  the  Foal  747 

tracture  by  tenotomy  or  myotomy,  and  remove  the  fetus  in  an 
otherwise  normal  manner. 

Wry- neck  in  the  Foal.  In  the  foal  the  abnormality  known 
as  "  wry-neck  "  is  comparatively  common  as  a  cause  of  dystokia. 
Wry-neck  is  usually  described  as  a  contracture,  with  the  implica- 
tion that  the  deformation  is  induced  by  contraction  or  abnormal 
shortening  of  fetal  muscles,  but  the  actual  cause  is  unknown. 
Usually  the  bones  themselves  are  bent.  The  anomaly  is  possibly 
due  to  the  anterior  feet  occupying  one  horn,  into  which  the  head 
has  failed  to  enter  and  becomes  reflected  back  along  the  fetal  body 
in  the  body  of  the  uterus,  there  to  be  held  firmly.  If  the  neck  of 
an  equine  fetus  becomes  accidentally  caught  in  lateral  deviation, 
and  is  so  held,  the  muscles  on  the  concave  side  naturally  shorten 
as  a  result.  This  abnormality  is  most  frequent,  or  practically 
confined  to  the  foal,  apparently  because  of  the  great  length  of 
its  neck. 

Wry-neck  constitutes  one  of  the  most  common  and  formidable 
obstacles  to  delivery  in  the  foal.  In  these  cases  the  neck  is  bent 
abruptly  backward  at  its  base,  and  the  head  lies  in  the  flank  of 
the  foal.  The  deviation  has  existed  throughout  a  long  period  of 
time,  as  is  shown  by  the  curvature  of  the  head  upon  its  long 
axis.  If  the  neck  is  curved  to  the  left  side  of  the  foal,  so  that 
the  head  rests  in  its  lett  flank,  then  the  left  side  of  the  head  and 
face  is  concave  and  moulded  to  the  surface  of  the  body,  while 
the  right  side  is  convex. 

In  our  experience,  wry-necked  foals  usually  present  either  an- 
teriorly, with  the  two  forefeet  more  or  less  extended  in  the  pas- 
sage and  the  head  out  of  reach,  or  transversely,  with  the  ventral 
surface  of  the  body  toward  the  pelvic  inlet  and  several  or  all  four 
of  the  feet  extended  in  the  vaginal  canal. 

In  the  anterior  presentation,  the  operator  may  not  be  able  to 
reach  the  head  because  of  its  extreme  deviation,  favored  by  the 
great  length  of  the  neck.  If  he  can  reach  the  head,  it  will  be 
found  exceedingly  difficult  or  impossible  to  bring  it  into  the  va- 
gina, because  when  the  fetus  is  repelled  the  head  recedes,  instead 
of  tending  to  become  extended  as  in  case  of  a  normally  developed 
head  and  neck,  where  the  head  has  recently  become  deviated. 
If  the  head  is  secured  by  means  of  hook  or  cord  or  other  device, 
it  is  still  found  exceedingly  difficult  to  bring  about  its  extension 
in  the  genital  passages,  because  of  the  contraction  of  the  muscles 


748 


Veterinary  Obstetrics 


and  the  fact  tliat  the  cervical  spine  has  been  long  bent  and  is 
quite  rigid. 

When  the  fetus  presents  transversely,  with  all  four  feet  in  or 
near  the  pelvic  inlet,  the  head  is  usually  undiscoverable  ;  if  it 
can  be  reached,  it  is  difficult  or  impossible  to  bring  it  into  the 
pelvic  inlet.  Fortunately  vi'e  do  not  wish  in  these  cases  to  ad- 
vance it  into  the  inlet  or  otherwise  secure  it. 

The  indications  in  instances  of  wry-neck  vary  according  to 
conditions.  These  will  be  considered  under  Lateral  Deviations 
of  the  Head  in  the  Anterior  Presentation,  on  page  765,  and 
under  Transverse  Ventral  Presentation  on  page  788. 

4.  Double  and  Triple  Monstrosities. 

Double  monstro-sities  occur  chiefly  in  the  cow  and  somewhat 
rarely  in  the  smaller  ruminants  and  the  sow,  while  in    the  mare 


Fig.  126.     Ga.strodidymus   Octipes.     (From  a  photograph.) 
they  are  almost  unknown.     They  constantly  offer  more  or  less 
serious  obstacles  to  delivery.     The  symptoms  of  double  monstros- 
ities   vary    according    to    the    particular    abnormality   and    the 
presentation. 

Commonly,  where  a  fetus  is  double  at  one  extremity  only,  it 
presents  by  that  extremity,  and  consequently  the  abnormal  por- 
tion of  the  fetus  is  within  reach  and  the  diagno.sis  can  be  made  by 
manual    exploration.     A    double    face,   head,   neck,  or  chest  is 


Double  and  Triple  Monstrosities  749 

usually  easy  to  differentiate  by  palpation.  Double  monstrosities 
in  which  the  double  condition  affects  the  posterior  extremity 
only,  if  presenting  posteriorly,  enable  the  operator  to  reach  for- 
ward a  sufficient  distance  to  properly  examine  the  point  of 
bifurcation  and  diagnose  the  double  character  of  the  fetus. 

In  those  cases  where  the  single  end  of  the  fetus  presents  and 
enters  the  pelvic  inlet,  the  dystokia  is  not  apparent  until  the 
double  portion  reaches  the  pelvic  inlet  and  its  progress  is  stopped 
because  of  the  abnormal  size.     Then  the  obstetrist,  in  making  an 


Fig.  127.     Tetrachirus  Choristocephalus.     (Gurlt). 

examination,  should  be  able  to  pass  his  hand  alongside  the  single 
portion  of  the  fetus  until  he  reaches  the  double  portion,  the 
character  of  which,  especially  the  spinal  bifurcation,  should  be 
recognized  by  the  sense  of  touch. 

In  the  complete  double  monster,  like  the  thoracopagus  and 
others  of  similar  type,  Figs.  126  and  127,  the  obstetrist  finds  the 
two  corresponding  portions  of  the  body  advancing  simultaneously, 
and  cannot  repel  or  advance  the  one  without  moving  the  other 
in  a  corresponding  direction.  Moreover,  as  a  general  rule  he 
will  be  able  to  reach  that  portion  of  the  two  bodies  where  they 
are  connected,  and  thus  determine  the  character  of  the  anomaly 
with  which  he  has  to  deal. 

In  the  very  rare  pigodidymus  aversus,  Fig.  129,  it  would  be  ex- 


750 


Veterinary  Obstetrics 


ceedingly  difficult  to  diagnose  the  condition  until  the  presenting 
portion  of  the  monster,  or  we  might  say  the  presenting  fetus,  is 
completely  withdrawn  or  at  least  its  croup  enters  the  pelvic  inlet, 
when  the  breech  of  the  second  or  posterior  twin  reaches  the 
pelvic  inlet,  becomes  impacted  in  it  and  stops  further  progress. 
If  the  operator  will  then  examine  carefully,  he  may  be  able  to 
reach  sufficiently  far  to  determine  the  character  of  the  monster 
with  which  he  has  to  deal. 

The  indications  in  cases  of  double   monsters  vary.      In   many 
instances  they  are  comparatively  small,  so  that  the    double   con- 


FlG.   128.      SCHISTOCEPHALUS.      CaLF. 

dition  does  not  prevent  their  extraction  entire  without  serious 
difficulty.  In  other  ca.ses  it  is  necessary  to  resort  to  embryotomy 
in  order  to  bring  about  delivery  with  safety  to  the  mother. 
There  are  no  .specific  rules  for  the  operation  of  embryotomy,  but 
the  reduction  in  the  size  of  the  monster  is  to  be  carried  out  ac- 
cording to  the  general  suggestions  already  made  on  page  641. 

It  may  be  well  to  suggest  that  it  is  highly  desirable,  whenever 
possible,  to  divide  the  double  monster  into  its  two  halves.     That 


Double  a?id  Triple  Monstrosities 


751 


is,  if  there  exists  a  double  head  and  neck,  we  should,  if  possible, 
amputate  one  of  the  necks  with  the  chisel  or  by  other  means,  and 
remove  it,  and  then  proceed  to  extract  the  remaining  portion  of 
the  fetus.     So  we  would  handle  a  posterior   presentation  where 


the  posterior  extremity  of  the  fetus  is  double.  Or  we  may  re- 
duce the  volume  of  the  double  body  by  evisceration,  page  658, 
by  the  destruction  of  the  pelvic  girdles,  or  by  amputation  of  the 
hind  limbs,  page  653. 


752  Veterinary  Obstetrics 

5.  The  Dystokia  of  Twins. 

Twins  occasionally  induce  dystokia,  and  may  at  times  cause 
confusion  in  diagnosis. 

The  diagnosis  of  twin  or  triplet  pregnancy,  when  dystokia  oc- 
curs, is  usually  not  very  difficult,  especially  if  the  fetu.ses  have 
not  become  impacted  in  the  pelvic  canal,  so  that  they  are  immov- 
able. When  they  produce  dystokia,  it  is  usually  because  one  or 
more  extremities  of  each  fetus  has  entered  the  pelvic  canal. 

A  little  carelessness  may  lead  to  an  error.  If  one  fetus  is  pre- 
senting posteriorly  and  the  other  anteriorly,  there  may  be  present 
in  the  passages  the  head  and  one  forefoot  of  one  fetus  and  one 
hind  foot  of  the  other  fetus.  This  latter  may  be  mistaken  for  a 
fore-foot  of  the  former,  or  other  similar  error  be  made  if  proper 
care  is  not  taken. 

In  other  cases  there  may  be  such  a  deformit}'  of  a  single  fetus 
that  it  may  be  mistaken  for  twins.  Especially  is  this  the  case  in 
campylorrhachis,  which  we  have  already  described  on  page  744. 

The  differentiation  between  twins  and  double  monstrosities  is 
usually  not  difficult.  In  case  of  double  monstrosities  the  two 
parts  necessarily  move  in  harmony  ;  they  advance  or  retreat 
together,  and  each  movement  that  one  is  caused  to  make  is  at  once 
accompanied  by  a  corresponding  movement  of  the  other.  This 
is  not  true  of  twins. 

The  indications  for  handling  dystokia  due  to  multiparity  are 
comparatively  simple.  The  operator  needs  repel  one  fetus,  or 
rather  the  presenting  parts  of  one  fetus,  and  advance  the  other. 

It  is  essential  that  the  one  fetus  shall  be  repelled  entirely  into 
the  abdominal  cavity,  and  kept  there  until  the  pelvic  canal  is 
fully  occupied  by  the  fetus  which  is  "being  advanced,  after  which 
it  is  delivered.  The  other  is  then  brought  into  position,  and 
also  extracted.  Deviations  of  the  extremities  of  twins  are 
subject  to  the  same  rules  as  those  of  single  pregnancies.  Twins 
are  usually  smaller  than  single  young,  and  permit  of  easier 
handling  and   correction  of  position. 


C.    ABNORMAL  PRESENTATIONS  OR  POSITIONS 
OF  THE  FETUS. 

I.    ANTERIOR  PRESENTATION. 

a.  Dorso-Ilial  or  Dorso-Pubic  Positions. 

In  the  larger  domestic  animals,  where  the  fetus  normally  lies  en 
arc  or  describes  in  its  attitude  the  segment  of  a  circle,  the  ventral 
surface  concave  and  the  dorsal  convex,  it  is  essential  to  the  easiest 
delivery  that  the  fetus  should  be  in  the  dorso-sacral  position.  The 
body  does  not  readih-  bend  dorsahvards,  because  the  inferior  wall 
of  the  fetus  is  comparatively  short  and  inextensible  and,  with  the 
viscera  in  position,  the  rigidity  of  the  fetal  body  is  maintained. 
A  further  obstruction  to  its  passage,  in  other  position  than  the 
dorso-sacral,  is  that  the  greater  diameter  of  its  body  does  not 
correspond  with  the  greater  diameter  of  the  pelvic  canal.  It  is 
possible  in  some  cases  to  bring  about  the  extraction  of  the  fetus 
in  the  dorso-ilial  or  dorso-pubic  position,  but  this  is  chiefly  in 
those  cases  where  the  fetus  is  comparatively  small  as  related  to 
the  genital  passages  of  the  mother.  When  the  fetus  is  so  small 
that  it  can  be  brought  out  in  this  unfavorable  position,  its 
diminutive  size  permits  the  correction  of  the  position  to  be  made 
with  very  little  labor. 

The  indications  are  usually  to  rotate  the  fetus  upon  its  long 
axis,  and  convert  the  dorso-ilial  or  dorso-pubic  into  the  dorso- 
sacral  position.  Under  special  conditions  it  may  be  advisable  or 
practicable  to  resort  to  forced  extraction.  W'e  have  already  dealt 
with  the  question  of  rotation  on  page  632,  and  of  forced  extraction 
on  page  586.  Both  of  these  failing,  it  may  be  necessary  to  resort 
to  embryotomy,  consisting  of  the  subcutaneous  amputation  of 
one  anterior  limb,  page  645,  and  evisceration,  page  658,  followed 
by  rotation. 

b.  Deviation  of  the  Anterior  Limbs. 

The  anterior  limbs  of  the  fetus  are  subject  to  greatly  var3'ing 
deviations.  While  these  may  sometimes  be  unimportant  in  the 
smaller  species,  they  become  of  fundamental  value  in  the  larger 
animals,  such  as  the  foal  and  calf.  The  long  and  rigid  limbs 
and  neck  of  these  make  it  es.sential  that  each  extremity  should 
be  fully  extended  in  order  to  pass  readily  through  the  pelvic 
48  753 


754 


Veterinary  Obstetrics 


canal.  Any  deviation  from  this  normal  attitude  is  liable  to  result 
in  more  or  less  serious  difficult^'  in  the  expulsion  of  the  young 
animal.. 

I.  Flexion  of  the  Anterior  Limbs  at  the  Elbow. 
Anterior    Limbs     Incompletely    Ex- 
tended IN  THE  Pelvis. 

It  is  not  ver}'  rare  to  meet  with  instances  in  the  calf  and  foal 
in  which  the  two  anterior  feet  present  in  their  normal  position 
and  appear  at  the  vulva,  accompanied  generally  by  the  nose, 
which  is  advanced  to  nearly  the  same  degree  as  the  feet  them- 
selves.   At  first  glance  the  position  seems  to  be  essentially  normal, 


Fig.  130.  Incomplete  Extension  ok  Anterior  Limbs. 
but,  when  the  fetus  has  reached  the  point  where  the  feet  and  nose 
are  visible,  its  advance  becomes  checked  and  the  expulsive  efforts 
of  the  mother  are  quite  unavailing  to  cause  any  further  progress. 
The  interpretation  of  this  condition  varies  somewhat  with  dif- 
ferent writers.  Fleming  says  :  "  It  is  usually  due  to  the  shoulders 
not  being  closely  applied  to  the  chest  of  the  fetus,  and  the  elbows, 


Abnormal  Presentations  of  the  Fetus  755 

consequently,  thrown  widely  apart,  coming  in  contact  with  the 
brim  of  the  pelvis,  thus  proving  an  obstacle  to  the  progress  of 
the  young  creature." 

We  interpret  it  as  purely  a  flexion  of  the  humero-radial  articu- 
lation, the  consequent  or  coincident  pushing  of  the  shoulders 
backward  upon  the  sides  of  the  chest,  and  the  impaction  of  the 
olecranon  against  the  pubic  brim.  In  this  position,  the  trans- 
verse diameter  of  the  chest  of  the  fetus  is  greatly  increased  by 
the  retention  upon  its  sides  of  the  entire  volume  of  the  fetal 
shoulders,  including  the  scapula  and  scapular  muscles,  the  hu- 
merus and  the  bulky  anconean  group  of  muscles.  The  perpen- 
dicular diameter  of  the  fetus  is  also  greatly  increased,  because  it 
must  represent  the  distance  from  the  top  of  the  spinous  processes 
of  the  dorsal  vertebrae  down  to  and  including  the  olecranon,  the 
latter  projecting  downward  to  constitute  an  unyielding  obstacle 
which  becomes  lodged  against  the  pubic  brim.  The  condition 
naturally  belongs  to  the  dorso-sacral  position. 

The  diagnosis  depends  fundamentally  upon  two  facts.  While 
the  two  forefeet  present  normally  and  the  nose  is  resting  on  top 
of  them  in  a  normal  position,  so  far  as  it  is  independently  con- 
cerned, there  is  an  abnormal  relation  between  the  degree  of  ad- 
vancement of  the  feet  and  the  nose.  While  normally  the  nose  of 
the  fetus  rests  about  the  middle  of  the  metacarpus,  in  these  cases 
it  is  advanced  to  the  fetlock  or  even  further.  Under  these  con- 
ditions, if  the  obstetrist  will  introduce  his  hand  along  the  ante- 
rior limbs  until  he  reaches  the  brim  of  the  pubis,  he  will  find  the 
olecranon  tightly  impacted  against  the  pubic  brim. 

The  indications  are  simple  and  obvious,  and  consist  merely  in 
releasing  the  olecranon  from  its  incarceration  in  front  of  the  pubis 
and  the  proper  extension  of  the  limb  in  the  birth  canal.  Little, 
if  any  repulsion  is  required.  When  both  limbs  are  retained,  each 
should  be  handled  separately.  The  operator  should  insert  his 
hand  along  the  inferior  surface  of  the  limb,  with  the  palm  turned 
upward,  until  it  has  been  forced  between  the  pubis  and  the  ole- 
cranon, so  that  the  latter  rests  in  the  hollow  of  the  hand.  An 
assistant  is  then  to  exert  traction  sharply  upward  and  backward, 
while  the  operator  causes  the  olecranon  to  glide  over  the  pubic 
brim  and  the  anterior  limb  to  become  extended  in  the  pelvic 
canal.  The  same  operation  is  carried  out  upon  the  other  limb, 
after  which  the  fetus  is  delivered  under  ordinary  precautions  in 
the  dorso-sacral  position. 


756  Veterinary  Obstetrics 

2.  The  Fore-limbs  Crossed  Over  the  Neck. 

It  is  very  rare  that  an  anterior  limb  of  the  fetus  becomes 
crossed  over  its  head  while  passing  through  the  birth  canal  in 
other  animals  than  the  mare,  and  even  here  it  is  not  v^xy  com- 
mon. Such  displacement  in  the  foal  offers  a  considerable  ob- 
stacle to  parturition,  partly  owing  to  the  obstruction  of  the  car- 
pus lying  on  top  the  fetal  poll  or  neck,  largely  because  it  induces 
the  same  position  of  the  shoulder  and  elbow  as  we  have  already 
described  in  the  previous  section.  By  this  displacement  the  di- 
ameter of  the  chest  is  greatly  increased  and  the  olecranon,  instead 
of  being  in  a  horizontal  position,  projects  downward  almost  per- 
pendicularly, and  thus  constitutes  a  very  serious  obstacle  to  the 
advancement  of  the  fetus  along  the  birth  canal. 

There  is  the  further  very  important  danger  that,  when  a  foot 
is  so  misdirected,  it  is  liable  to  become  engaged  in  the  roof  of 
vagina  and,  perforating  it,  cause  a  rupture  of  the  rectum  or  of 
the  perineum. 

The  false  position  of  the  deviated  foot  or  feet  is  readily  recog- 
nized upon  examination. 

Handling.  It  is  not  difficult  ordinarily  to  .seize  the  misdi- 
rected foot  with  the  hand  and,  while  exerting  .some  traction  upon 
it,  pus>i  it  toward  the  side  where  it  belongs,  first  somewhat  up- 
ward to  cause  it  to  glide  over  the  poll,  thence  in  a  lateral  direc- 
tion and  downward,  and  finally  toward  the  central  line  to  bring 
it  beneath  the  head  and  neck.  If  both  feet  are  crossed  over  the 
head,  as  it  is  alleged  occurs  in  rare  instances,  that  one  which  is 
uppermost,  the  one  which  is  crossed  over  the  other  foot  as  well 
as  over  the  head,  should  first  be  brought  into  position,  after 
which  the  other  is  to  be  similarly  handled.  It  is  not  essential  to 
repel  the  fetus,  unless  the  fore-foot  has  become  engaged  in  the 
roof  of  the  vagina  and  has  pushed  its  way  into  it  so  far  that  the 
repulsion  is  necessary  to  its  di.sengagement.  In  such  cases  the 
repulsion  should  be  merely  sufficient  to  enable  the  operator  to 
bring  about  the  necessary  replacement  of  the  foot. 

Should  the  replacement  of  the  limb  prove  difficult,  it  is  ad- 
visable to  cord  the  foot  and  have  an  assistant  exert  traction 
upon  it  in  such  direction  as  the  operator  may  indicate,  while 
he  guides  and  aids  the  repo.sition  directly  with  his  hand.  After 
completing  the  replacement  of  the  foot  into  its  normal  position, 


Flexion  of  Anterior  Limbs  at  Carpus 


151 


the  operator  should  take  the  further  precaution  to  see  that  the 
elbow  is  completely  extended,  before  any  traction  is  applied 
to  other  portions  of  the  fetus,  because,  until  this  is  done,  the 
position  remains  such  that  expulsion  cannot  readily  occur. 

3.  Flexion  op  the  Anterior  IvImbs  at  the  Carpus. 

This  obstacle  to  birth  occurs  chiefly  in  the  calf  and  foal,  and  to  a 
lesser  extent  in  the  lamb  and  kid,  but  in  these  cases  it  is  very  rare 
and  of  less  significance.  In  carnivora  and  the  sow  the  condition  is 
not  present,  or  not  of  moment  as  a  cause  of  dystokia,  because  the 
limbs  are  short  and  may  readily  fold  backward  and  permit  the 
head  to  present  alone. 


Fig.  131.  Flexure  of  the  Anterior  Limbs  at  the  Carpus. 
(vSt.  Cyr.) 
In  such  cases  the  metacarpus  is  flexed  upon  the  radius,  the  ra- 
dius upon  the  humerus,  and  the  humerus  upon  the  scapula,  so 
that  the  entire  limb  is  folded  and  the  shoulders  are  pushed  back 
upon  the  chest,  thus  greatly  increasing  the  perpendicular  and 
transverse  diameters  of  the  fetal  bod}'  in  the  region  of  the  chest, 
and  offering  a  very  great  obstacle  to  its  expulsion,  which  is 
greatly  heightened  by  the  impaction  of  the  carpus  in  the  pelvic 
canal,  or  in  front  of  or  beneath  the  pubic  brim. 


758  Veterinary  Obstetrics 

Normally  the  fetus,  until  just  prior  to  birth,  lies  somewhat  up- 
on its  side  with  all  the  limbs  flexed  along  the  ventral  surface  of 
its  body,  the  radius  upon  the  humerus  and  the  metacarpus  upon 
the  radius  in  such  a  way  that  the  very  long  limbs  of  the  foal 
and  calf  occupy  the  least  possible  space  in  the  uterus.  When  ex- 
pulsive efforts  set  in,  should  the  fetus  be  dead,  the  limbs  may 
remain  flexed  during  parturition,  just  as  they  were  prior  to  the 
beginning  of  that  act.  Should  the  fetus  be  alive,  it  is  quite  pos- 
sible that,  because  of  close  investment  by  the  fetal  membranes, 
its  feet  may  not  become  extended  upon  the  carpus.  Consequent- 
ly the  fetus  approaches  the  pelvic  inlet  with  the  limbs  still  flexed, 
in  which  case  they  almost  inevitably  become  impacted  in  the 
pelvic  cavity,  or  beneath  or  against  the  pubic  brim,  to  constitute 
a  more  or  less  serious  obstacle  to  delivery. 

Some  obstetrists  hold  that  the  displacement  may  occur  other- 
wise. They  claim  that  at  the  moment  when  the  limbs  of  the 
fetus  enter  the  pelvic  inlet  they  may  not  be  fully  extended,  and 
the  toes  may  become  caught  against  the  border  of  the  pubis. 
As  the  fetus  advances  the  limbs  become  flexed  at  the  carpus,  and 
later  the  metacarpus  and  phalanges  become  directed  backward, 
and  the  folded  limbs  thus  applied  against  the  neck.  If  we  study 
carefull}'^  the  mechanism  here  proposed,  we  find  it  probable  that, 
if  it  came  about  in  this  manner,  when  the  parts  became  folded 
the  carpus  would  be  far  advanced  in  the  pelvis  along  the  side  of 
the  neck  of  the  fetus.  This,  as  every  obstetrist  well  knows,  is  very 
rarely  the  case,  but  instead  the  flexed  carpus  is  engaged  against 
or  beneath  the  pubic  brim,  a  position  which  it  could  acquire  only 
with  the  greatest  possible  difficulty,  by  the  method  which  has 
been  suggested. 

Another  objection  to  the  tlieor)^  of  the  flexion  of  the  carpus 
during  parturition  may  be  realized  by  the  obstetrist  when  he  at- 
tempts to  extend  the  flexed  member  so  as  to  bring  about  the 
extraction  of  the  fetus.  He  finds  at  once  that  the  length  of  the 
metacarpus  exceeds  the  perpendicular  diameter  of  the  pelvis  and 
that  the  limb  has  to  be  pushed  completel}'  back  into  the  abdomen 
in  order  to  be  extended.  If  the  mechanism  of  this  flexion,  as  found 
in  dystokia,  is  of  the  character  here  alleged,  when  the  flexion  is 
coming  about  it  would  tend  to  become  stopped  by  the  carpus 
abutting  against  the  sacrum  and  becoming  lodged  in  a  perpen- 
dicular position  across  the  pelvic  inlet. 


Flexion  of  Anterior  Limbs  at  Carpus  759 

We  consequent!}^  regard  this  deviation  as  being  usually  a  per- 
sistence of  the  pre-parturient  attitude  of  the  limb  of  the  fetus, 
and  not  as  an  acquired  deviation  of  the  part.  Consequently  we 
may  well  find  both  anterior  limbs  flexed  at  the  carpus,  and  the 
head  of  the  fetus  flexed  ventralward,  with  its  chin  resting  up- 
on the  sternum.  This  attitude  of  the  fetus  is  especially  frequent 
in  cases  of  abortion  in  the  mare,  where  the  dead  fetus  quite  fre- 
quently presents  by  the  poll  and  the  two  carpal  joints. 

Sometimes  one  foot  presents  normally,  along  with  the  head  ; 
sometimes  the  head  only  ;  and  sometimes  one  anterior  foot  only. 
Any  one  of  these  suggests  at  once  that  there  is  either  a  flexion 
of  the  carpus  which  checks  delivery,  or  else  that  the  anterior 
limb  has  been  completely  retained.  It  is  thus  essential  to  diag- 
nosis that  a  manual  examination  be  made. 

In  the  mare  and  cow  the  retention  of  the  anterior  limbs  at  the  car- 
pus usually  constitutes  an  insurmountable  obstacle  to  parturition, 
except  artificial  assistance  is  given.  Saint-Cyr  properly  suggests 
that  the  dystokia  does  not  result  so  much  from  the  flexion  of  the 
carpus  itself  as  it  does  because  all  the  long  bones  of  the  anterior  limb 
are  flexed  upon  each  other  and  the  entire  mass  of  the  shoulder 
and  limb  is  pushed  backward  upon  the  chest  walls,  to  abnormally 
increase  the  tran.sverse  and  perpendicular  diameters  of  this  por- 
tion of  the  body  and  render  it  so  gross  that  it  cannot  pass  through 
the  birth  canal  without  the  deviation  being  first  corrected. 

The  indications  are  to  secure  the  deviated  limb  or  limbs  and 
to  bring  them  into  their  normal  position.  The  position  of  the 
fetus  is  usually  dorso-sacral,  but,  should  it  be  dorso-pubic  or 
dorso-ilial,  the  same  general  rules  for  the  correction  of  the  de- 
viation apply  in  the  main,  and  in  many  respects  are  actually  easier 
than  though  the  fetus  were  in  the  normal  or  dorso-sacral  position. 

I.  Mutation.  In  order  to  bring  about  the  extension  of  the 
limb  or  limbs,  repulsion  of  the  fetus  is  necessary.  If  the  head  of  the 
fetus,  with  or  without  one  anterior  limb,  has  advanced  only  a  short 
distance  along  the  pelvJc  canal,  it  may  be  quite  practicable  to  push  it 
back  into  the  uterus  and  acquire  room  for  the  correction  of  the  de- 
viation in  the  abdominal  cavity.  If  the  fetus  is  very  small,  or  the 
pelvis  of  the  mother  quite  roomy,  it  may  be  possible  to  repel  the 
fetus  after  its  head  has  passed  completely  beyond  the  vulva,  but 
this  generally  proves  very  difficult,  and  frequently  impossible.  If 
the  fetus  is  dead,  which  is  generally  the  case  with  the  foal,  and 


760  Veterinary  Obstetrics 

the  head  has  passed  beyond  the  vulva  or  can  readily  be  brought 
beyond  it,  the  most  desirable  method  of  procedure  is  to  resort  at 
once  to  decapitation,  as  described  on  page  642,  and  then  repel. 
The  decapitation  is  a  very  simple  procedure  under  these  condi- 
tions, decreases  very  greatly  the  amount  of  labor  required  for 
repulsion  and  the  time  neccessary  for  the  correction  of  the  devi- 
ation, and  thereby  very  largely  increases  the  favorable  outlook 
for  the  mother. 

When  the  head  of  the  calf  has  passed  beyond  the  vulva,  its 
prominent  and  blunt  poll  makes  its  repulsion  more  difficult  than 
that  of  the  foal.  Hence,  if  the  head  has  protruded  beyond  the 
vulva  and  the  calf  is  dead  or  is  of  little  or  no  value  to  the  owner, 
or  if  the  conditions  are  such  that  the  life  of  the  mother  will  be 
greatly  jeopardized  by  tedious  repulsion,  the  obstetrist,  as  in  the 
foal,  should  at  once  proceed  with  decapitation. 

Pronounced  elevation  of  the  posterior  parts  of  the  body  greatly 
facilitates  repulsion.  In  the  ewe  and  other  small  animals,  the 
patient  may  be  almost  or  quite  suspended  by  the  hind  legs  in  order 
to  favor  repulsion.  Tepid  unctuous  fluids  may  then  be  introduced 
through  the  vulva  into  the  vagina  by  gravity.  The  fluid  lubri- 
cates the  walls,  rendering  fetal  movements  more  easy,  and  the 
weight  of  the  liquid  contributes  toward  repulsion.  The  repulsion 
may  be  aided  by  manual  force. 

Having  accomplished  repulsion,  with  or  without  decapitation, 
as  described  on  page  595,  the  obstetrist  should  first  secure 
the  anterior  limb,  or  limbs,  with  the  hand  or  by  means  of  cords. 
First,  if  practicable,  lift  the  bent  carpus  from  beneath  the  pubis 
and  carry  it  up  into  the  pelvic  canal.  Then  place  a  cord  upon 
the  pastern  as  described  on  page  579.  When  this  has  been 
secured,  the  operator  proceeds  to  extend  the  limb  as  described  on 
page  636. 

As  soon  as  the  toe  has  been  brought  into  the  birth  canal,  the 
foot  is  quickly  extended,  and  the  entire  anterior  limb  is  brought 
into  complete  extension  by  traction.  The  other  forefoot,  if 
retained,  is  handled  in  the  same  manner. 

If  the  head  is  also  deviated,  it  is  to  be  handled  according  to  the 
directions  given  under  C  on  page  765.  After  proper  adjustment 
of  the  relations  between  the  two  anterior  limbs  and  the  head,  the 
delivery  is  proceeded  with  in  the  usual  manner. 

When  this  deviation  occurs  in  the  dorso-ilial  or  dorso-pubic 


Flexion  of  Anterior  Lifubs  at  Carpus  761 

position,  its  correction  is  usually  easier  than  when  the  fetus  pre- 
sents dorso-sacrally,  and  is  to  be  brought  about  in  a  corresponding 
manner.  If  the  fetus  is  presenting  in  a  dorso-pubic  position,  it 
will  be  necessary  to  press  the  carpus  downward  in  the  front  of 
the  pubis  and  bring  the  toe  of  the  foot  along  beneath  the  sacrum 
in  order  to  extend  it.  In  the  dorso-ilial  position,  the  retained 
carpus  is  pushed  outwards  in  front  of  the  shaft  of  one  of  the  ilia, 
while  the  toe  is  carried  over  the  ilium  of  the  other  side  and  ex- 
tended in  the  birth  canal.  After  the  limbs  have  been  properly 
extended  in  the  birth  canal,  the  fetus  is  to  be  rotated  upon  its 
long  axis,  page  632,  and  brought  into  the  dorso-sacral  position. 

2.  Forced  Extraction.  Under  certain  conditions  forced  ex- 
traction may  be  advisable.  Some  obstetrists  highly  recommend 
it,  especially  in  the  case  of  a  living  foal.  Naturally,  it  is  only 
practicable  in  those  cases  where  the  bent  carpus  is  already  ad- 
vanced in  the  pelvic  canal,  or  is  in  a  position  where  it  may  be 
readily  secured  and  brought  into  the  pelvic  canal  injts  state  of 
flexion.  In  these  cases,  especially  when  a  foal  is  living  and 
prompt  delivery  is  essential  to  the  preservation  of  its  life,  the 
flexed  carpus  may  be  grasped  by  the  hand,  or  a  cord  may  be  ap- 
plied to  it.  By  exerting  firm  traction,  the  shoulder,  arm  and 
forearm  are  normally  extended,  the  flexed  carpus  advanced,  the 
entire  body  then  advanced  by  the  application  of  force,  and  the 
fetus  delivered. 

3.  Embryotomy  is  rarely  demanded  except  to  the  extent  of 
the  preliminary  decapitation,  which  is  desirable  in  order  to  facili- 
tate repulsion.  It  is  rarely,  if  ever,  essential  or  advisable  to 
amputate  the  anterior  limbs  at  the  carpus. 

3.  Complete  Retention  of  the  Anterior  Limbs. 

Instead  of  the  limb  being  fiexd  at  the  carpus,  as  in  the  pre- 
ceding instance,  we  meet  with  cases  in  which  one  or  both  anterior 
limbs  are  completely  retained,  and  assume  the  position  shown  in 
Fig.  132.  Under  these  conditions  one  or  both  carpal  articula- 
tions project  down  deeply  into  the  uterine  cavity  in  front  of  the 
pubis  of  the  mother,  with  the  radius  fully  extended  upon  the 
humerus,  so  that  those  two  bones  constitute  one  elongated,  rigid 
column.  In  this  position  of  the  fetus  there  can  be  no  yielding 
in  a  posterior  direction  from  the  scalpulo-humeral  articulation  to 
the  carpus.     As  a  consequence  of  this  deviation,  the  shoulders  of 


762 


Veterinary  Obstetrics 


the  fetus  are  pushed  back  upon  the  sides  of  the  chest  so  as  to 
greatly  increase  its  transeverse  diameter,  while  the  perpendicular 
diameter  is  still  more  profoundly  increased  by  the  rigidity  of 
the  limb,  and  now  equals  the  distance  from  the  fetal  withers  or 
back,  to  the  carpus. 

The  causes  of  this  deviation  may  be  two.  When  a  fetus  pre- 
sents at  the  pelvic  inlet  with  one  or  both  carpal  joints  flexed, 
these  become  impacted  against  the  pubis,  and,  as  the  fetus  con- 


FiG.  132.    Complete  Retention  of  the  Anterior  Limbs. 

tinues  to  be  advanced  by  the  expulsive  efforts  of  the  mother  or 
by  traction,  they  tend  to  glide  downward  and  finally  backward 
in  a  way  to  convert  the  flexed  carpus  into  complete  retention  of 
the  anterior  limb. 

It  is  quite  possible  that  in  many  instances  the  fetus  approaches 
the  pelvic  inlet  with  the  limbs  extended  backwards,  due  to  an 
arrest  in  their  forward  exten.sion.  With  the  anterior  limbs  of  the 
fetus  folded  against  the  ventral  surface  of  its  body,  a  small 
amount  of  force,  applied  to  the  lower  end  of  the  radius,  pushes 
it  backward,  and  causes  the  fetus  to  offer  at  the  inlet  with  the 
entire  forelimb  retained. 

The  position  is  not  abnormal  for  the  smaller  domestic  animals. 


Co7nplete  Rete?ition  of  Aiiterior  Limbs  763 

For  the  carnivora  the  position  is  more  favorable  for  easy  dehvery 
than  though  the  anterior  limbs  were  extended  beneath  the  head. 
It  is  only  in  the  larger  domestic  animals  that  this  position  be- 
comes abnormal  and  interferes  seriously  with  parturition. 

The  diagnosis  is  comparatively  easy.  The  condition  permits 
the  advancement  of  the  head  and  neck  to  a  further  degree  than 
when  the  limbs  are  flexed  at  the  carpus.  Con-sequenth',  as  a 
rule,  when  the  veterinarian  is  called  the  head  has  passed  beyond 
the  vulva.  Upon  examining  with  the  hand,  the  differentiation 
between  the  complete  retention  of  the  anterior  limbs  and  their 
flexion  at  the  carpus  is  easily  made. 

Handling,  i.  Mutation.  The  indications  are  to  correct  the 
deviation  of  the  anterior  limb  or  limbs.  The  fetus  must  almost 
ahva5^s  be  repelled,  page  595.  Before  this  can  be  accomplished 
it  is  best,  unless  the  fetus  is  living,  to  decapitate,  as  described  on 
page  642.  With  or  without  decapitation,  the  repulsion  should 
be  made  backward  and  upward,  assuming  that  the  fetus  has  pre- 
sented in  the  dorso-sacral  position.  As  the  fetus  is  repelled,  the 
forearm  tends  to  come  within  reach,  so  that  it  may  be  grasped. 

The  beginner  especially  should  bear  in  mind  that,  the  further 
upward  and  backward'the  fetus  is  repelled,  the  nearer  the  radius 
approaches  to  the  pubis,  and  consequently  the  more  readily  it  is 
reached.  Without  repulsion  it  is  frequently  quite  impossible  to 
reach  the  radius  at  all.  As  repulsion  progresses  and  the  radius 
comes  within  reach,  a  cord  should  be  passed  around  it  and  a  run- 
ning noose  applied  as  low  down  toward  the  carpus  as  is  possible. 
Drawing  from  time  to  time  upon  the  cord  with  which  the  limb  is 
secured,  the  operator  should  continue  the  repulsion  and,  with  the 
aid  of  the  cord  and  the  operator's  hand,  bring  the  limb  into  the 
position  of  carpal  flexion  described  in  the  preceding  .section. 
From  this  point  the  operation  is  the  .same  as  described  under  that 
head. 

2.  Forced  Extraction  has  been  suggested  by  some.  It  is  fre- 
quently practicable  in  the  sheep  and  goat.  In  the  mare  and  cow 
we  consider  it  wholly  unwarranted.  It  is  said  that  some  veter- 
inary obstetrists  have  succeeded  in  the  forced  extraction  of  the 
foal  or  calf  in  this  position,  but  the  records  in  the  cases  are  not 
sufficiently  lucid  to  enable  the  reader  to  determine  whether  they 
were  dealing  with  an  average  sized  fetus  or  with  an  abortion  at 
a  comparatively  early  period  in  gestation.     When  a  fetus  is  not 


764  Veteri7iary  Obstetrics 

fully  developed,  its  limbs  are  comparatively  much  shorter  and 
far  more  pliable,  and  consequently  it  may  be  forced  through  the 
passage  in  almost  any  conceivable  position,  dependent  upon  its 
size.  When  the  fetus  has  reached  its  normal  dimensions  and  at- 
tained the  degree  of  rigidity  regularly  shown  at  the  time  of  birth, 
the  question  of  the  correct  position  of  each  extremity  becomes 
one  of  fundamental  importance,  and  whenever  we  attempt  to 
bring  about  forced  extraction  under  these  conditions  we  must  as- 
sume an  extraordinary  risk.  If  a  fetus  can  be  drawn  away  by 
forced  extraction  when  an  anterior  limb  is  completely  retained, 
it  must  be  because  it  is  a  very  small  fetus,  in  which  instance 
there  is  no  necessity  for  forced  extraction,  because  the  deviation 
is  easily  corrected. 

3.  Embryotomy.  Except  the  amputation  of  the  head,  which 
we  always  advise,  embryotomy  is  rarely  demanded  in  this  devia- 
tion. Fleming  states  :  "  Amputation  of  the  head  will  not  always 
prove  advantageous  in  retropulsion  ;  indeed,  it  will  often  be 
found  to  be  a  disadvantage."  Upon  what  clinical  facts  such  an 
opinion  is  based  we  are  not  aware,  and  cannot  readily  understand 
how  amputation  of  the  head  could  in  any  case  prove  disadvanta- 
geous in  bringing  about  repulsion  of  the  fetus.  It  is  possible 
that  sometimes  further  embryotomy  may  prove  desirable.  If  the 
head  has  been  removed,  and,  after  repulsion,  it  is  still  impossible 
or  impracticable  to  correct  the  deviation,  especially  in  cases  of 
emphysema  of  the  fetus,  it  may  become  desirable  to  remove  one 
or  both  of  the  shoulders.  This  cannot  be  done  by  subcutaneous 
amputation,  described  on  page  645  ;  but  it  would  be  necessary  to 
divide  and  detach  the  skin  over  the  region  of  the  shoulder  and 
follow  this  by  a  division  of  the  muscles  which  attach  the  scapula 
to  the  chest. 

These  are  chiefly  the  trapezius  and  rhomboideus,  which  would 
free  the  superior  end  of  the  scapula  and  permit  it  to  be  secured 
by  means  of  a  cord  with  a  running  noose.  Then  should  follow 
the  division  of  the  latissimus  dorsi  and  the  pectoral  muscles,  after 
which  the  limb  may  be  drawn  out  from  the  skin  covering  it,  in 
an  inverted  manner.  After  the  one  limb  has  been  removed,  the 
chest  of  the  fetus  may  be  opened  and  evisceration,  page  658,  em- 
ployed. Further  diminution  in  size  of  the  fetus  may  be  prose- 
cuted to  any  desired  extent,  and  the  remnant  finally  drawn  away. 


Complete  Retention  oj  'Anterior  Li?nbs  765 

c.  Deviations  of  the  Head  and  Neck. 

In  domestic  animals,  the  tendency  for  the  head  to  become  more 
or  less  deviated  at  the  time  af  birth  varies  greatl}^  because  of  the 
differences  in  the  length  of  the  neck  as  compared  to  its  transverse 
diameter.  In  the  pig,  where  the  neck  is  thicker  than  its  length, 
it  is  verj^  difficult  for  the  head  to  become  deviated,  in  marked 
contrast  to  the  foal,  with  the  very  long  and  slender  neck,  in  which 
these  deviations  are  among  the  most  common  and  serious  forms  of 
dystokia.  Not  only  is  the  head  of  the  foal  very  liable  to  deviation 
at  the  time  of  birth,  but  frequently  the  head  and  neck  have  be- 
come bent  laterall}'  at  a  very  early  date  in  gestation  and  have  re- 
mained so  throughout  the  development  of  the  fetus,  constituting 
a  serious  deformity — wr^'-neck. 

I.  Lateral  Deviation  of  the  Head. 

The  most  common  form  of  deviation  of  the  head  is  the  lateral, 
as  it  is  in  this  direction  that  the  neck  is  most  flexible  and  the 
head  most  readily  displaced.  The  deviation  may  occur  with 
equal  facility  to  the  right  or  the  left. 

The  causes  of  lateral  deviation  of  the  head  are  two.  In  the 
foal  the  deviation  frequently  occurs  during  an  early  period  of 
gestation,  to  constitute  wry-neck,  so  that  when  the  end  of  gesta- 
tion arrives  the  head  and  neck  have  already  been  doubled  back 
along  the  side  of  the  foal  for  weeks  or  months,  the  parts  have 
become  thoroughly  adapted  to  this  position,  and  the  head  lies  in 
the  flank  of  the  foal,  where  it  is  moulded  to  the  convex  surface 
of  its  body.  That  side  of  the  head  in  contact  with  the  body  of 
the  foal  is  concave,  and  the  opposite  side  convex. 

The  second,  and  except  in  the  foal,  perhaps  the  only  cause  of 
deviation,  and  the  one  which  is  most  subject  to  remedy,  is  an 
accidental  misdirection  of  the  head  at  the  time  of  the  parturition. 
As  the  fetus,  in  an  anterior  presentation,  is  being  forced  along 
the  genital  canal,  the  nose  or  other  portion  of  the  head  becomes 
somewhat  deflected  to  the  right  or  the  left,  and,  becoming  im- 
pacted against  some  projecting  portion  of  the  pelvis  or  genital 
canal  or  entangled  in  some  way  in  the  fetal  membranes,  is  drawn 
farther  to  one  side,  until  it  becomes  caught  between  the  side  of 
its  body  and  the  wall  of  the  uterus  or  vagina.  When  this  oc- 
curs it  is  highly  improbable  that  delivery  can  proceed  spontane- 
ously, but  instead  the  head  tends  to  become  farther  and  farther 


766 


Veterinary  Obstetrics 


deviated  as  the  body  of  the  fetus  is  pushed  more  and  more  for- 
ward. Finally  the  neck  is  doubled  directly  backward  as  far  as 
possible  from  the  shoulder,  and  the  head  lies  far  back  in  the  flank. 

The  diagnosis  of  this  deviation  usually  offers  little  difficulty. 
It  generally  needs  to  be  differentiated  from  onh'  the  two  succeeding 
forms  of  deviation,  the  downward  and  upward  displacements. 

First,  the  operator  must  identify  the  two  anterior  limbs,  one 
or  both  of  which  are  ordinarily  in  the  passages.  Having  accom- 
plished this,  he  is  yet  to  determine  whether  the  head  is  deviating 
upward  or  downward,  or,  if  laterally,  whether  it  be  to  the  right 
or  to  the  left. 


Fig.  133.     Lateral  Deviation  of  the  Head.     (St.  Cvr.  ) 


The  determination  of  the  direction  is  not  always  easy.  If  the 
head  can  be  reached,  that  decides  the  question.  When  the  head 
cannot  be  reached  with  the  hand,  the  diagnosis  becomes  more 
difficult.  As  a  general  rule  it  is  only  in  the  foal  that  the  head 
cannot  be  reached  and  examined  with  the  hand,  and  in  the  foal 
we  are  aided  by  the  presence  of  the  somewhat  prominent  mane. 
If  the  head  is  bent  laterally  and  the  operator  passes  his  hand  as 
far  as  possible  along  the  presenting  portion  of  the  fetus,  he  will 
usually  be  able  to  identify  the  withers.     From  this  point,  turning 


Lateral  Deviation  of  the  Head  ']6'] 

either  to  the  left  or  the  right  and  then  backwards,  he  may  trace 
the  top  of  the  neck,  bearing  the  mane.  At  the  lower  margin  of 
the  neck,  the  operator  will  usually  be  able  to  identify  the  trachea. 
In  one  direction  he  can  trace  this  to  its  point  of  disappearance 
within  the  fetal  chest  between  the  two  anterior  limbs,  and  in  the 
other  may  follow  it  across  the  right  or  left  anterior  limb  to  later 
turn  backward  toward  the  patient's  head. 

In  the  upward  and  downward  deviations  of  the  head,  the  rela- 
tions of  the  trachea  and  the  superior  border  of  the  neck  or  mane 
are  wholly  different,  and  serve  to  distinguish  these  displacements. 
In  the  upward  deviation  of  the  head,  the  top  of  the  neck  or  the 
mane  is  out  of  reach,  whereas  the  lower  margin  of  the  neck  or 
the  trachea  is  quite  fully  exposed,  and  curves  upward  and  then 
backward  above  the  withers  and  di.sappears.  When  the  devia- 
tion is  downward,  the  trachea  cannot  be  discovered,  but  the 
superior  portion  of  the  neck  or  the  mane  disappears  downward 
between  the  two  anterior  limbs. 

The  indications  in  lateral  deviations  of  the  head  will  vary 
greatly  according  to  species  and  individual  cases. 

I.  Mutation.  In  those  cases  where  the  deviation  is  recent, 
where  wry-neck  is  not  present,  where  the  fetus  is  not  emphy- 
sematous or  there  are  no  other  evidences  of  insurmountable 
obstacles  to  the  correction  of  the  deviation,  this  is  the  conserva- 
tive and  proper  course.  The  cow  or  mare  should  be  operated 
upon  in  the  standing  position,  with  the  hind  parts  elevated,  or,  if 
recumbent,  should  be  placed  in  lateral  recumbency  on  the  side 
opposite  to  the  fetal  head,  with  her  hind-quarters  elevated. 

The  operation  consists,  first,  of  repulsion,  as  described  on  page 
595,  which  is  to  be  applied  to  the  chest  of  the  fetus,  directed 
obliquely  backward  and  away  from  the  misdirected  head.  If 
the  head  is  deviated  to  the  right  side  of  the  mother,  the  repulsion 
should  be  obliquely  toward  her  left  side,  so  as  to  tend  to  relea.se 
the  head  and  cause  it  to  advance  toward  the  pelvic  inlet. 

After  repulsion  has  been  accomplished,  the  operator  should 
secure  and  extend  the  head  of  the  fetus  by  those  means  most 
available  in  the  particular  case,  under  the  rules  laid  down  on  page 
636.  In  many  instances  it  is  merely  necessary  to  grasp  some 
portion  of  the  head  with  the  hand  or  fingers,  and  give  it  a  sharp 
pull,  by  which  it  is  brought  into  its  normal  position.  When  the 
nose  is  pointing  backward,  that  is,  toward  the  anterior  part  of 


768  Veterhiary  Obstetrics 

the  mother,  the  nostrils  and  commissure  of  the  Hps  offer  a  secure 
hold  for  the  finger  of  the  operator  or  for  the  insertion  of  a  blunt 
hook,  and  this  hold  may  prove  of  value  until  the  head  has  turned 
somewhat. 

In  the  correction  of  this  deviation  it  will  often  prove  highly 
advantageous  to  place  a  repeller  securely  against  the  chest  of  the 
fetus  and  have  an  assistant  maintain  constant  repulsion,  thus 
keeping  the  body  of  the  fetus  pushed  away  from  the  pelvic  inlet 
in  a  manner  to  insure  to  the  operator  the  greatest  amount  of  room 
for  manipulating  the  head. 

In  the  bitch,  cat  and  ewe,  the  patient  maybe  more  or  less  sus- 
pended by  the  hind  legs,  the  vagina  filled  with  a  warm,  unctuous 
fluid,  and  the  fetus  repelled,  partly  by  gravity,  partly  by  the  pres- 
sure of  the  fluids,  aided  by  .shaking  the  animal,  by  pushing  upon 
the  fetal  limbs  or  by  means  of  a  finger-tip  placed  against  the 
chest.  When  repulsion  has  been  accomplished,  the  operator 
may  locate  the  fetal  head  through  the  abdominal  wall,  and  by  ex- 
ternal manipulation  push  it  upward  (the  patient  being  suspended 
by  the  hind  feet)  toward  the  vulva,  while  a  finger  or  fingers  in- 
serted in  the  vulva  aid  in  adjusting  the  head  in  proper  position, 
after  which  traction  may  be  applied. 

2.  Forced  extraction  has  been  advised  in  the  mare  by  .some 
veterinary  obstetrists,  and  a  few  of  them  have  reported  good  re- 
sults by  this  method.  It  has  been  suggested  by  some  that  by 
this  means  it  is  pcssible  to  save  a  foal,  though  we  have  been  un- 
able to  find  a  record  of  so  fortunate  an  occurrence. 

The  plan  of  forced  extraction  has  already  been  described  on 
page  640.  We  have  not  had  occasion  to  apply  this  method  of 
delivery  in  the  mare  or  other  animal,  but  we  have  observed  a  con- 
siderable number  of  instances  in  which  others  have  done  .so,  and 
have  learned  definitely  of  but  one  instance  in  this  country  where 
the  life  of  the  mare  has  been  saved,  and  none  where  the  fetus  has 
not  perished.  In  European  countries  there  are  a  number  of  rec- 
ords of  successful  deliveries  of  mares,  in  these  cases  of  dystokia^ 
by  forced  extraction. 

There  was  entered  in  our  clinic  a  mare  from  which  a  fetus  in 
this  po.sition  had  been  extracted  by  force.  Her  perineum  was 
completely  ruptured,  the  afterbirth  was  retained,  she  was  very 
weak  and  exhausted,  and  presented  a  repulsive  and  pitiable  sight. 
The  afterbirth  was  removed,  and  the  ruptured  perineum  wasdis- 


Lateral  Deviatio7i  of  the  Head  769 

infected.  In  a  few  days  she  succumbed,  and  upon  post-mortem 
examination  there  was  found  a  small  perforation  upon  the  floor 
of  the  cervix  uteri,  which  had  caused  a  septic  peritonitis. 

We  consider  forced  extraction  in  this  position  in  the  mare  as 
unnecessary,  unsurgical  and  brutal.  There  is  one  possible  ex- 
ception to  this  condemnation — if  the  foal  is  known  to  be  alive, 
cannot  be  promptly  extracted  otherwise  and  its  life  preserved, 
and  there  is  a  possibility  of  saving  its  life  by  forced  extraction. 
Under  all  other  conditions  we  hold  that  embryotomy  is  far  safer 
for  the  mare,  requires  little  labor  upon  the  part  of  the  obstetrist, 
is  on  the  whole  one  of  the  easiest  forms  of  embrj^otomy  with 
which  the  veterinary  obstetrist  is  acquainted,  and  offers  to  him 
the  most  favorable  prognosis.  If  a  fetus  is  so  small  that  it  can 
be  safely  extracted  by  force,  without  correction  of  the  deviation 
or  embryotomy,  then  it  is  so  small  that  it  need  not  be  extracted 
by  force,  because  the  deviation  can  be  easily  corrected  or  embry- 
otomy can  be  verj'  readily  performed.  We  consequently  see  no 
good  reason  for  forced  extraction,  and  consider  that  such  a  plan 
should  be  constantly  and  vigorously  condemned.  As  the  calf  has 
a  very  blunt  poll  and  a  thick  head,  forced  extraction  becomes, 
highly  dangerous  in  the  cow  and  should  not  be  considered. 

3.  Embryotomy  constitutes  one  of  the  most  practical  and 
favorable  methods  for  overcoming  dj^stokia  due  to  the  lateral 
deviation  of  the  head  in  the  mare  and  cow,  if  the  displacement, 
cannot  be  readily  corrected.  Nowhere  in  obstetrics  has  embry- 
otomy a  more  favorable  application  than  in  this  deviation, 
especially  in  those  cases  of  foals  where  wry-neck  is  present,  which 
renders  it  extremely  difficult,  if  not  impossible,  to  bring  about  a 
correction  of  the  vicious  position.  In  all  those  cases  where  the 
fetus  is  dead  and  the  head  is  deviated  laterally  to  so  great  an 
extent  that  it  cannot  be  readily  adjusted,  or  even  if  the  fetus  is 
alive  and  of  comparatively  little  value  or  if  it  is  evident  that  its 
life  cannot  be  saved,  embrj'otom}-  should  be  proceeded  with  at 
once. 

While  the  veterinarian  should  not  undertake  embryotomj^ 
when  the  deviation  can  readily  be  corrected,  he  should  be  equally- 
careful  not  to  exhaust  his  physical  powers  in  a  vain  endeavor  to 
bring  about  a  correction  of  the  deviation  before  he  resorts  to 
embryotomy.  The  operation  consists  of  the  subcutaneous  removal- 
of  one  anterior  limb,  as  described  on  page  645.  The  limb  away 
49 


770  Veterinary  Obstetrics 

from  which  the  head  is  bent,  and  which  is  thereby  fully  exposed, 
is  the  one  to  be  selected  for  amputation.  After  the  removal  of 
the  anterior  limb,  the  chest  should  be  opened  at  the  exposed 
point  and  evisceration  carried  out,  as  described  on  page  658. 
When  this  has  been  accomplished,  and  the  fetal  ribs  have  been 
severed,  the  size  of  the  presenting  portion  of  the  fetus  is  re- 
duced to  such  a  degree  that  it  is  now  no  greater  with  the  head 
turned  back  than  it  would  have  been  had  it  presented  normally. 
It  may  then  be  drawn  away  with  the  head  deviated,  or  what  is 
usually  better,  the  fetus  has  now  become  very  flaccid  and  much 
room  is  gained,  so  that  it  may  usually  be  very  readily  repelled 
and  the  head  brought  into  position,  so  that  the  extraction  may 
finally  take  place  in  a  somewhat  normal  manner. 

Some  operators  advise,  instead  of  subcutaneous  amputation  of  the  limb, 
the  amputation  of  the  head  and  neck,  which  we  have  described  on  page  644. 
We  regard  the  amputation  of  the  limb  as  an  easier,  quicker  and  safer  opera- 
tion. Should  the  fetus  be  emphysematous,  it  is  also  more  efficient.  If  the 
fetal  body  is  normal,  the  accomplishment  of  either  operation  is  efficient. 

4.  Hysterotomy,  or  Caesarian  section,  is  uncalled  for  in 
the  larger  domestic  animals,  and  usually  in  the  sheep  and  goat. 
In  the  smaller  animals,  where  the  correction  of  the  deviation 
fails,  and  embryotomy  is  not  available  because  of  the  narrowness 
of  the  passages,  Caesarian  section,  as  described  on  page  663,  is 
the  only  recourse,  and  offers  a  fair  prognosis  if  undertaken  at  the 
proper  time  and  under  proper  conditions. 

2.  Downward  Deviation  of  the  Head  Between  the 
Anterior  IvImbs. 

In  describing  the  lateral  deviation  of  the  head,  we  did  not  state 
the  very  evident  fact  that  such  a  deviation  may  not  be  direct  but 
may  be  variably  oblique  upward  or  downward.  Such  devia- 
tions from  the  direct  lateral  line  are  not  materially  important, 
and  offer  nothing  unusual  for  our  consideration.  In  other  in- 
stances there  is  a  downward  deviation,  in  which  the  head  passes 
downwards  between  the  two  anterior  limbs. 

We  have  stated,  in  considering  the  normal  attitude  of  the  fetus 
in  the  uterus,  that  it  rests  with  its  head  and  neck  bent  ventral- 
wards,  with  its  chin  in  close  proximity  to  or  resting  upon  the 
sternum.  It  is  easy  to  understand  that  in  some  cases  the  head 
may  remain  in  this  position,  and  the  two  anterior  limbs  become 
extended  and  enter  the  pelvic  canal.  The  head,  passing  down 
between  the  anterior  limbs,  is  tightly  held  in  that  position,  be- 
cause the  limbs  are  firmly  pressed  together  over  the  back  of  the 
neck. 


Downward  Deviation  of  the  Head  771 

There  occur  variations  in  the  degree  of  the  deviation,  as  in 
other  cases,  but  they  largely  arrange  themselves  into  two  groups. 
The  first  group  includes  those  of  a  minor  character,  in  which, 
when  the  fetus  advances  along  the  birth  canal,  its  nose  catches 
against  the  pubic  brim.  As  the  fetus  is  pushed  along,  there  is  a 
constant  tendency  for  the  nose  to  turn  more  and  more  downward 
and  backward,  while  the  head  becomes  sharply  flexed  upon  the 
neck  and  the  poll  passes  into  the  pelvis,  to  constitute  what  is 
sometimes  known  as  the  poll  presentation. 

From  this  position  it  has  been  assumed  by  some  that  the  devi- 
ation may  become  more  and  more  accentuated  until  it  reaches 
that  degree  where  the  head  passes  completely  downward  between 
the  legs.  A  study  of  the  circumstances  under  which  the  devia- 
tion occurs  tends  to  throw  serious  doubt  upon  this  view.  When 
th^  limbs  are  advanced  in  the  pelvic  canal,  they  are  necessarily 
confined  quite  closely  to  each  other,  and  it  is  only  during  the 
early  stages  of  advancement,  before  the  feet  have  yet  approached 
the  vulva,  that  the  muzzle  of  the  foal  or  calf  can  well  drop  down 
between  the  two  anterior  feet  and  become  jammed  against  the 
pubic  brim.  As  the  two  limbs  advance  further  and  further,  .they 
become  applied  more  and  more  closely  to  each  other,  so  that  it 
would  be  highly  improbable  for  the  head  of  the  fetus  to  pass  com- 
pletely down  between  them  to  occupy  a  position  beneath  them. 
We  hold,  therefore,  that  the  two  positions  are  not  differences  of 
degree,  but  are  fundamentally  different  in  origin,  and  that  one 
does  not  pass  into  the  other  by  imperceptible  gradations. 

The  diagnosis  by  manual  exploration  is  comparatively  easy. 
In  the  first  instance  the  head  is  found  lying  upon  the  anterior 
limbs,  with  the  poll  directed  more  or  less  upwards  and  forwards, 
while  the  nose  projects  down  between  the  limbs  and  is  caught 
against  the  pubic  brim.  In  the  second  instance  the  head  at  first 
cannot  be  felt,  but  the  limbs  seem  to  be  pushed  somewhat  apart 
as  they  near  the  chest.  Careful  manipulation  will  reveal  the  fact 
that  the  top  of  the  neck  or  the  mane  disappears  almost  straight 
downward  from  the  top  of  the  withers,  to  finally  recurve  back- 
ward. By  reaching  around  underneath  the  anterior  limbs  and 
fetal  chest,  some  portion  of  the  head  will  most  likely  be  reached 
and  identified. 

The  handling  of  the  downward  deviation  of  the  head  offers 
some  variations  according  to  type. 


772  Veterinary  Obstetrics 

1.  Mutation  is  iisualh-  applicable  in  those  milder  cases  where 
the  nose  is  caught  against  the  pubic  brim,  and  the  correction  of 
the  deviation  constitutes  the  most  rational  and  economic  proced- 
ure. In  such  cases  it  is  not  difficult  to  repel,  as  described  on 
page  595.  The  operator  should  correct  the  deviation  by  insert- 
ing his  hand  between  the  pubic  brim  and  the  muzzle  of  the  fetus, 
and,  grasping  the  latter  in  the  palm  of  his  hand,  lift  it  over  the 
pubic  brim  and  extend  it  in  the  pelvis.  The  case  is  then  to  be 
proceeded  with  in  the  ordinary  manner  of  normal  parturition. 
When  the  head  has  passed  completely  down  between  the  legs, 
correction  of  the  deviation  may  prove  highly  difficult  or  impos- 
sible. It  is  essential  to  so  far  repel  the  fetus  that  the  carpal  joints 
pass  into  the  abdomen  and  permit  the  limbs  to  part  sufficiently  to 
allow  the  head  to  pass  up  between  them  and  resume  its  normal 
position. 

When  the  fetus  has  been  sufficiently  repelled  to  permit  the 
carpal  joints  to  be  flexed  and  parted,  the  lower  jaw  may  be  corded 
as  described  on  page  637,  grasped  with  the  hand  or  secured  by 
a  hook  in  the  orbit,  and  lifted  upwards  between  the  legs. 

In  the  smaller  animals  the  correction  of  the  displacement  is  to 
be  undertaken  in  the  same  manner  as  we  have  just  related  for  the 
lateral  deviation. 

2.  Forced  extraction.  Tapken  strongly  advises  forced  ex- 
traction in  those  cases  in  the  mare  where  the  nose  of  the  foal  is 
caught  against  the  pubic  brim,  if  there  is  any  hope  that  the  fetus 
is  alive.  He  believes  that  he  thereby  greatly  advances  the  inter- 
ests of  the  foal  without  materially  injuring  tho.se  of  the  mother. 
However,  it  is  very  rare  that  the  foal  is  alive  when  the  veteri- 
narian reaches  the  case,  and  there  is  rarel}',  if  ever,  any  reason 
for  precipitancy. 

3.  Embryotomy.  Where  the  head  is  completely  deviated 
downward  and  the  two  anterior  limbs  are  closed  over  above  it, 
and  a  reasonable  effort  demonstrates  that  the  replacement  of  the 
head  is  improbable,  or  if  it  will  apparently  prove  very  difficult 
and  the  fetus  is  dead  or  comparatively  valueless,  we  should  pro- 
ceed at  once  with  embryotomy.  We  prefer  to  remove  one  ante- 
rior limb  subcutaneously,  according  to  the  technic  on  page  645, 
by  which  process  we  relieve  the  incarceration  of  the  head  and 
permit  it  to  be  readily  brought  into  position,  after  which  the  ex- 
traction occurs  in  the  ordinary  way. 


Interlocking  of  the  Fetal  and  Maternal  Pelves  'JT^ 

3.  Upward  Deviation  of  the  Head. 

The  upward  deviation  of  the  head  is  exceedingly  rare  in  prac- 
tice, and  is  due  to  some  accidental  misdirection  while  the  fetus 
is  passing  along  the  birth  canal.  In  most  animals,  and  especially 
in  the  foal,  a  primary  upward  deviation  is  so  unstable  that  the 
head  is  v^ery  liable  to  drop  off  to  one  side  and,  revolving  some- 
what upon  its  long  axis,  assume  a  more  or  less  lateral  displace- 
ment. Owing  to  the  anatomical  peculiarities  of  the  head  and 
neck,  this  displacement  is  perhaps  most  frequently  observed  in 
carnivora,  where  it  may  constitute  a  very  serious  obstruction  to 
birth. 

The  diagnosis  is  not  readily  made  in  the  smaller  domestic  ani- 
mals. In  the  larger  ones,  where  manipulation  is  practicable,  the 
obstetrist  finds  upon  the  in.sertion  of  his  hand  that,  though  the 
position  isdorso-sacral,  the  head  is  not  readily  grasped  or  touched, 
and  that  the  trachea  of  the  fetus,  freely  exposed  and  presenting 
toward  the  pelvic  inlet,  emerges  from  the  chest  and  turns  upward 
and  then  backward  to  disappear  along  the  sacrum  of  the  mother. 

The  indications  are  analogous  to  tho.se  already  related  under 
lateral  deviation.  First  we  should  consider  the  question  of  re- 
pulsion and  correction  of  the  deviation  by  methods  alread}'  de- 
scribed. Second,  before  exhausting  the  strength  of  the  opera- 
tor or  of  the  patient,  if  the  replacement  is  difficult,  or  threatens 
to  be  futile,  embryotomy  is  to  be  recommended,  and  should  be 
carried  out  upon  the  same  basis  as  in  the  lateral  deviation. 

Caesarian  section,  page  663,  necessarily  constitutes  a  valu- 
able and  available  method  for  handling  this  deviation  in  the 
carnivora,  where  the  hand  of  the  operator  cannot  be  inserted 
along  the  genital  passages  to  correct  the  vicious  position.  As  in 
other  cases  of  hysterotomy,  the  operation  should  here  be  under- 
taken early,  before  the  patient  has  become  exhausted  or  the 
fetuses  have  perished  and  become  emph5'sematous,  and  especially 
before  the  genital  passages  have  been  lacerated  and  infected  in  a 
vain  effort  to  bring  about  extraction  by  other  means. 

d.  dvstokia  in  the  anterior  presentation, 
Due  to  the  Hips. 

Interlocking  of  the  Maternal  and  Fetal  Pelves. 

It  not  infrequently  occurs,  especially  in  the  cow,  that  birth 
has  proceeded  with  more  or  less  facility,  with  the  fetus  in  an  ap- 


774  Veterinary  Obstetrics 

parently  normal  position,  until  the  anterior  portions  have  passed 
beyond  the  vulva  and  the  hips  of  the  fetus  have  reached  the 
pelvic  inlet,  when  the  progress  is  interrupted  and  the  fetus  re- 
fuses to  move,  even  under  vigorous  traction.  The  interpretation 
of  this  condition  varies  with  different  obstetrists. 

Some  hold  that  the  dystokia  occurs  because  the  two  stifles  are 
in  a  state  of  abduction  and  thus,  standing  apart,  catch  upon  the 
pelvic  margin  and  stop  the  progress  of  the  fetus.  It  is  difficult 
to  conceive  of  the  possibility  of  such  a  condition,  because  there 
is  nothing  to  maintain  such  abduction,  but  all  the  expulsive 
forces  tend  to  promptly  and  effectively  overcome  it. 

According  to  our  interpetation  of  this  difficulty,  the  conditions 
are  as  we  have  depicted  in  Fig.  109,  page  650,  and  consist  es- 
sentially of  the  interlocking  of  the  pelves  of  the  fetus  and  mother 
in  such  a  way  that,  if  the  traction  is  applied  in  a  somewhat  unfa- 
vorable upward  direction,  the  incarceration  is  emphasized  instead 
of  being  overcome. 

During  its  development  the  embryo  lies  in  the  form  of  the  seg- 
ment of  a  circle,  and  the  ventral  surface  of  the  body  is  main- 
tained in  a  somewhat  concave  form.  When  the  fetus  begins  its 
passage  through  the  birth  canal,  it  maintains  this  curved  form 
until  it  has  been  completely  expelled  from  the  vulva.  If  this 
direction  becomes  interrupted,  according  to  our  observation,  the 
pelvis  of  the  fetus  may  become  interlocked  with  that  of  the 
mother. 

If,  when  the  chest  of  the  fetus  is  passing  through,  or  has 
passed  beyond  the  vulva,  traction  is  directed  upward  instead  of 
downward,  the  external  tuberosities  of  the  fetal  ilia  are  thrown 
upward,  and  the  prepubian  tendon  of  the  fetus,  being  rendered 
tense,  draws  the  fetal  pubis  forward,  flexes  the  fetal  pubis  upon 
the  sacrum  and  increases  the  transverse  diameter  between  the 
supero-external  tuberosities  of  the  fetal  ilia. 

The  tension  upon  the  prepubic  tendon,  by  advancing  the  fetal 
pubis,  increases  greatly  and  dangerously  the  perpendicular 
diameter  of  the  fetal  pelvis.  Normally  the  fetal  pelvis  leaves  the 
spinal  column  at  an  acute  angle,  and,  if  traction  is  exerted  on 
the  spine,  this  angle  is  increased,  the  ilial  tuberosities  are  low- 
ered, and  the  ischia  and  pubis  pass  backwards  and  upwards.  If 
the  traction  is  instead  applied  to  the  pubis  through  the  prepu- 
bian tendon,  the  angle  is  reduced   and  the  ilial  shafts  approach 


Interlocking  of  the  Fetal  and  Maternal  Pelves  775 

the  perpendicular  to  the  fetal  spine.  The  error  in  the  direction 
of  traction  causes  the  fetal  ilia  to  become  firmly  lodged  against 
the  anterior  border  of  the  maternal  ilia,  and  the  more  violent  the 
traction,  the  firmer  the  interlocking. 

When  the  fetal  pelvis  is  large  and  the  external  ilial  tuberosi- 
ties prominent,  the  hips  may  offer  serious  resistance  in  passing 
the  pelvic  inlet,  even  without  the  complication  of  misdirected 
traction. 

With  misdirected  traction  we  have  twice  seen  cows  tied  firmly 
by  the  head  to  a  post,  with  one  or  two  horses  hitched  to  the 
fetus  and  pulling  their  utmost  in  an  attempt  to  bring  away  the 
calf,  but  without  avail. 

The  symptoms  and  diagnosis  of  this  form  of  dystokia  require 
but  little  consideration.  The  fetus,  possibly  rather  large,  gen- 
erally offers  in  the  normal  anterior  presentation,  and  advances 
somewhat  slowly  until  the  hips  have  reached  the  pelvic  inlet, 
when  the  progress  is  stopped  and  the  fetus  cannot  be  advanced 
by  traction  so  long  as  it  is  applied  in  a  direct  line,  parallel  to  the 
long  axis  of  the  body  of  the  mother  or  .somewhat  upwards.  If 
the  operator  can  succeed  in  inserting  his  hand  along  the  fetus 
into  the  uterus,  he  will  find  that  everything  is  apparently  normal, 
except  that  the  pelvis  of  the  fetus  is  firmly  wedged  against  that 
of  the  mother  and  seems  immovable.  We  know  of  but  one  con- 
dition from  which  we  need  to  differentiate  it,  and  that  is  the 
double  monstrosity  known  as  pigodidymus  aversus.  Fig.  129. 

The  indications  in  this  form  of  dystokia  are  : 

1.  The  Application  of  Traction  in  the  Proper  Direction. 
When  a  fetus  is  advanced  without  serious  difficulty  until  it  has 
reached  the  hips,  and  is  in  every  way  normal,  there  is  no  good 
rea.son  why  its  extraction  should  not  be  readily  completed,  if  care 
is  taken  to  apply  the  traction  directly  downward  toward  the  feet 
of  the  mother,  according  to  the  technic  given  on  pages  586  and 
640.     Some  suggest  release  by  partial  rotation. 

2.  Embryotomy.  Failing  to  bring  about  extraction  under 
moderate  force,  the  obstetrist  should  at  once  resort  to  embryot- 
omy, consisting  of  the  destruction  of  the  pelvic  girdle,  as  already 
described  on  page  649. 


7/6 


Vetcrinarv  Obstetrics 


e.  Dystokia  in  the  Anterior  Presentation  due  to  the 

Forward  Extension  of  the  Hind  Limbs 

Beneath    the    Fetal    Body. 

In  the  mare,  and  possibly  in  other  animals,  we  occasionally 
encounter  a  fetus  presenting  anteriorly,  with  the  anterior  limbs 
and  head  in  an  approximately  normal  position,  and  the  two 
posterior  limbs  thrust  forward  in  extreme  extension  beneath  the 
body  of  the  fetus,  so  that  the  two  hind  feet  are  lodged  just  in 
front  of  the  maternal  pubic  brim,  or  have  passed  some  distance 
along  the  pelvic  canal.  This  places  the  fetal  body  in  such  a 
position  that  its  progress  becomes  blocked  when  the  neck  or  chest 
has  appeared  at  the  vulva. 


Fig 


[34.     Forward  Deviation  ok  Posterior  Limbs 
IN  Anterior  Presentation.  (St.  Cyr.) 


The  nature  of  this  presentation  suggests  to  one  that  of  the 
ventral  transverse  presentation,  in  which  all  four  feet  are  present, 
but  the  head  is  wanting,  whereas  in  this  case  all  four  feet  and 
the  head  offer  at  the  inlet,  and  become  more  or  less  engaged  in  it. 

The  fetus  is  ordinarily  in  the  dorso-sacral  position,  with  the 
proper  relations  existing  between  the  two  anterior  limbs  and  the 
head  and  neck.  However,  when  it  has  advanced  sufficiently  for 
the  fore  feet  and  nose  to  show  at  the  vuK'a,  its  further  progress 
becomes  blocked.  In.serting  the  hand  beneath  the  body  of  the 
fetus,  the  operator  encounters  one  or  both  posterior  feet,  either  in 
the  pelvic  canal  or  just  anterior  to  the  brim  of  the  pubis,  where 
they  are  easily  recognized,  their  soles  directed  downwards.  The 
spinal  column  is  jammed  hard  against  the  maternal  sacrum. 


Forward  Extension  of  Posterior  Litnbs  777 

The  prognosis  is  extremely  unfavorable.  Next  to  bi-cornual 
pregnancy,  this  is  one  of  the  most  dangerous  positions  of  the 
fetus  encountered  in  the  mare.  The  fetus  is  doubled  up  in 
such  a  manner  as  to  cause  very  severe  pain  and  violent  straining, 
constantly  threatening  serious  or  fatal  injury  to  the  mother. 
The  position  offers  unusual  opportunity  for  damage  by  empirics, 
and  invites  violent  traction  by  laymen  without  knowledge  of  the 
serious  results  which  are  almost  sure  to  follow.  When  the  two 
posterior  feet  are  lodged  against  the  brim  of  the  pubis,  the  danger 
is  perhaps  greater  than  when  the  hind  feet  are  well  advanced  in 
the  pelvis,  because  the  expuLsive  efforts  of  the  mare,  or  traction 
applied  by  attendants,  tend  to  force  the  two  po.sterior  feet  through 
the  floor  of  the  uterus.  It  is  also  a  position  in  which  the  laj-man 
and  empiric  may  undertake  embryotomy,  and  in  one  case  at- 
tended by  us  they  had  performed  detruncation  through  the 
dorsal  region,  but  had  failed  to  protect  the  genital  organs  from 
the  sharp  bones  which  thej^  had  left.  As  a  consequence,  the 
vagina  was  very  badly  lacerated  and  a  chronic  vagino-cystitis 
followed,  from  which  the  mare  never  recovered,  although  she 
survived. 

The  method  of  handling  varies  greatly  in  the  hands  of  different 
obstetrists. 

I.  Mutation.  Some  advise  the  adjustment  of  the  misplaced 
members,  but  we  find  no  data  to  show  in  what  proportion  of  cases 
such  a  plan  may  succeed.  The  directions  given  are  to  repel  the 
two  hind  feet  as  far  as  possible  into  the  uterine  cavity  and  abdo- 
men, and  then  by  traction  to  bring  the  fetus  away.  It  must  be 
evident  that  it  is  only  in  very  favorable  cases  that  such  an  oper- 
ation can  succeed  in  the  mare.  With  the  anterior  portion  of  the 
fetus  and  its  body  impacted  firmly  in  the  pelvic  canal,  the  oper- 
ator cannot  reach  very  far  into  the  abdominal  cavit)^  and  cannot 
expect  to  repel  the  two  posterior  feet  to  any  very  great  degree. 

The  character  of  the  position  generally  excludes  all  possibility 
of  repelling  the  head  and  body  of  the  fetus,  and  if  the  hind  limbs 
are  very  far  advanced  in  the  pelvic  canal  it  would  seem  impossi- 
ble to  effectively  repel  them.  Even  when  repulsion  has  suc- 
ceeded to  a  degree,  it  is  impossible  for  the  operator  to  know  if 
the  two  hind  feet  rest  in  a  safe  position  where  they  may  turn 
backward  as  the  fetus  nioves  forward,  or  not.  It  seems  to  us, 
from  our  clinical  observation,  that  there  would  be  constant  danffer 


778  Veterinary  Obstetrics 

of  the  hind  feet  being  thrust  through  the  floor  of  the  uterus 
while  traction  is  being  applied  to  the  anterior  portion  and  the 
hips  are  advancing  and  passing  over  the  bent  limbs. 

We  do  not  consider  adjustment  of  the  deviated  posterior  limbs 
safe,  practicable  or  advisable  in  the  mare.  Such  an  operation 
may  be  wholly  feasible  in  the  cow,  but  dystokia  of  this  form  has 
not  been  observed  by  us  in  this  animal.  The  deviation  is 
generally  observed  in  the  mare. 

2.  Forced  Extraction.  Other  obstetrists  advise  forced  ex- 
traction. What  success  they  have  attained  we  cannot  determine 
from  the  literature  before  us,  but  it  would  appear  that  the  posi- 
tion is  one  which  renders  this  operation  specially  dangerous. 
The  plan  of  forced  extraction  is  to  secure  the  two  hind  feet  with 
cords,  advance  them  well  under  the  body  of  the  fetus,  and  then, 
applying  powerful  traction  simultaneously  upon  the  two  hind 
limbs  and  the  head,  bring  it  away  entire.  Such  a  plan  of  delivery 
necessarily  draws  the  pubis  forward  and  forces  the  pelvis  into 
that  unfavorable  position  we  have  already  described  as  "  Inter- 
locking of  the  Fetal  and  Maternal  Pelves." 

3.  Embryotomy  constitutes,  according  to  our  view,  the  most 
desirable  and  rational  method  for  handling  these  cases  in  the 
mare.  In  performing  embryotomy,  our  chief  operation  would 
be  that  of  detruncation,  page  648,  repulsion  of  the  hips,  and 
conversion  of  the  fragment  into  the  posterior  presentation. 

In  all  cases  of  dystokia  in  this  position,  an  unfavorable  prog- 
nosis should  be  given,  whatever  the  method  of  handling.  Be- 
fore beginning  his  operation,  the  veterinarian  should  determine  as 
far  as  possible  if  any  rupture  of  the  uterus  has  been  caused  by 
the  two  posterior  feet,  or  if  they  have  wounded  the  large  uterine 
vessels  of  this  part,  causing  serious  hemorrhage. 

In  our  practice,  one  mare  died  from  uterine  hemorrhage  while  we  were 
preparing  to  attempt  deliver}',  although  the  case  was  a  very  recent  one  and 
had  not  been  greatly  tampered  with. 

In  another  case,  to  which  we  have  already  alluded,  the  owner  and  his 
neighbors  had  bisected  the  fetus  through  the  thorax  and  left  the  vertebrae 
and  ribs  freely  exposed,  and  had  lacerated  and  torn  the  vulva  and  vagina  in 
a  very  repulsive  manner,  so  that,  although  we  succeeded  in  detruncation  at 
the  proper  point  and  the  removal  of  the  remnant  of  the  fetus,  the  lacera- 
tions which  had  been  caused  by  the  owner  were  followed  by  a  severe  and 
chronic  infection,  which  not  only  involved  the  vagina  and  vulva,  but  ex- 
tended into  the  bladder,  causing  a  severe  chronic  purulent  cystitis,  from 
which  recovery  was  very  tardy  and  incomplete. 


Forward  Extensio7i  of  Posterior  Limbs  779 

We  were  called  to  attend  a  vigorous  young  mare  suffering  from  this  form 
of  dystokia.  The  case  was  recent  and  had  not  been  meddled  mth.  Delivery 
by  detruncation  was  prompt  and  easy.  The  mare  died  two  days  later  from 
gangrene  of  the  vulva  and  vagina. 

In  a  fourth  case  a  foal  was  found  one  morning  incarcerated  in  this 
position.  Apparently  the  dystokia  had  existed  much  of  the  night.  The 
delivery  was  eisy.  Gangrene  of  the  vulva  with  sloughing  occurred,  followed 
by  vulvar  constriction  of  such  a  degree  that  copulation  was  not  possible. 

We  have  not  had  a  satisfactory  recovery  in  this  form  of  dys- 
tokia. 


II.  DYSTOKIA  OF  THE  POSTERIOR  PRESENTATION. 

I.    DOKSO-ILIAL    AND    DORSO-Pl'BIC    POSITIONS. 

When  considering  the  normal  course  of  birth  we  had  occasion 
to  observe  that  a  fetus  presenting  posteriorly,  especially  in  the 
larger  domestic  animals,  may  pass  quite  readily  through  the 
pelvic  canal,  so  long  as  it  is  in  the  dorso-sacral  position  ;  but, 
whenever  it  deviates  to  any  great  extent  from  this,  its  passage 
becomes  more  or  less  difficult  or  impossible,  depending  largely 
upon  the  size  of  the  fetus  as  related  to  the  dimensions  of  the 
channel  through  which  it  must  pass. 

The  dorso-pubic  position  is  the  most  unfavorable,  because, 
owing  to  the  curvature  of  the  body  of  the  fetus,  the  hind  feet 
project  upward  against  the  roof  of  the  vagina,  so  that  they  may 
readily  become  engaged  in  the  vaginal  walls  and  cause  more  or 
less  obstruction  to  the  progress  of  the  fetus,  and  at  the  same 
time  greatly  imperil  the  integrity  of  the  soft  parts  of  the  mother. 
When  the  fetus  is  lying  upon  its  back,  its  buttocks  drop  down 
in  front  of  the  pubic  brim  in  such  a  position  that  it  is  exceed- 
ingly difficult  for  the  contraction  of  the  uterus  and  abdominal 
walls  to  lift  it  up  over  the  pubis  and  cause  it  to  enter  the  pelvic 
canal. 

The  indications  in  these  positions  are  to  bring  about  an  ad- 
justment by  rotating  the  fetus  upon  its  long  axis,  as  described 
on  page  632. 

Some  obstetrists  hold  that  the  fetus  ma)--  pass  through  the 
canal  somewhat  easily  when  in  the  dorso-ilial  or  dorso-pubic  po- 
sition, and  that,  in  either  of  these  positions,  it  may  often  be 
forcibly  extracted  without  serious  peril  to  the  mother,  but  ac- 
cording to  general  experience  such  positions  offer  more  or  less 
serious  obstacles  to  delivery,  especially  in  the  calf  and  the  foal. 

If  the  fetus  is  very  large,  the  amount  of  traction  necessary  to 
bring  it  away  passes  the  limit  of  safety  ;  if  the  amount  of  force 
required  is  not  great  it  is  usually  very  easy  to  bring  about  rota- 
tion and  delivery  by  the  more  natural  method.  Thus,  forced 
extraction  has  a  very  limited  application  in  this  form  of  dystokia. 

Embryotomy  might   be  demanded   in  very  rare  cases,  where, 
owing  to   firm  impaction   in   the  pelvic  canal,  rotation  becomes 
impossible  and  forced  extraction  unsafe. 
780 


Flexion  of  the  Hind  Legs  at  the  Tarsus  781 

2.  Flexion  of  the  Hind  Limbs  at  the  Tarsus. 

We  meet  occasionally,  especially  in  the  mare  and  cow,  with 
dystokia  due  to  the  tarsal  articulations  becoming  flexed  and 
either  entering  the  pelvic  canal  or  becoming  caught  just  in  front 
of  the  pubis.  This  displacement  constitutes  a  formidable  obstacle 
to  the  expulsion  of  the  fetus,  because  it  necessarily  involves  the 
flexion  of  all  the  articulations  of  the  limb,  and  consequently 
greatly  increases  the  diameter  as  measured  from  the  fetal  sacrum 
down  through  the  folded  limb.  The  femur  is  flexed  upon  the 
pelvis,  the  tibia  upon  the  femur,  the  metatarsus  upon  the  tibia, 


Fic.  135.     Rktextiox  of   Posterior  Li.mrs  at 

THK    T.\RSUS.       (FrANCK). 

and  the  phalanges  upon  the  metarsus.  We  cannot  extend  one 
of  these  articulations  completely  until  the  others  are  ready  to  be 
simultaneously  extended,  and  the  folding  of  the  limbs  in  this 
manner  quite  effectively  prevents  the  passage  of  a  fetus  of  normal 
dimensions  through  the  pelvic  canal. 

The  diagnosis  is  comparatively  easy.  Upon  inserting  the 
hand,  the  operator  may  first  touch  the  tail,  or  the  ischiatic  tuber- 
osities, lyying  just  beneath  and  in  front  of  the  pubic  border, 
there  is  recognized  the  summit  of  one  or  both  hocks.  In  some 
cases  the  flexed  hocks  extend  into  the  pelvic  canal.     The  fetus 


782  Veterinary  Obstetrics 

is  thus  lying  in  the  position  of  ordinary  sternal  recumbency,  with 
the  hind  feet  closely  doubled  immediately  beneath  the  body. 

The  cause  of  this  displacement  is  not  far  to  seek.  In  discuss- 
ing the  normal  position  of  the  fetus  in  the  uterus,  we  have  noted 
that  it  usually  lies  with  its  hind  legs  folded  beneath  its  abdomen. 
When  parturition  occurs,  the  limbs  should,  under  normal  condi- 
tions, become  extended,  so  that  in  a  posterior  presentation  the 
most  advanced  part  should  be  the  two  hind  feet.  When  this  ex- 
tension fails  to  take  place,  and  the  fetus  is  forced  toward  the 
pelvic  inlet  in  the  position  in  which  it  has  previously  lain,  the 
points  of  the  ossa  calces  naturally  become  caught  against  the  pubic 
brim,  or  advance  fora  short  distance  in  the  pelvic  canal,  and  stop 
further  progress  in  the  expulsion  of  the  fetus. 

Handling,  i.  The  correction  of  the  deviation  should  in  all 
cases  be  undertaken  if,  in  the  judgment  of  the  obstetrist,  it  can 
be  properly  accomplished.  The  overcoming  of  the  deviation 
consists  first  in  the  repulsion  of  the  fetus  obliquely  forward  and 
upward,  as  described  on  page  595.  The  mother  should  prefer- 
ably be  in  the  standing  position,  with  the  hind  parts  elevated. 
If  unable  to  rise,  she  should  be  placed  in  lateral  recumbency,  or 
sometimes  still  better,  in  the  dorsal  position,  still  applying  the 
rule  of  keeping  the  posterior  portions  of  the  mother  higher. 
When  the  repulsion  has  been  accomplished,  the  extension  of  the 
limbs  is  to  be  carried  out  as  described  on  page  636. 

2.  Forced  extraction  has  been  suggested  by  some  operators,  although 
neither  its  advantages  nor  safety  have  been  clearly  demonstrated.  As  a 
general  rule  the  so-called  forced  extraction  in  this  position  really  involves 
partial  embryotomy  by  the  severing  of  the  tendo-Achilles,  which,  by  permit- 
ting dorsal  flexion  at  the  fetlock,  ameliorates  the  dystokia.  In  our  judg- 
ment forced  extraction  is  never  necessary,  and  rarely  if  ever  justifiable,  even 
with  the  severing  of  the  tendo-Achilles. 

3.  Embryotomy  occasionally  becomes  necessary  or  desirable. 
In  case  of  a  very  large  foal,  or  when  the  foal  or  calf  is  dead  and 
emphysematous,  and  especially  in  those  cases  where  the  patient 
is  unable  or  unwilling  to  stand,  it  may  be  impossible,  or  at  least 
impracticable,  to  adjust  the  position,  and  consequently  embry- 
otomy must  be  performed. 

Embryotomy  in  these  cases  is  very  simple,  consisting  merely 
of  the  amputation  of  the  foot  with  the  chisel,  through  the  lower 
portion  of  the  tarsus,  as  described  on  page  651. 

4.  Caesarian  section,  page  663,  may  become  necessary  iu  the 


Cotnplete  Retention,  of  the  Posterior  Limbs 


783 


smaller  domestic  animals,  where  the  adjustment  of  the  deviated 
limbs  or  embryotomy  is  not  available. 

3.  Complete  Retention  of  the  Posterior  Limbs. 
Breech  Presentation. 

The  breech  presentation  may  be  met  with  in  any  of  the  domes- 
tic animals,  and  probably  acquires  its  greatest  .significance  in  the 
mare,  where  it  constitues  a  very  formidable  cause  of  dystokia.  It 
differs   from   the   preceding  deviation  in  that,   instead  of  being 


Fig.  136.     Breech  Presentation-.     (St.  Cvr.  ) 

flexed  at  the  hocks,  the  posterior  limbs  are  flexed  upon  the 
pelvis,  beyond  which  each  joint  is  in  rigid  extension  and  the 
limbs  are  thrust  forward  beneath  the  abdomen  and  chest  of  the 
fetus.  The  causes  are  identical  with  those  of  the  preceding,  and 
probably  in  many  cases  complete  retention  follows  flexion  at  the 
tarsus.  The  flexed  tarsus  becomes  caught  against  the  brim  of 
the  pubis,  and  the  expulsive  efforts  of  the  mother,  pushing  the 
fetal  body  along,  cause  the  ossa  calces  to  glide  downward  and  then 
forward,  and  the  tarsus  to  become  extended,  until  finally  the  en- 
tire limb  is  pushed  forward  beneath  the  body.  The  operator,  upon 
examining  the  case,  usually  meets  first  with  the  tail  or  buttocks 


784  Veterhiarv  Obstetrics 

of  the  fetus,  and  in  many  cases  can  only  touch  the  tibia  or  other 
portion  of  the  limb  with  very  great  difficulty.  Sometimes  na 
part  of  the  hind  limb  can  be  grasped  or  recognized  until  after  re- 
pulsion has  taken  place. 

1.  The  adjustment  of  the  deviated  limbs  is  first  of  all  indi- 
cated. The  fetus  should  be  repelled,  as  described  on  page  595, 
after  which  the  tibia  or  metatarsus,  as  may  be  available,  should 
be  secured  by  means  of  cords,  as  described  on  page  579.  By 
continuing  repulsion,  the  position  is  to  be  converted  into  a  hock 
presentation,  after  which  the  further  handling  of  the  case  is  iden- 
tical with  that  position  which  has  already  been  described. 

2.  Forced  extraction  has  been  advised  by  some  operators  in 
these  cases.  As  to  how  successful  they  have  been  our  veter- 
inary literature  is  not  very  clear.  They  suggest  a  variety  of  ways 
for  bringing  about  forced  extraction.  Some  recommend  that  a 
cord  with  a  running  noose  be  passed  around  the  loins  of  the  fetus 
and  secured,  or  rather  that  the  cord  be  passed  around  each  of  the 
thighs  and  then  passed  through  the  noose  at  the  top  of  the  back, 
so  that  the  loins  of  the  fetus  are  secured  and  the  operator  is 
enabled  to  apply  any  degree  of  traction  which  may  be  desired. 

Others  would  apply  traction  by  means  of  sharp  hooks  deeply 
imbedded  in  the  flanks,  like  the  flank  hooks  of  Harms.  Yet  other 
obstetrists  would  incise  the  perineum  of  the  fetus  and,  inserting 
the  hook  through  the  fetal  pelvis,  engage  it  in  the  obturator 
foramen  or  in  front  of  the  pelvis,  and  exert  traction  in  this  way. 

While  forced  extraction  may  be  somewhat  easier  for  the  ob- 
stetrist,  we  do  not  consider  it  warranted  by  modern  surgical  prin- 
ciples. We  have  at  no  time  found  any  need  for  applying  forced 
extraction. 

3.  Embryotomy  offers  the  most  valuable  method  for  over- 
coming this  form  of  dystokia,  especially  in  the  mare,  in  all  those 
cases  where  adjustment  is  impossible  or  difficult.  Whenever  the 
fetus  is  comparatively  large  or  is  dry  or  emphysematous,  or  for 
any  other  reason  it  is  exceedingly  difficult  or  impracticable  to 
bring  about  an  adjustment  of  the  position,  embryotomy  is  highly 
commended,  and  should  be  undertaken  promptly,  before  the  ope- 
rator and  patient  have  become  exhausted  in  fruitless  endeavors. 
Various  forms  of  embryotomy  have  been  recommended  b\'  differ- 
ent writers,  but  we  greatly  prefer  the  intra-fetal  amputation  of 
the  two  posterior  limbs,  as  described  on  page  653.     Others  prefer 


Complete  Retention  of  the  Posterior  Limbs  785 

to  amputate  the  limbs  extra- fetally,   with  the  knife,    Persson's 
saw,  or  the  Pflanz  embrytom. 

4.  Caesarian  section,  as  described  on  page  663,  is  sometimes 
necessar}^  in  the  smaller  animals,  like  the  sow  and  bitch,  but  is 
uncalled  for  in  the  cow  and  mare  because  embryotomy  is  always 
readily  available. 


50 


III.   TRANSVERSE  PRESENTATIONS. 

a.  DoKSAL  Transverse  Presentation. 

Transverse  presentations  are  virtually  confined  to  the  unipa- 
Tous  animals,  and  among  these  the  overwhelming  majority  occur 
in  the  mare.  The  fetus  usually  presents  ventrally,  except  in 
those  cases  we  have  already  described  as  Bi-cornual  Pregnancy 
on  page  716. 

When  the  dorsum  of  the  fetus  offers  at  the  pelvic  inlet  in  the 
right  or  left  cephalo-ilial  position,  the  position  is  usually  uncom- 
plicated by  any  further  deviation,  so  that,  when  the  operator 
inserts  his  hand,  it  comes  at  once  into  contact  with  the  dorsal 
surface  of  the  fetus,  which  is  easily  recognized.  By  extending 
the  hand  to  the  right  or  left,  he  may  palpate  and  recognize  the 
hips  or  the  shoulders  and  neck.  As  a  general  rule  the  operator 
does  not  come  in  contact  with  the  head  or  any  of  the  feet,  but 
only  with  the  body,  although  in  rare  cases  one  or  more  of  the 
feet  may  be  more  or  less  misplaced  in  their  general  relation  to 
the  body  of  the  fetus,  and  project  in  such  a  manner  that  they 
may  be  felt  or  grasped  by  the  operator,  in  one  case  in  our  ex- 
perience, one  hind  leg  passed  backward  over  the  fetus  into  the 
pelvic  canal. 

The  causes  of  transverse  presentations  are  not  well  defined. 
Most  obstetrists  hold  that  they  are  acquired  positions,  occurring 
during  labor  ;  but,  as  we  have  related,  page  716,  the  fetus  of  the 
mare  occasionally  develops  equally  in  the  two  uterine  cornua-,  in 
a  transverse  position.  In  the  anomalous  development  which  we 
have  described,  the  fetal  body  revolves  upon  its  long  axis  in  order 
to  attain  a  stable  position. 

We  do  not  know  that  all  fetuses  developing  transversely  in 
the  mare  undergo  this  rotation,  and  we  can  readily  conceive  it  as 
being  wholly  possible  that  no  rotation  should  occur,  in  many 
cases,  and  consequently  that  the  fetus  may  develop  transversely 
and,  without  rotation,  present  transversely  at  the  time  of  partu- 
rition. 

Handling.  Version,  as  described  on  page  634,  is  usually 
the  best  and  most  effective  method  of  handling.  In  almost  every 
case  it  succeeds  well.  Should  this  fail,  it  may  be  necessary  to 
perform  detruncation  in  the  lumbar  region.  The  detruncation 
is  to  be  accomplished  chiefly  with  the  chisel,  severing  first  the 
786 


Traiisverse  Presentations 


787 


spinal  column.  The  soft  parts  may  be  most  conveniently  sev- 
ered with  the  finger  knife.  Evisceration,  page  648,  should  fol- 
low. The  posterior  half  may  be  secured  by  means  of  a  rope  noose 
about  the  lumbar  vertebrae,  or  by  hooks  or  cords  applied  inside 
the  pelvis. 

It  may  prove  necessary  to  extend  the  embryotomy  to  include 
the  destruction  of  the  pelvic  girdle,  pages  661  and  649.  In 
other  cases,  the  posterior  half  of  the  fetal  body  may  be  repelled, 
and  converted  into  a  posterior  presentation. 


Fig.  137.     Dorsal  Presentation..   (Franck). 

The  anterior  half  is  to  be  managed  in  a  similar  manner.  After 
evisceration  it  may  be  desirable  to  sever  the  ribs,  page  656,  so 
as  to  permit  the  fetal  chest  to  collapse.  The  remnant  may  now 
be  extracted  by  securing  the  dorsal  vertebrae  by  means  of  a  cord 
and  exerting  traction  upon  it. 

In  some  cases  it  may  be  practicable  or  preferable  to  convert 
the  anterior  half  into  the  anterior  presentation. 

In  one  instance  occurring  in  our  practice,  due  to  abortion  in 
a  mare,  the  fetus  was  in  the  dorsal  transverse  presentation,  with 
its  upper  hind  leg  extended  over  its  back  into  the  pelvic  canal. 
The  leg  could  not  be  returned  into  the  uterine  cavity,  and  con- 
sequently detruncation  was  effected,  after  which  it  was  easy  to 
convert  the  posterior  half  into  a  posterior  presentation,  and  the 
two  pieces  were  readily  removed. 


788  Veter7iary  Obstetrics 

b.  Ventral  Transverse  Presentation. 

Most  fetuses  in  the  transverse  presentation  offer  at  the  pelvic 
inlet  by  their  ventral  surfaces.  The  head  of  the  fetus  is  retained, 
all  the  feet  offer  in,  or  are  somewhere  near  to,  the  pelvic  inlet,  and 
the  fetus  lies  upon  its  side,  more  or  less  transverse  to  the  spinal 
axis  of  the  mother,  with  the  fetal  head  resting  in  the  region  of 
one  or  the  other  of  the  maternal  ilia — right  or  left  cephaloilial 
position. 

Symptoms.  In  most  instances  some  or  all  feet  appear  at  or 
near  the  vulva,  but  no  essential  progress  is  made  in  the  expul- 
sion of  the  fetus,  although  the  animal  may  make  violent  expul- 
sive efforts,  and  neighbors  and  empirics  may  apply  force. 

In  a  large  proportion  of  the  cases  in  the  mare,  wr3'-neck  is 
present.  If  the  wry-neck  is  to  the  right  the  fetus  usually  lies 
upon  its  right  side,  and  if  to  the  left  upon  its  left  side,  so  that  the 
head  in  a  large  proportion  of  cases  is  entirely  out  of  reach,  which 
in  many  respects  is  fortunate.  Upon  inserting  the  hand,  the 
obstetrist  usually  meets  with,  and  can  identify,  all  four  of  the 
limbs.  In  some  cases  it  may  be  exceedingly  difficult  for  him  to 
differentiate  between  the  different  members,  so  badly  are  they 
entangled  with  each  other,  and  so  tightly  impacted  in  the  pelvic 
canal. 

This  form  of  dystokia  is  quite  favorable  for  the  mare,  because 
the  owner  or  empiric  is  usually  balked  at  once  in  any  effort  to 
meddle  with  the  case,  and  must  consequently  await  the  arrival 
of  the  veterinarian.  Even  more  or  less  violent  traction  upon  the 
fetus,  as  a  general  rule,  produces  little  harm,  because  its  position 
is  such  that  any  moderate  force  applied  to  the  feet  cannot  wedge 
the  fetal  body  in  the  pelvic  inlet  or  force  any  projecting  portion 
of  the  fetus  against  the  soft  parts  of  the  mother. 

Handling,  i.  Version.  In  the  cow  it  may  be  practical  and 
advisable  to  attempt  adjustment  without  embryotomy,  because 
the  feet  and  legs  are  shorter  and  more  pliable  than  those  of  the 
foal.  If  it  is  decided  to  perform  version  of  the  fetus,  the  two 
posterior  limbs  are  to  be  corded  at  the  pastern,  and  the  two 
anterior  limbs  pushed  away  forward  as  far  as  the  operator  can 
reach,  while  an  assistant  advances  the  posterior  limbs  by  exert- 
ing traction  upon  the  cords,  as  described  on  page  634.  The 
operator  thus  converts  a  transverse  into  a  posterior  presentation, 
after  which  the  delivery  is  completed  as  such. 


Ve?itral  Transverse  Presenilation 


789 


2.  Embryotomy.  In  the  mare  we  regard  embryotomy  as  be- 
ing simpler  and  safer  than  version,  without  generally  involving  any 
great  amount  of  labor  upon  the  part  of  the  obstetrist.  Embry- 
otomy in  these  cases  consists  of  the  subcutaneous  removal  of  the 
two  anterior  limbs,  as  described  on  page  645,  followed  by  version 
of  the  fetal  remnant,  which  is  to  be  brought  about  by  repelling 
the  chest  and  applying  traction  to  the  two  posterior  limbs,  in  or- 
der to  convert  the  transverse  into  a  posterior  presentation. 

This  position  is  subject  to  a  variety  of  complications,  which 
may  tax  the  skill  and  endurance  of  the  operator.  In  the  typical 
case  in  the  mare,  which  we  have  described  above,  it  requires  only 
about  one  hour  or  one  and  a  half  hours  to  perform  embryotomy 


Fig.  138.     Ventral  Presentation.     (Franck). 
and  deliver  the  fetus  as  outlined.     An  expert  operator  may  even 
accomplish  the  task  in   much  le.ss  time,  but  in  the  presence  of 
certain  complications  it  may  require  very  much  more  time. 

In  one  of  mv  cases  all  four  feet  of  the  fetus  had  already  passed  through 
the  vulva,  and  the  four  large,  bony  limbs  were  tightly  impacted  in  the  pelvic 
canal,  completely  filling  it,  so  that  it  was  only  with  difficulty  that  the  arm 
could  be  inserted  alongside  or  between  them.  I  could  reach  neither  of  the 
shoulders  to  amputate  subcutaneously,  but  was  forced  to  amputate  one  at 
the  elbow  joint,  and  the  other  with  difficulty  at  the  scapulo-humeral  articu- 
lation, but  these  amputations  served  my  purpose,  and  permitted  delivery 
after  some  five  or  six  hours  of  fatiguing  labor.  The  case  was  further  com- 
plicated by  the  viciousness  of  the  mare,  which  persistently  fought  by  kick- 
ing, striking  or  biting  at  any  one  within  her  reach,  so  that  it  became  neces- 
sary to  cast  her  and  securely  tie  all  four  feet.     The  recumbency,  with  the 


790  Veterinary  Obstetrics 

cramped  position  of  all  four  feet,  induced  extraordinary  pressure  upon  the 
abdomen  and  greatly  restricted  the  room  for  the  work.  Nevertheless  she 
made  a  good  recover}'. 

In  another  instance  the  two  anterior  limbs  were  well  advanced  in  the  pel- 
vis, with  the  feet  protruding  beyond  the  vulva,  while  the  two  hind  feet  were 
jammed  across  the  pelvic  inlet.  The  upper  hind  foot  crossed  above  the  up- 
per forefoot  in  front  of  the  pelvic  inlet,  and  the  toe  was  firmly  caught  in 
front  of  the  shaft  of  the  maternal  ilium,  while  the  hock  lay  immovably  fixed 
against  the  iliac  shaft  on  the  other  side.  The  lower  hind  foot  passed  be- 
tween the  two  anterior  limbs,  and  was  otherwise  engaged  in  the  same  way 
as  the  upper  hind  foot. 

It  was  impossible  to  repel  the  fetus,  and  equallj'  impossible  to  reach  the 
uppermost  shoulder  to  amputate  the  anterior  limb,  because  of  its  being 
crossed  by  the  metatarsus.  With  the  chisel,  we  therefore  amputated  the  up- 
per hind  foot  through  the  lower  part  of  the  tarsus,  removed  the  foot,  and 
secured  the  stump  above  the  os  calcis  with  a  cord.  The  upper  fore-leg  was 
then  removed  subcutaneously.  Next  the  lower  hind  foot  was  amputated  at 
the  tarsus,  in  the  same  manner  as  the  first  one,  and  the  stump  was  secured 
with  a  cord.  Finally  the  lower  anterior  limb  was  amputated  subcutaneous- 
ly, after  which  the  chest  was  repelled,  while  traction  was  applied  to  the 
stumps  of  the  amputated  hind  limbs,  and  the  remnant  of  the  fetus  was  con- 
verted into  a  posterior  presentation. 


PATHOLOGY  OF  THE  PARTURIENT  OR  PUERPERAL 
STATE. 

Grouped  about  the  act  of  parturition,  there  is  a  highly  inter- 
esting and  important  series  of  accidents  and  diseases  of  the  mother, 
which  require  close  study  upon  the  part  of  the  veterinary  obstet- 
rist.  They  occur  in  all  animals,  although  one  or  another  disease 
or  accident  may  be  far  more  frequent  in  one  species  than  in  an- 
other. These  diseases,  injuries  or  infections  usually  have  some 
definite  time  at  which  their  foundation  is  chiefly  laid,  but  there 
are  wide  variations  as  to  the  exact  time  of  the  advent  of  the 
symptoms.  In  some  instances  they  may  occur  before  parturition; 
in  others,  during  or  after  that  act.  Many  of  them  pass  by  im- 
perceptible gradations  from  one  into  another,  which  tends  to  ren- 
der their  classification  somewhat  difficult,  and  subjects  any  plan 
which  may  be  suggested  to  certain  objections.  For  con- 
venience, this  group  of  affections  may  be  divided  into  five 
classes  :  Pathology  of  the  Placenta  ;  Wounds  and  Injuries  of  the 
Genital  and  Neighboring  Organs  ;  Puerperal  Infections  ;  Partu- 
rient Eclamptic  Diseases  ;  and  Di.seases  of  the  Mammae. 

I.  PATHOLOGY  OF  THE  PLACENTA. 

Retention  of  the  fetal  Envelopes.     Retained 
Afterbirth. 

In  dealing  with  the  question  of  birth,  we  have  already  had  oc- 
casion to  allude  on  page  516  to  extra  resistance  of  the  chorion, 
which,  it  has  been  claimed,  sometimes  imperils  the  life  of  the 
fetus  ;  on  page  742,  to  adhesions  between  the  fetal  membranes  and 
the  fetus  as  a  cause  of  difficult  labor  ;  and  on  page  525,  to  the  rup- 
ture of  the  chorion  and  its  expulsion  with  the  other  membranes, 
in  advance  of  the  fetus,  leading  thereby  to  fetal  death.  These 
conditions  are  rare,  and  relatively  unimportant  from  an  economic 
standpoint. 

Retained  placenta  constitutes  one  of  the  most  common  and 
serious  maladies  among  the  diseases  of  the  puerperal  state,  espe- 
cially in  the  cow.  In  considering  normal  birth,  we  have  noted 
that,  as  a  consequence  of  that  act  and  following  closely  upon 
the  expulsion  of  the  fetus  itself,  there  should  normally  occur  a 
separation  of  the  fetal  placenta  from  that  of  the  mother  and  an. 
791 


792  Veterinary  Obstetrics 

expulsion  of  the  fetal  membranes  from  the  uterus.  If  they  remain, 
they  inevitably  undergo  decomposition  and  cause  more  or  less 
serious  disease.  When  the  fetus  has  been  removed  or  has  ceased 
to  live,  and  the  passage  of  blood  through  the  umbilic  cord  has 
ceased,  these  membranes  become  essentially  foreign  bodies,  highly 
subject  to  infection,  which  more  or  less  seriously  involves  the 
uterus  and  the  animal  system  as  a  whole. 

A  study  of  the  placentae  of  the  domestic  animals  shows  that 
the  intimacy  of  contact  between  fetal  and  maternal  placentae 
varies  greatly  in  the  different  species.  The  placental  tufts  are 
very  much  longer  and  more  complex  in  ruminants  than  in  other 
domestic  animals.  In  ruminants  the  placental  attachments  are 
not  uniform  over  a  large  area,  as  in  the  mare  and  sow,  but  they 
are  concentrated  upon  certain  well-defined  areas,  where  their 
attachment  is  all  the  more  complex.  It  would  at  once  be  sus- 
pected, after  a  study  of  the  anatomy  of  the  placentae  of  various 
domestic  animals,  that  ruminants,  with  their  highly  complex 
cotyledonous  placentae  and  very  complex  placental  villi,  would 
be  far  more  subject  to  retention  of  the  fetal  membranes  than  is  any 
other  animal.  This  suggestion,  however,  holds  true  for  but  one 
member  of  the  group,  the  cow.  Retained  placenta  may  almost 
be  said  to  be  a  disease  of  the  cow,  so  far  as  the  domestic  animals 
are  concerned.  While  the  condition  is  met  with  in  all  domestic 
animals,  and  acquires  importance  in  mares,  there  is  no  such 
number  of  instances  in  any  other  domestic  animator  in  all  others 
combined,  as  in  the  cow.    See  Fig.  97,  p.  361  and  Fig.  139,  p.  802. 

It  is  diflficult  to  define  in  exact  terms  what  constitutes  retained 
placenta.  The  line  between  the  normal  and  abnormal  duration 
of  retention  of  the  placenta,  after  the  expulsion  of  the  fetus, 
constantly  vacillates  according  to  species  and  individual,  so  that 
the  term  is  largely  a  comparative  one.  In  the  mare  the  chorion 
usually  separates  from  the  uterus  within  10  to  15  minutes  after 
the  expulsion  of  the  fetus,  and  if  it  remains  over  30  minutes  it 
might  be  very  properly  considered  abnormal,  although  in  all 
probability  it  may  yet  separate  and  come  away  spontaneously 
after  a  further  trifling  delay,  and  the  case  pursue  an  apparently 
normal  course. 

In  cows  the  fetal  membranes  usually  do  not  become  detached 
so  quickly.  In  a  large  proportion  of  cases  they  still  remain  at- 
tached to  the  cotyledons  after  one-half  to  one  hour,  and,  not  at 


Retained  Placenta  in  the  Cow  793 

all  rarely,  in  cases  which  are  apparently  normal,  they  remain  from 
4  to  12  hours  or  ev^en  more,  before  becoming  detached  and  drop- 
ping away.  However,  if  they  remain  for  a  longer  period  than  10 
to  12  hours  after  the  expulsion  of  the  fetus,  especially  if  the  latter 
has  been  carried  for  the  full  term,  most  obstetrists  would  regard 
the  further  retention  as  abnormal. 

In  the  smaller  ruminants,  the  ewe  and  goat,  the  placenta  is 
usually  expelled  with  more  promptness  and  uniformity  than  in 
the  cow. 

In  raultiparous  animals  it  is  the  rule,  if  not  a  necessity,  that  the 
placenta  of  each  fetus  shall  become  expelled  prior  to  the  expul- 
sion of  the  next  fetus  from  the  same  cornu,  and  the  last  fetus  is 
almost  immediately  followed  by  the  expulsion  of  its  membranes. 

I.  Retained  Placenta  in  the  Cow. 

Although,  among  all  the  domestic  animals,  the  cow  is  by  far  the 
most  subject  to  retained  fetal  membranes,  the  causes  of  such  re- 
tention have  not  been  made  wholly  clear  by  veterinary  writers, 
and  in  fact  comparatively  little  investigation  has  been  made, 
with  a  view  to  a  scientific  explanation  of  the  pathologic  condi- 
tion. 

By  many  it  has  been  regarded  as  a  disease  of  the  membranes, 
by  which  they  adhere  with  abnormal  tenacity  to  the  maternal 
placenta.  While  the  tufts  of  the  chorion  are  very  long  and  nu- 
merously branched,  and  sink  into  the  recesses  in  the  cotyledons 
of  the  mother,  they  have  no  power  within  themselves  of  holding 
fast  to  the  maternal  tissues.  It  has  already  been  stated  that,  at 
no  time  during  fetal  life,  is  there  any  direct  communication  be- 
tween the  maternal  placenta  and  the  placental  tufts  of  the  cho- 
rion, but  they  are  always  normally  separated  by  two  layers  of 
epithelial  cells,  the  one  maternal,  the  other  fetal. 

It  has  long  been  believed  and  taught  that,  under  certain  dis- 
eased conditions,  adhesions  take  place  between  the  tufts  of  the 
fetal  chorion  and  the  corresponding  septa  of  the  maternal  pla- 
centa, but  no  such  adhesions  have  as  yet  been  observed  by  his- 
tologic examination.  While  we  are  not  in  a  position  to  deny  the 
possibility  of  such  adhesions,  it  is  certain  that,  if  they  occur  at 
all,  they  are  so  rare  as  to  constitute  no  important  element  in  the 
question  as  a  whole. 


794  Vetertnarv  Obstetrics 

Retention  of  the  fetal  membranes  in  the  cow  is  due  primarily 
to  the  incarceration  of  the  tufts  of  the  chorion  within  the  crypts 
of  the  maternal  cotyledons. 

Recently  Pomayer,'  in  a  very  extended  study,  has  quite  well 
shown  the  principal  causes  of  retained  afterbirth  by  histologic 
research,  and  his  findings  and  conclusions  are  in  full  accord  with 
clinical  experience.  Pomayer  holds  that  retained  fetal  mem- 
branes are  due  to  inflammation  and  swelling  of  the  maternal  pla- 
centa, that  is,  placentitis  or  cotyledonitis.  The  lesions  within 
the  cotyledons  may  be  of  two  classes,  aseptic  and  septic. 

During  pregnancy  an  animal  may  receive  a  blow,  be  gored  by  a 
cow,  or  meet  with  some  other  external  injury  which  may  more 
or  less  detach  some  portion  of  the  chorion  from  the  maternal  pla- 
centa. Hemorrhage  may  take  place  to  a  limited  degree,  followed 
by  a  more  or  less  extensive  inflammation,  with  new  formation  of 
connective  tissue  between  the  mucous  membrane  of  the  placenta 
and  the  epithelial  tufts  of  the  chorion.  Should  the  hemorrhage 
between  the  two  parts  become  very  great,  it  may  cause  so  exten- 
sive a  separation  as  to  induce  the  death  and  expulsion  of  the 
fetus.  If  the  hemorrhage  is  not  so  great,  and  the  inflammatory 
processes  already  mentioned  take  place,  the  fetal  membranes  may 
become  more  or  less  incarcerated  and  held  over  a  limited  area, 
but  there  would  be  no  general  retention  of  the  entire  fetal  mem- 
branes, or  rather  we  would  say  that,  in  the  cow,  the  fetal  mem- 
branes would  become  readily  detached  from  all  the  cotyledons 
.save  one  or  two  which  had  been  implicated  in  the  injury  during 
pregnancy.  With  this  group  of  cases,  we  have  little  to  do,  and 
clinically  it  is  virtually  neghgible. 

The  important  group,  from  the  practitioner's  standpoint,  con- 
sists of  those  cases  in  which  infection  plays  the  chief  role  and 
the  retention  of  the  afterbirth  is  finally  maintained  by  the  in- 
flammation of  the  maternal  placenta.  By  observing  Figs.  79  and 
139,  it  will  be  .seen  how  intimate  is  the  relation  between  the  chorion 
and  the  cotyledons  in  the  cow,  and  it  will  be  readily  understood 
that,  when  the  cotyledons  become  inflamed  and  swell,  the  very 
complex  chorionic  tufts  may  become  more  or  less  immovably 
fixed  and  held. 


I^as  Zuriickhalten  der  Nachgeburt  beim  Rind,  by  Dr.  Phil.  C.  Pomaver. 


Retained  Place^ita  in  the  Coiv  795 

The  advent  of  cotyledonitis  may  vary  in  different  cases.  In 
many  instances,  the  disease  of  the  placenta  precedes  the  expul- 
sion of  the  fetus,  and  consequently,  at  the  time  of  the  expulsion 
of  the  calf,  the  pathologic  conditions  which  must  result  in  reten- 
tion of  the  fetal  membranes  are  already  present,  and  fully  devel- 
oped. This  is  especially  true  in  contagious  abortion,  in  which 
there  is  frequently  more  or  less  infection  of  the  cotyledons,  prior  to 
the  expulsion  of  the  uterine  contents.  If  the  abortion  occurs 
early  in  pregnancy,  before  the  chorionic  tufts  have  become  de- 
veloped, the  fetal  membranes  are  regularly  expelled  along  with 
the  aborted  fetus.  L^ater  in  pregnancy,  after  the  chorionic  tufts 
have  become  more  developed,  with  corresponding  complexity  of 
the  maternal  placenta,  retained  afterbirth  becomes  v^ery  common, 
and  is  referable  to  the  existence,  at  the  time  of  the  expulsion  of 
the  fetus,  of  a  distinct  inflammation  of  the  maternal  placenta, 
which  incarcerates  and  holds  the  chorionic  tufts  of  the  fetal  pla- 
centa. In  other  cases,  also,  inflammation  has  already  advanced 
into  the  uterus,  and  brought  about  an  inflammation  of  the  coty- 
ledons, prior  to  the  expulsion  of  the  fetus.  In  the  granular  vene- 
real disease  of  cows,  where  the  granular  inflammation  extends 
into  the  uterus,  if  the  death  of  the  fetus  fails  to  be  brought 
about,  but  instead  its  premature  expulsion  is  caused,  the  cotyle- 
dons readily  suffer,  and  the  expulsion  of  the  immature  fetus  may 
be  followed  by  the  retention  of  the  membranes. 

When  a  pregnant  animal  has  suffered  for  a  long  period  of  time 
from  prolapse  of  the  vagina  and  of  the  vaginal  portion  of  the 
uterus,  the  uterine  cavity  is  very  prone  to  become  infected,  since 
the  chief  barrier  to  uterine  infection,  the  healthy  vagina,  has 
been  replaced  by  a  diseased  and  infected  organ. 

Similar  conditions  prevail  when  torsion  of  the  uterus  has  oc- 
curred, because  compression  and  stretching  of  the  tissues  have 
greatly  decreased  their  power  of  resisting  infection  and  permitted 
the  infection  to  extend  into  the  uterine  cavity  and  involve  the 
placenta.  Any  cause  which  may  operate  in  such  a  way  as  to 
permit  the  access  of  disease-producing  organisms  into  the 
uterine  cavity  may  at  any  time  cause  infection  of  the  maternal 
placenta  and  bring  about  a  degree  of  inflammation  and  swelling 
which  will  eventually  cause  a  retention  of  the  fetal  membranes. 

In  the  other  important  group  of  cases,  those  in  which  the  dis- 
eased condition  occurs  after  the  completion  of  birth,  infection 


796  Veteri7iary   Obstetrics 

is  favored  in  a  quite  different  manner.  The  observations  of 
Poniayer  upon  this  point  are  very  exact  and  convincing.  If 
birth  has  been  difficult,  if  the  animal  is  weak  and  debilitated,  or 
if  the  uterus  is  in  a  debilitated  state  from  the  expulsion  of  the  fetus, 
retention  of  the  fetal  membranes  is  very  probable.  The  expul- 
sion of  the  fetus  has  exhausted,  in  these  cases,  the  contractile 
powers  of  both  the  uterus  and  the  abdominal  walls.  In  most 
cases  of  parturition,  there  is  a  definite  and  well-marked  exhaus- 
tion at  the  completion  of  the  act.  and  a  period  of  rest  at  once 
follows.  Later,  when  the  animal  system  and  the  uterus  have 
recovered  from  the  exhaustion  of  parturition,  contractions  of  the 
uterine  and  of  the  abdominal  walls  normally  occur,  and  serve  to 
press  out  any  remaining  fetal  fluids,  and  the  afterbirth,  and 
close  the  uterine  cavity. 

If,  for  any  reason,  the  exhaustion  is  abnormal  and  the  con- 
tractions of  the  uterine  walls  do  not  recur  promptly,  infection 
takes  place  very  quickly.  As  soon  as  the  navel  cord  is  ruptured, 
the  fetal  membranes  at  once  cease  to  live,  and  assume  the  signifi- 
cance of  a  foreign  body.  The  entire  mass  of  membranes  is  dead 
tissue,  filled  with  fluid  and  containing  portions  of  the  fetal 
fluids  which  have  not  been  thrown  out.  Taken  together,  the 
membranes  and  the  fluids  constitute  a  highly  favorable  breeding 
ground  for  disease-producing  organisms.  Usually  the  broken 
end  of  the  navel  cord  hangs  from  the  vulva,  comes  in  con- 
tact with  bedding,  feces,  urine  and  other  substances  reeking  in 
raicro-organismal  life,  and  furnishes  an  excellent  avenue  along 
which  the  organisms  may  pass  into  the  uterine  cavity. 

Still  more  important,  in  many  cases,  micro-organisms  of  the 
most  dangerous  kind  are  introduced  directly  into  the  uterine 
cavity  on  the  hands  of  laymen,  or  other  persons  who  have  inter- 
fered in  cases  of  dystokia  or  have  inserted  their  hands  into  the 
uterus  immediately  after  the  expulsion  of  the  fetus.  Thus  there 
is  abundant  opportunity  for  infection  of  many  kinds  to  gain 
access  to  the  uterine  cavity  and,  having  reached  that  organ,  find 
the  conditions  of  heat,  moisture,  nutritive  material  and  exclusion 
of  air  ideal  for  their  lapid  and  efficient  multiplication.  If  the 
exhaustion  of  the  uterus  continues  for  10,  12  or  more  hours,  the 
infection  of  the  cotyledons  has  probably  occurred,  and  within 
24-48  hours  the  disease  processes  in  the  cotyledons  may  have  so 
far  advanced  as  to  firmly  incarcerate  and  hold  the  chorionic  tufts. 


Retained  Placenta  in  the  Cow  797 

The  pathology  of  the  retention  of  the  fetal  membranes  is 
necessarily  somewhat  foreshadowed  by  the  causes  which  have 
been  related  above.  Inflammation  of  the  cotyledons  in  the  cow, 
or  of  the  placenta  in  other  animals,  naturally  follows  the  general 
course  of  inflammation  of  tissues,  resulting  from  infection.  It 
may  abate  in  the  course  of  a  few  days,  and  the  swelling  of  the  coty- 
ledons may  decrease  and  result  in  the  release  of  the  incarcerated 
placental  tufts,  so  that  the  chorion  may  finally  come  away,  ac- 
companied by  contraction  of  the  uterus  and  prompt  recovery  from 
the  disease.  If,  however,  the  infection  is  more  extensive  and 
virulent,  the  cotyledon  may  undergo  total  necrosis  and  slough 
away,  still  holding  firmly  incarcerated  the  section  of  chorion  to 
which  it  is  attached.  We  have  observed  this  result  in  the  cow 
repeatedly,  and  sometimes  it  has  involved  the  necrosis  and 
sloughing  away  of  all  or  nearly  all  the  cotyledons  in  the  entire 
uterine  cavity. 

The  ravages  of  the  disease  do  not  always  cease  with  the  necro- 
sis of  the  cotyledons,  but  may  extend  to  the  walls  of  the  uterus, 
involving  the  mucous,  muscular  and  peritoneal  coats  more  or  less 
in  their  order,  and  extending  beyond  the  peritoneal  covering  of 
the  uterus,  to  involve  the  peritoneum  in  general. 

The  fetal  membranes  undergo  more  or  less  rapid  decomposi- 
tion, so  that  in  48  hours,  as  a  rule,  the}'  become  quite  putrid  and 
give  off  a  very  fetid  odor.  The  inflammation  of  the  uterine  mu- 
cosa, endometritis,  causes  a  more  or  less  abundant  excretion  into 
the  uterine  cavity,  which  is  usually  very  fetid  and  consists  of  a 
dirty,  grayish,  flocculent,  semi-fluid  or  fluid  mass,  which  may 
vary  greatly  in  amount.  Naturally  it  is  mixed  with  shreds  of 
afterbirth  and  placenta,  and  sometimes  contains  cotyledons  which 
have  sloughed  away  from  their  pedicles.  In  some  cases,  the  uter- 
ine mucosa  is  covered  over  with  diphtheritic  membranes. 

Depending  upon  the  degree  of  infection,  the  uterine  mucosa  or 
the  entire  uterine  walls  may  be  more  or  less  thickened  and 
changed  in  consistency.  Sometimes  the  uterine  walls  are  very 
firm  and  hard,  as  a  result  of  an  exudative  inflammation,  especially 
if  the  disease  is  of  somewhat  long  standing.  At  other  times,  the 
walls  are  very  thick  and  soft,  as  a  result  of  gangrene. 

When  the  inflammation  of  the  uterine  walls  is  virulent,  and 
the  pathologic  changes  serious,  the  uterus  quickly  loses  all  con- 
tractile power  and  lies  as  an  inert  organ.     The  pathologic  secre- 


798  Veterinary  Obstetrics 

tions  accumulate  within  the  organ,  until  sometimes  it  may  con- 
tain four  or  five  gallons.  Any  expulsion  of  the  contents  of  the 
uterus  must  now  be  brought  about  by  the  contraction  of  the  ab- 
dominal walls,  including  the  diaphragm,  and  even  these  forces 
are  too  frequently  in  abeyance,  so  that  the  uterine  contents  in- 
crease more  or  less  rapidly,  and  in  many  cases  flow  away  spon- 
taneously, especially  when  the  animal  is  lying  down,  simply  as 
a  result  of  passive  pressure  upon  the  abdominal  walls. 

The  constitutional  symptoms  are  usually  parallel  to  the  local 
changes  in  the  organ.  The  systemic  disturbances  will  vary, 
however,  according  to  the  vitality  of  the  patient  and  her  powder  of 
resistance  to  bacterial  products.  Usually,  when  the  inflammation 
of  the  uterus  has  extended  to  any  considerable  degree,  there  are 
more  or  less  well-marked  symptoms  of  septicaemia  or  pyaemia. 
These  include  inappetence,  irregularity  of  the  bowels,  either  in 
•the  form  of  diarrhea  or  of  constipation,  cardiac  debility  with  a 
very  weak  or  imperceptible  pulse,  great  depres.sion  of  the  animal, 
cold  extremities,  rapid,  shallow  respiration,  and  any  other  of  the 
long  train  of  symptoms  which  may  accompany  .septicaemia. 

The  symptoms  of  retained  placenta,  in  the  cow,  are  variable, 
and  include  the  symptoms  of  all  the  pathologic  lesions  which 
may  result  from  the  di.sease.  Generally  they  are  self-evident, 
and  consist  of  the  navel  cord  and  portions  of  the  chorion  hanging 
from  the  vulva,  while  other  portions  are  retained  within  the 
uterus.  This  is  not  always  true.  vSometimes  the  major  portion 
of  the  chorion,  and  the  navel  cord,  have  dropped  away,  and  the 
owner  believes  that  the  expulsion  of  the  fetal  membranes  has  been 
complete,  but  within  the  uterus  there  remain  imprisoned  more 
or  less  extensive  portions  of  the  afterbirth,  which  .soon  become 
infected  and  undergo  decomposition.  In  other  cases,  the  entire 
mass  of  fetal  membranes,  or  essentially  all,  is  retained  within  the 
uterine  cavity,  the  os  uteri  has  contracted,  and  no  portions  of 
the  membranes  protrude  from  the  vulva,  to  reveal  in  that  very 
apparent  way  the  condition  which  exists. 

In  addition  to  the.se  usual  visible  signs,  there  are  present 
symptoms  of  the  pathologic  changes  which  we  have  enumerated 
above.  These  may  not  be  very  marked,  but  the  animal,  soon 
after  parturition,  loses  her  normal  vigor,  and  there  are  generally 
symptoms  of  ill  health  of  a  more  or  less  serious  character.  In 
many  cases,  the  retention   of  the  membranes  may  be  suspected 


Retained  Placenta  in  the  Cow  799 

from  the  presence  of  a  vaginal  discharge,  with  the  general  appear- 
ances of  ill-health.  In  other  cases,  there  occurs  a  more  or  less 
evident  prolapse  of  the  vagina. 

When  retention  of  the  placenta  is  neglected,  the  membranes 
and  cotyledons  may  slowly  slough  away,  the  os  uteri  contract, 
chronic  metritis  and  pyometra  become  established,  marasmus  and 
emaciation  follow,  and  the  disease  continue  month  after  month, 
to  finally  terminate  in  death,  or  in  recovery  with  sterility. 

Under  such  conditions,  following  within  a  few  days  or  a 
few  weeks  upon  parturition,  it  behooves  the  veterinarian,  when 
called  to  attend  the  animal,  to  make  a  careful  search  of  the 
uterus.  If  the  os  uteri  is  open,  he  may  profitably  make  this  ex- 
amination direct  through  the  vagina,  but,  if  the  os  be  closed, 
the  examination  needs  be  made  per  rectum,  when  the  enlarged 
uterus  will  be  discovered  and  the  nature  of  the  disease  understood. 

The  handling  of  retained  placenta  .in  the  cow  calls  for  care- 
ful study,  and  the  display  of  great  judgment.  Mostly  the  work 
has  been  undertaken  in  a  haphazard  way  by  the  layman  or  the 
dairyman,  and  these  methods  have  been  largely  copied  by  the 
veterinary  practitioner.  No  practice  in  connection  with  our 
professional  duties  could  be  more  unfortunate.  As  a  general 
rule,  the  layman  or  the  veterinarian  removes  the  afterbirth  by 
manual  force,  more  or  less  completely,  at  a  time  which  is  arbi- 
trarily fixed,  or  when  it  may  siiit  the  convenience  of  the  parties 
concerned.  As  a  result  of  this  haphazard  and  unscientific 
method  of  handling  this  very  serious  disease,  the  lives  of  many 
valuable  cows  are  annually  sacrificed,  and  many  more  are  ren- 
dered useless  for  dairying  or  other  purposes.  In  order  to  handle 
retained  placenta  successfully,  the  veterinarian  must  first  under- 
stand the  physiologic  expulsion  of  these  membranes  and  the 
pathologic  conditions  which  occur  in  the  course  of  the  disease. 
Three  different  courses  present  themselves  for  consideration  in 
the  handling  of  each  case  of  retained  placenta  in  the  cow,  and 
the  veterinarian  must  use  good  judgment  in  determining  which 
of  these  three  courses  he  should  pursue. 

I.  The  manual  removal  of  the  placenta.  As  early  as  24 
hours  after  parturition,  the  veterinarian  should  examine  the 
retained  luembranes  and  determine  whether  or  not  they  may  be 
safely  and  completelj-  detached  by  manual  force,  and,  if  practi- 
cable, .should  remove  them.     The  preci.se  time  for  this  examina- 


8oo  Veterinary  Obstetrics 

tion  cannot  be  definitely  fixed.  If  the  veterinarian  attends  a  case 
of  dystokia,  and  finds,  after  the  removal  of  the  fetus,  that  he 
can  follow  with  the  removal  of  the  placenta,  without  tearing  the 
cotyledons  and  without  causing  hemorrhage,  this  should  be  ac- 
complished immediately.  If  there  are  any  wounds  in  the  uterus 
or  vagina,  there  is  greater  need  for  the  removal  of  the  membranes, 
in  order  to  prevent  wound  infection  and  injury  to  the  parts.  If 
the  fetus  has  been  dead  and  emphysematous,  it  is  quite  important 
to  remove  the  afterbirth  immediately  following  the  removal  of 
the  fetus,  and  in  such  cases  it  is  generally  quite  practicable  to 
do  so. 

The  operation  of  the  manual  removal  of  the  placenta  should  be 
accomplished  in  a  careful  and  thorough  manner.  During  partu- 
rition, the  chorion  has  become  separated  from  some  of  the  cotyle- 
dons about  the  cervical  canal,  and  the  farther  toward  the  horns 
we  proceed  the  more  intimate  do  we  usually  find  the  attachments 
of  the  membranes  to  the  cotyledons.  The  veterinarian  should 
begin  by  detaching  those  cotyledons  which  are  first  recognizable 
posteriorly,  along  the  top  of  the  uterus,  and  then,  gradually  work- 
ing forward,  eventually  detach  those  from  the  bottom  of  the 
uterus  and  from  the  horns. 

The  method  of  detachment  should  aim  at  the  complete  removal 
of  all  the  chorionic  tufts,  without  injury  to  the  cotyledon  or  to 
its  pedicle.  The  operator  grasps  the  cotyledon  with  his  thumb 
resting  upon  one  side  at  the  margin  of  the  attachment  of  the 
chorion  to  the  cotyledon  and  his  index  and  middle  fingers  resting 
upon  the  opposite  border  of  the  organ.  By  pressing  upon  the 
chorion,  between  the  thumb  and  fingers,  the  chorionic  tufts  are 
gradually  detached  and  forced  out  of  the  crypts  in  the  cotyledons, 
while  no  force  is  exerted  upon  the  stalk  of  the  cotyledon,  and 
consequently  it  escapes  injury.  After  the  fetal  placenta  has 
begun  to  be  detached  on  the  side  where  the  thumb  is  located, 
the  detached  margin  may  be  grasped  between  the  thumb  and  in- 
dex finger,  while  the  other  fingers  rest  upon  the  opposite  side  of 
the  cotyledon,  and  the  detachment  of  the  chorion  gradually  com- 
pleted. This  process  is  to  be  repeated  upon  one  after  another 
of  the  cotyledons,  until  all  are  finally  detached. 

The  operator  usually  has  difficulty  in  reaching  the  most  distant 
cotyledons  located  in  the  two  horns,  especially  those  in  the  gravid 
horn.     This  horn  turns  downward,  and   then  backward,  and  is 


Retained  Placenta  in  the  Cow  8oi 

longer  than  the  reach  of  a  man's  arm.  The  operator  may  bring 
these  cotyledons  somewhat  nearer  to  him  by  having  assistants 
lift  upon  the  floor  of  the  abdomen  with  a  blanket  or  board,  or  in 
some  cases,  by  gradually  pulling  backward  on  the  curved  horn, 
and  thus  drawing  it  toward  the  pelvis.  If  the  uterine  walls  are 
not  paretic,  one  may  also  cause  a  decrease  in  the  size  of  the  organ 
by  filling  the  uterus  with  warm  water  and  causing  it  to  contract 
and  expel  the  liquid.  This  causes  a  diminution  in  the  size  of 
the  organ,  and  brings  the  most  distant  cotyledons  more  nearly 
within  reach. 

Before  beginning  the  operation,  the  veterinarian  should  wash 
and  disinfect  the  vulva  and  tail  carefully,  and  should  irrigate  the 
vagina.  The  operator  should  take  precautions  against  infection 
of  his  arms  and  hands.  For  this  purpose,  we  recommend  the 
repeated  immersion  of  the  arms  and  hands  in  a  reliable  antiseptic 
fluid,  and  would  especially  recommend  lysol,  because  of  its  unc- 
tuous character.  Some,  like  Pomayer,  condemn  antiseptics  for 
this  purpose,  and  recommend  oils  or  fats  instead,  but  our  expe- 
rience has  been  that  oils  and  fats  are  almost  instantly  dissolved 
by  the  fluids  present  and  washed  away. 

We  also  practice  and  recommend  the  irrigation  of  the  uterine 
cavity  prior  to  the  beginning  of  the  removal  of  the  afterbirth. 
We  would  not  use,  for  this  purpose,  a  powerful  disinfectant, 
which  would  tend  to  cause  abnormal  expulsive  efforts,  but  would 
use  instead  soft  warm  water,  with  a  small  amount  of  disinfectant, 
like  5i%  carbolic  acid,  which,  we  find,  tends  to  soothe  rather 
than  irritate  the  diseased  uterus.  If  the  uterus  is  too  feeble  to 
cause  the  expulsion  of  this  liquid,  and  it  is  not  accomplished  by 
the  abdominal  walls,  it  should  be  siphoned  out. 

For  making  the  injections  we  prefer  to  use  a  rubber  tube, 
especially  the  pure  gum  horse  stomach  tube,  which,  to  our  mind, 
makes  an  ideal  apparatus  for  the  irrigation  of  the  uterine  cavity. 
To  the  distal  end  of  this,  we  may  attach  either  an  aseptible  enema 
pump  or  a  funnel.  The  funnel  is  cheaper,  lighter  to  carry,  and 
is  highly  efficient. 

If  the  operation  of  the  manual   removal  cannot  be  carried  to 
completion,  or  cannot  be  performed  without  injury  to  the  cotyle- 
dons or  causing  hemorrhage,  it   should   not.  for  the  time  being, 
be  persisted  in. 
51 


8o2  I'^eterhiary  Obstetrics 

The  membranes  should  not  be  divided,  but  should  be  removed 
completely  or  left  together  attached  to  the  uterus.  One  important 
element  in  the  normal  detachment  of  the  membranes  is  the  weight 
and  volume  of  the  chorion  and  umbilic  cord.  If  the  principal 
volume   and   weight  of   these   is  removed,  the  tendency   for  the 


Fig.   139.     Placentai,  TuKTs  from  thk  Chorion  of  the 
Cow.     ( Pomayer. ) 

remnant  to  continue  to  be  retained  is  intensified.  If  the  main 
body  of  the  chorion  is  torn  away,  and  the  placental  tufts  remain 
imbedded  in  the  cotyledons,  the  incarcerated  portions  lose  the  in- 
fluence of  traction,  which   is  so  necessary  to  their  eventual  re- 


Retained  Placenta  in  the  Cora  803 

moval.  It  is  the  dead  and  putrefying  placental  tufts  im- 
prisoned in  the  cotyledons,  and  not  the  other  portions  of 
the  chorion,  which  constitute  the  element  of  danger  in  the 
disease.  If  we  cannot  remove  these  tissues,  w^hich  con- 
stitute the  fundamental  danger  in  retained  placenta,  then 
we  should  not,  under  any  conditions,  remove  those  harm- 
less portions,  which  may  later  serve  a  highly  necessary 
and  useful  purpose  in  withdrawing  the  imprisoned 
placental    tufts. 

2.  Expectant  Handling.  When  it  is  impracticable  to  manu- 
ally remove  the  entire  mass  of  the  chorion,  including  the  tufts, 
the  afterbirth  should  be  allowed  to  remain  in  the  uterine  cavity 
with  the  detached  portions  hanging  from  the  vulva.  The  at- 
tending veterinarian  should  attempt  to  control  and  alleviate  the 
infection  in  the  organ,  and  to  retard,  as  far  as  possible,  the  putrid 
decomposition  of  the  retained  membranes  by  irrigating  the  uterine 
cavit}'  with  warm  water,  to  which  he  may  add  a  small  amount  of 
disinfectant,  being  careful  not  to  use  sufficient  to  cause  any  irri- 
tation of  the  uterus.  One  may  use  from  ^  to  ^  %  carbolic  acid, 
or  an  equal  amount  of  lysol.  If  the  animal  does  not  throw  out 
the  injected  liquid,  along  with  the  accumulated  discharges  in 
the  uterine  cavity,  it  should  be  siphoned  out  by  means  of  a  tube. 

It  is  wrong  to  leave  this  fluid  in  the  uterine  cavity,  where  it 
can  work  no  good.  We  cannot  disinfect  the  diseased  tissues, 
because  any  disinfectant  sufficiently  powerful  to  pass  into  the 
tissues  and  destroy  the  micro-organisms  must  destroy  the  tissues 
before  the  micro-organisms  are  reached.  It  is  of  great  use,  how- 
ever, to  remove  from  the  uterine  cavity  the  accumulated  disease 
discharges  or  bacterial  products.  The  washing  should  be  re- 
peated at  least  once  a  day,  and  should  be  continued  each  time 
until  the  fluid,  when  expelled  or  siphoned  out,  is  comparatively 
clear  and  free  from  odor.  When  this  has  been  siphoned  out, 
there  should  be  deposited  within  the  uterus  some  antiseptic  which 
will  tend  to  obviate  any  increase  of  the  infection,  without  in- 
ducing any  marked  irritation  of  the  diseased  organ.  In  our 
judgment,  the  most  reliable  drug  for  this  purpose  is  iodoform, 
which  may  be  introduced  into  the  uterine  cavity  in  the  powdered 
form,  enclosed  in  a  gelatine  capsule,  which  the  operator  may 
leave  to  dissolve  or  may  open  and  scatter  the  powder  about  in  the 
various  parts  of  the  uterus.     This  plan   has  been  carried  out  by 


8o4  Veterinary  Obstetrics 

us,  aud  some  of  our  colleagues,  with  very  satisfactory  results. 
Possibly  other  antiseptics,  such  as  powdered  boric  acid,  would 
prove  of  similar  value,  introduced  in  the  same  manner. 

The  patient  should  be  examined  daily.  If  it  is  found  that  the 
inflammation  in  the  cotyledons  has  abated,  so  that  the  chorion 
may  be  effectively  detached,  the  manual  removal  of  the  membranes 
should  be  proceeded  with.  If  they  are  still  firmly  held,  the  treat- 
ment should  be  repeated,  and  so,  day  by  day,  the  case  should  be 
carefully  watched,  until  finally  it  is  possible  to  remove  the  chorion 
complete,  including  all  the  placental  tufts. 

3.  Removalof  the  Cotyledons.  The  preceding  plans  may  fail 
aud  the  disease  proceed  rapidly  to  the  necrosis  of  the  cotyledons. 
Sometimes  this  necrosis  is  very  acute,  and  calls  for  prompt  recog- 
nition and  handling.  We  observed  especially,  in  one  case,  where 
apparently  infection  had  been  carried  into  the  uterine  cavity  by 
the  operator,  while  overcoming  dystokia,  that  placental  gangrene 
was  well  established  in  about  24  hours.  The  cotyledons  were 
enormously  enlarged,  very  firm  and  tense.  They  were  about  four 
times  their  normal  volume.  The  fetal  placentae  could  not  be  de- 
tached from  the  cotyledons,  but  it  was  found  that  the  cotyledons 
themselves  were  very  easily  detached  from  the  uterus,  and  this 
was  not  followed  by  hemorrhage  or  by  any  apparent  pain. 

The  cotyledons  were,  one  after  another,  detached  and  with- 
drawn, with  the  chorion  still  firmly  attached  to  them.  No  mate- 
rial hemorrhage  followed.  The  uterus  was  immediately  irrigated 
with  warm  water,  to  which  about  ^  %  of  carbolic  acid  had  been 
added.  The  cow,  which  had  previously  shown  all  the  cardinal 
symptoms  of  septicaemia,  accompanied  by  a  very  high  tempera- 
ture, improved  immediately  after  the  operation,  and  within  24 
hours  her  temperature,  appetite,  and  general  condition  were 
normal.  She  made  an  uneventful  recovery,  and  in  due  time 
again  became  pregnant. 

In  other  cases  of  retained  placenta  in  the  cow,  we  have  fre- 
quently found  many  or  all  of  the  cotyledons  lying  free  within  the 
uterine  cavity,  still  attached  to  the  chorion,  Sometimes  we  have 
been  able  to  distinguish  these  enlarged  necrotic  cotyledons  when 
they  were  almost  ready  to  drop  off,  and  have  removed  them  with 
good  results.  In  one  case,  in  a  valuable  cow  which  had  been 
neglected,  we  found  the  os  uteri  rather  firmly  closed.  In  the 
uterine  cavity  lay   the  entire   chorion,  with  the  cotyledons  still 


Retained  Placenta  in  the  Cozv  805 

firmly  attached  to  it,  but  sloughed  away  from  the  uterine  walls. 
The  removal  of  the  cotyledons  and  chorion,  with  irrigation  of  the 
uterus,  was  followed  by  uneventful  recovery,  without  destroying 
the  fertility'  of  the  cow. 

Because  of  these  experiences  with  necrosis  of  the  cotyledons, 
we  hold  in  all  those  cases  where  the  uterine  walls  are  compara- 
tively sound  and  the  cotyledons  have  undergone  necrosis,  that 
the  veterinarian  is  not  only  warranted  in  removing  them,  but 
that  their  removal  is  clearly  indicated  as  the  proper  surgical 
procedure. 

Such  removal  of  the  cotyledons  in  the  cow  is  somewhat  anal- 
ogous to  the  curetting  of  the  placenta  in  woman.  It  produces, 
in  proper  cases,  the  same  results.  It  removes  the  decaying  frag- 
ments of  the  fetal  membranes  and  the  irrecoverably  diseased 
maternal  placenta. 

While  the  decomposing  chorionic  tufts  are  incarcerated  within 
the  crypts  of  the  cotyledons,  and  the  cotyledons  are  yet  alive  but 
diseased,  the  diseased  surface,  from  which  bacterial  poisons  may 
be  absorbed,  is  the  superficial  area  of  the  mucosa  of  all  the  pla- 
cental crypts.  When  the  cotyledon  has  been  removed,  the  re- 
ceptive surface  is  reduced  to  the  area  of  the  cross  section  of  the 
cotyledonal  stalk — probably  less  than  1 000th  part  of  the  area  of 
the  placental  epithelium. 

The  collateral  handling  will  vary  greatly,  according  to  cir- 
cumstances. If  the  patient  is  not  seriously  depressed,  if  she  is  not 
straining  abnormally,  if  her  temperature  and  appetite  are  good, 
there  is  no  call  for  general  medication.  When  there  are  evi- 
dences of  serious  constitutional  disturbances,  such  as  fever  and 
weakness,  the  patient  should  be  supported  and  strengthened  by 
easily-digested,  nutritive  foods,  if  she  will  take  them,  to  which 
may  be  added  stimulants  and  tonics.  Alcohol  is  especially  use- 
ful, and  may  be  given  in  large  and  frequent  doses.  When  symp- 
toms of  septicaemia  appear,  it  has  been  our  practice  to  administer 
large  doses  of  quinine,  and  in  our  experience  the  results  have 
been  good. 

Some  have  practiced  and  advised  the  administration  of 
ecbolics  such  as  ergot,  savin  and  rue,  but  this  is  opposed  by  many 
and  the  clinical  evidence  of  the  value  of  this  group  of  drugs  is 
not  clear. 


8o6  Veterinary  Obstetrics 

Others,  and  with  more  reason,  advise  and  use  carminatives  and 
aromatics  internally,  such  as  anise  seed,  fenugrec,  gentian,  and 
camomile,  or  the  gum-resins  like  camphor  and  others.  T\\&y 
are  probably  of  distinct  value  as  adjuncts  to  the  local  handling, 

In  many  cases,  great  good  may  come  from  prompt  catharsis, 
and  for  this  purpose  we  prefer  one  of  the  hypodermic  cathartics, 
such  as  eserine  or  arecoline.  Owing  to  the  feebleness  of  the 
heart,  we  would  administer  it  in  small  and  repeated  doses,  com- 
bined with  strychnine,  and  continue  it  until  the  desired  evacua- 
tion of  the  bowels  has  been  brought  about.  This  in  itself  fre- 
quently causes  a  great  reduction  of  the  temperature,  and  marked 
improvement  of  the  general  symptoms. 

The  food  should  be  easily  digestible.  Such  highly  nutritious 
food  as  linseed  meal  serves  an  excellent  purpose,  while  roots  are 
also  valuable,  because  of  their  keeping  the  bowels  more  or  less 
freely  open. 

The  prevention  of  retained  afterbirth  in  the  cow  is  an  im- 
portant problem,  which  offers  hope  for  success  in  numerous  cases. 
It  is  highly  important,  from  the  standpoint  of  prevention, 
that,  in  all  cases  of  dystokia  attended  by  a  veterinarian,  the  after- 
birth should  be  removed,  if  possible,  immediately  after  the  re- 
moval of  the  fetus,  followed  bj^  irrigation  of  the  uterus,  bringing 
about  its  firm  contraction.  It  is  also  important  that  the  owners 
of  pregnant  animals  should  keep  them  in  vigorous  condition, 
allowing  plenty  of  exercise,  air  and  light,  with  an  abundance  of 
good  digestible  food,  for  some  weeks  at  least  prior  to  parturition. 

A  very  important  element  in  the  prevention  of  retained  pla- 
centa, and  for  which  the  veterinarian  fs  directly  responsible,  is 
the  question  of  handling  in  cases  of  dystokia.  In  discussing  the 
general  handling  of  dystokia  on  page  620,  we  have  already-  em- 
phasized the  value  of  aseptic  precautions  in  all  these  operations. 
It  is  well  to  repeat  here  the  duty  of  the  veterinarian  to  take  every 
possible  precaution  against  carrying  infection  into  the  uterine 
cavity  while  he  is  dealing  with  a  case  of  dystokia.  To  this  end, 
he  needs  to  follow  out  carefully  the  rules  which  we  have  already 
laid  down  regarding  sterilization  or  disinfection  of  his  clothing, 
his  hands  and  arms,  his  instruments,  and  the  exposed  parts  of 
the  patient. 

As  soon  as  fears  of  placental  retention  are  entertained,  the 
veterinarian  can,  and  should,  do  much  to  obviate  the  disea.se. 


Retained  Placenta  in  the  Coiv  807 

Copious  irrigation  of  the  uterine  cavity,  within  a  few  hours  after 
calving,  washes  away  placental  debris,  fetal  fluids  and  retained 
blood  clots,  stimulates  uterine  involution,  and  greatly  favors  the 
spontaneous  expulsion  of  the  membranes. 

The  irrigating  fluid  should  be  at  least  as  warm  as  the  uterine 
cavity,  but  not  of  appreciably  higher  temperature,  and  should  be 
of  soft  water  or  softened  by  the  addition  of  soda  bi-carbonate,  to 
which  may  be  added  0.6%  of  salt. 

The  irrigation  should  be  begun  as  early  as  convenient  after 
calving,  and  may  be  repeated  every  4  to  6  hours.  The  irriga- 
tion is  to  be  carried  out  under  antiseptic  precautions,  and  very 
gently.  When  the  horse  stomach  tube  we  have  advised  is  used 
for  irrigation,  the  properly  lubricated  end  can  be  pushed  forward 
gently,  and  with  some  rotary  motion,  through  the  vagina  and 
into  the  uterine  cavity,  usually  without  inserting  the  hand,  thus 
avoiding  the  manual  introduction  of  infection.  The  tiibe  is 
rigid  enough  to  be  reasonably  subject  to  external  direction,  and 
pliable  enough  to  obviate  any  danger  of  wounding  the  genital 
tract. 

The  prognosis  of  retained  placenta  is  exceedingly  variable, 
but  must  always  be  cautious.  Whenever  the  afterbirth  can  be 
completely  removed  manually  within  24-48  hours  after  calving, 
the  prognosis  is  highly  favorable.  It  must,  however,  depend 
upon  the  state  of  the  uterus  itself,  and  upon  the  general  vigor  of 
the  animal.  If  the  uterus  is  highly  inflamed  and  paretic,  the  out- 
look is  always  serious. 

In  our  experience,  the  most  serious  ca.ses  have  usually  been 
those  where  some  part}'  has  unsuccessfully  attempted  to  remove 
the  membranes,  and  has  merely  succeeded  in  tearing  away  the 
major  portion  of  the  chorion,  leaving  many  of  the  fetal  placentae 
still  firmly  attached  to  the  cotyledons,  and  naturally  leaving  many 
of  the  cotyledons  themselves  more  or  less  seriously  injured. 
When  this  has  been  done,  and  severe  straining  follows,  accom- 
panied \yy  a  high  temperature  and  loss  of  appetite,  we  have  found 
the  disea.se  highly  fatal.  On  the  other  hand,  the  uterine  walls 
may  be  very  intensely  inflamed,  firm,  paretic,  and  yet  recovery 
occur.  Pomayer  has  emphasized  the  value,  in  this  disease,  of 
the  degree  of  leucocytosis  in  the  uterine  walls.  It  is,  he  says, 
the  number  of  leucocytes  which    exist  in  the   uterine  walls,  or 


8o8  Veterinary  Obstetrics 

which  may  be  attracted  to  them,  which  brings  about  recovery. 
If  the  infection  of  the  cotyledons  and  of  the  uterine  walls  is  of 
such  a  character  as  to  destroy  the  leucocytes,  recovery  cannot 
occur. 

2.  Retained  Placenta  in  the  Mare. 

Retention  of  the  placenta  is  much  less  frequent  in  the  mare 
than  in  the  cow.  Clinically,  retention  of  the  placenta  in  the 
mare  is  divisible  into  two  separate  forms,  total  and  fragmentary. 

Total  retention  of  the  fetal  membranes  in  the  mare  corre- 
sponds in  a  measure  to  the  disease  in  the  cow.  It  is,  however, 
verj'  rare,  not  only  as  related  to  placental  retention  in  other  ani- 
mals, but  also  as  compared  with  the  fragmental  retention  in  this 
animal. 

The  rarity  of  placental  retention  in  the  mare  is  explained  upon 
various  hypotheses.  Most  significant,  perhaps,  is  the  compara- 
tive simplicity  of  the  chorionic  tufts,  so  that  any  swelling  of  the 
uterine  mucosa  does  not  tend  materialh*  to  incarcerate  them  and 
hold  the  chorion.  It  bears  another  important  difference  when 
compared  with  ruminants  ;  the  placenta  is  diffuse.  The  chorion 
is  thick,  rigid,  not  readih'  compressible.  When  involution  of 
the  uterus  occurs,  the  area  of  attachment  in  the  uterine  mucosa 
rapidly  decreases,  while  the  opposing  chorionic  attachments  are 
not  subject  to  like  diminution  in  area  and  are  consequently  de- 
tached. The  placentae  of  sheep  and  goats  are  essentially  as  intri- 
ate  as  those  of  the  cow,  and  are  upon  the  same  general  plan,  but 
retention  of  the  fetal  membranes  in  rhese  is  very  rare  as  com- 
pared wdth  the  cow.  According  to  our  observations  also  the  dis- 
ease is  less  common  in  the  ewe  than  in  the  mare.  Hence  the 
arrangement  of  the  placental  structures  does  not  wholly  control 
the  probability  of  retention. 

The  causes  of  total  placental  retention  in  the  mare  are  analo- 
gous to  those  already  mentioned  in  the  cow,  such  as  placentitis 
as  an  accompaniment  of  contagious  abortion,  and  fatigue  of  the 
uterine  walls  during  difficult   labor,   followed  b}'  infection. 

The  symptoms  of  total  placental  retention  in  the  mare  usu- 
ally consist  merely  of  the  visible  protrusion  from  the  vulva  of 
the  umbilic  cord  and  portions  of  the  chorion.  There  is  rarely 
any  .straining.  If  neglected,  and  infection  occurs,  as  it  does  very 
quickly,  a  diffuse  endometritis  quickly  follows,  the  chorion  usu- 


Retahied  Placenta  in  the  Mare  809 

ally  sloughs  away,  the  uterine  walls  become  paretic,  voluminous 
excretions  into  the  uterine  cavity  occur,  and  the  cavity  of  the 
organ  is  soon  occupied  by  two  to  five  or  more  gallons  of  a  dirty 
grayish,  flocculent,  stinking  semi-fluid  mass.  Following  closely 
upon  these  changes,  perhaps  even  noted  first,  parturient  lamini- 
tis  occurs. 

The  handling  of  total  retained  placenta  in  the  mare  consists 
of  the  manual  removal,  and  should  be  undertaken  at  the  earliest 
convenient  time  subsequent  to  parturition.  In  cases  of  dystokia, 
the  veterinarian  should  remove  the  membranes  as  soon  after  de- 
livery has  been  completed  as  possible,  allowing  merely  a  few 
minutes  for  the  animal  to  recover  from  her  exhaustion. 

In  removing  the  afterbirth  of  the  mare  it  is  to  be  remembered 
that  ordinarily  the  chorion  comes  away  everted,  but  when  we 
desire  to  remove  it  artificially  it  should  be  done  right  side  out. 
First  the  veterinarian  needs  locate  the  margins  of  the  rupture  in 
the  chorion  through  which  the  fetus  has  been  expelled.  Neces- 
sarily this  margin  is  detached  for  some  distance  from  the  torn 
border. 

Secure  the  torn  border  and  carefully  draw  it  out  through  the 
vulva.  Insert  the  open  hand  or  clenched  fist  between  the  chorion 
and  uterine  wall,  and,  while  exerting  enough  traction  upon  the 
ruptured  margins  to  keep  the  chorion  tense,  gently  and  cau- 
tiou.sly  push  the  hand  along  between  the  chorion  and  uterine 
wall.  The  process  should  be  carried  out  almost  equally  around 
the  entire  circumference  of  the  uterus,  and  the  chorion  gradually 
detached  until  the  coruna  are  reached  and  included. 

In  many  cases  of  retention  in  the  mare,  it  is  not  actually  needful 
to  insert  the  hand  into  the  uterus.  If  the  protruding  chorion  be 
carefully  grasped,  folds  of  it  picked  up  first  here  and  then 
there,  and  gentle  traction  exerted  upon  each  area  by  turn,  it  will 
.soon  be  found  that  drawing  upon  a  given  part  of  the  chorionic 
sac  causes  dehiscence  of  the  placenta  and  distinct  advance  is 
made.  Section  after  section  is  cautiously  tested,  and  gradually 
the  entire  chorion  comes  away  with  the  placental  side  outward. 

If  there  has  been  no  infection,  if  the  operator  has  not  inserted 
his  hatid,  nothing  further  is  demanded. 

If  there  is  infection  in  the  uterusor  if  the  operator  has  inserted 
his  hand,  the  uterus  should  be  well  irrigated  with  tepid  water  to 
which  0.5%  carbolic  acid  may  be  added.  This  should  be  repeated 
as  frequently  as  conditions  demand. 


8io  l^'eterhiary  Obstetrics 

Fragmentary  placental  retention  is  in  a  way  peculiar  to  the 
mare.  It  consists  in  the  accidental  transverse  rupture  of  the 
chorion  of  the  non-gravid  cornu,  followed  by  the  chorionic  mass 
from  the  gravid  cornu  and  uterine  body  coming  away,  and  leav- 
ing behind  the  small   isolated  fragment   in   the  non-gravid  horn. 

This  fragment  is  usually  8  to  12  inches  in  length,  and  its  lumen 
sufficiently  large  to  admit  of  the  insertion  of  a  man's  hand  into 
its  cavity. 

The  cause  of  this  retention  is  not  far  to  .seek.  The  chorionic 
mass  of  the  mare  is  very  heavy,  and  she  usually  stands  while  the 
membranes  are  being  expelled.  The  non-gravid  cornu  is  last  to 
expel  its  membranes,  so  that,  before  the  chorion  in  the  non-gravid 
cornu  becomes  detached,  it  must  support  the  weight  of  the  re- 
mainder of  the  membranous  mass.  At  this  time  the  greater  mass 
of  the  chorion  hangs  outside  the  vulva,  and  the  umbilic  cord 
drags  upon  the  ground,  where  it  may  be  stepped  upon  and  the 
attached  area  of  chorion  torn  off.  Possibly  the  cord  is  still  intact 
and  the  foal,  in  trying  to  rise,  may  partly  do  so  and  fall,  giving 
a  violent  pull  upon  the  cord,  which  is  promptly  transmitted  to 
the  still  attached  strip  of  chorion  in  the  non-gravid  cornu,  and 
causes  it  to  give  way. 

Once  this  fragment  becomes  separated,  the  narrow  horn  has 
little  or  no  expulsive  power  and  the  mechanical  assistance  ordi- 
narily afforded  through  the  weight  of  the  other  portions  of  the 
chorion  is  wanting. 

Infection  of  the  isolated  fragment  quickly  follows.  In  two  to 
five  days  the  chorionic  fragment  has  become  well  decomposed, 
the  uterine  wall  has  become  inflamed,  the  abdomen  is  very 
tender  upon  pressure,  the  infection  has  spread  throughout 
the  uterus  (purulent  endometritis),  extensive  purulent  col- 
lections have  occurred  in  the  uterine  cavity,  the  uterine 
walls  are  thick,  hard  and  paretic,  and  parturient  laminitis  is 
present. 

At  about  this  time,  if  the  veterinarian  will  carefully  explore 
the  uterine  cavity  he  will  be  able  to  recognize  by  touch  the  re- 
tained .segment  of  chorion,  somewhat  loosened  and  readily  de- 
tached, putrid,  fragile  and  extremely  fetid.  He  will  not  always 
find  the  piece  as  it  may  have  sloughed  away  and  pa.ssed  out.  In 
one  such  case,  as  we  approached  the  recumbent  patient,  she  sud- 
denly .sprang  to  her  feet.  As  she  did  so,  there  came  a  gush  of 
pus  from  the  vulva,  in  which  was  the  tell-tale  fragment  of  chorion. 


Retained  Placeiita  iji  Small  Anhnals  8ii 

The  handling  consists  fundamentally  of  a  careful  search  for, 
and  removal  of,  the  retained  chorionic  fragment,  followed  b}'  the 
proper  handling  of  the  resulting  endometritis  and  laminitis. 
These  we  shall  discuss  later. 

This  type  of  retention  is  subject  to  preventive  measures. 
The  veterinarian,  when  attending  a  mare  in  labor,  or  removing 
the  fetal  membranes  when  completely  retained,  should  always 
carefully  note  whether  the  two  horns  of  the  chorion  are  complete. 
If  not,  the  mi.ssing  apex  should  at  once  be  removed  and  the 
uterine  cavity  well  irrigated. 

3.    Retained  Placenta  in  the  Smaller  Animals. 

The  smaller  domestic  animals  do  not  suffer  so  frequently  from 
retained  placenta  as  do  the  cow  and  mare.  The  ewe  and  goat 
with  cotyledonal  placenta  suffer  occasionally.  The  sow  and  car- 
nivora  suffer  but  rarely  from  retention.  De  Bruin  records  teta- 
nus infection  in  the  ewe  as  a  result  of  placental  retention.  Gen- 
erally the  disease  in  the  ewe  has  about  the  same  danger  as  in  the 
cow.     The  sow  withstands  the  disease  well. 

The  handling  is  somewhat  similar  to  that  in  the  cow.  If  the 
genital  canal  is  large  enough  to  admit  of  the  in.sertion  of  the 
operator's  hand,  manual  removal  may  be  carried  out  as  in  the 
cow.  Otherwise  the  uterine  cavity  is  to  be  irrigated  with  warm 
normal  salt  solution,  thus  mechanically  clean.sing  the  organ, 
stimulating  normal  involution  of  the  uterus  and  increasing  pre- 
sumably the  number  of  leucocytes  in  the  uterine  walls.  De  Bruin 
condemns  the  use  of  antiseptics  in  these  cases. 

Should  chronic  metritis,  with  chronic  vaginal  discharge  or 
with  vaginal  prolapse,  follow,  hysterectomy,  page  669,  may  be 
indicated  in  the  sow  and  carnivora. 


II.   WOUNDS  AND    INJURIES  TO  THE  GENITAL 
AND   NEIGHBORING  ORGANS. 

PosT-PARTu.M  Hemorrhage. 

Post-partuni  hemorrhage  i.s  comparatively  rare  in  domestic 
animals,  and  occurs  chiefly  in  the  larger  species.  In  woman 
hemorrhage  following  childbirth  is  very  common  as  a  result  of 
the  highly  developed  and  vascular  placenta,  but  in  domestic 
animals,  in  which  there  are  generally  more  or  less  diffuse  pla- 
centae of  the  disseminated  or  cotyledonous  form,  the  conditions 
are  such  that  we  rarely  observe  spontaneous  placental  hemorrhage. 
In  fact  we  have  no  definite  records  to  show  that  serious  placental 
hemorrhage  proper,  occurs  in  animals,  although  slight  hemor- 
rhage from  the  placenta  is  quite  commonly  observed  in  the  mare 
and  cow,  and  to  a  lesser  degree  in  other  domestic  animals. 

The  hemorrhages  which  occur  during  or  immediately  subse- 
quent to  parturition  in  domestic  animals  are  generally  due  to 
traumatic  injury  which  is  more  or  less  independent  of  the  pla- 
centa, although  it  may  naturally  involve  that  structure.  We 
have  already  had  occasion  to  mention,  on  page  457.  that  in  rare 
instances  uterine  hemorrhage  occurs  during  gestation  and  may 
with  extreme  rarity  prove  serious. 

During  the  act  of  giving  birth  to  young,  serious  and  fatal 
hemorrhage  is  not  exceedingly  rare,  especially  in  the  mare,  as  a 
result  of  a  rupture  of  the  uterine  walls  involving  some  of  the 
great  vessels  of  the  organ.  Neces.sarily  in  the  mare  it  involves 
in  the  lesion  the  placenta  itself,  since  this  is  distributed  over  the 
entire  organ.  After  the  expulsion  of  the  fetus,  whether  in  the  mare 
or  the  cow,  there  frequently  follows  immediately  a  considerable 
discharge  of  blood,  which  may  be  placental  in  origin,  but  which 
is  more  probably  due  to  the  rupture  of  uterine  vessels  of  con- 
siderable size.  The  point  of  origin  and  the  exact  character  of 
such  a  hemorrhage  is  very  rarely  determined. 

After  the  fetus  has  been  expelled,  the  rude  removal  of  the  fetal 
membranes  by  laymen  or  empirics  frequently  induces  profuse 
hemorrhage,  which  may  even  end  fatally.  In  the  mare,  if  the 
chorion  is  very  firmly  adherent  to  the  uterus  and  violence  is  used 
to  bring  about  separation,  the  mucosa  may  be  wounded  to  such  a 
degree    as  to  cause  profuse  hemorrhage.     In  some  cases  of  re- 


Woiaids  a?id  Injuries  to  the  Genital  Organs  813 

tention  it  is  impracticable  to  separate  the  envelopes  at  once  be- 
cause of  hemorrhage  due  to  the  uterine  injuries.  In  the  cow, 
when  the  placenta  is  retained  and  involution  of  the  uterus  has 
not  yet  occurred,  and  the  layman  or  empiric  attempts  to  de- 
tach the  membrane,  profuse  and  fatal  hemorrhage  is  liable  to 
result,  which  is  greatly  accentuated  when  the  cotyledons  are  rudely 
torn  away  from  the  uterus. 

In  one  instance  observed  by  us,  an  empiric  attempted  to  remove 
the  membranes  from  a  cow  immediately  after  calving,  and,  by 
tearing  them  away,  brought  on  a  hemorrhage  which  proved  fatal 
to  the  patient  in  the  course  of  a  few  hours.  When  we  were 
called,  the  entire  uterine  cavity  was  filled  with  a  great  mass  of 
blood  ;  much  blood  had  already  escaped  from  the  vulva  ;  the 
cow  was  down,  and  unable  to  rise  ;  the  mucous  membranes  were 
blanched  ;  the  animal  was  pulseless,  and  in  a  dying  condition. 
In  the  mare  we  have  observed  fatal  hemorrhage  as  a  result  of 
ruptures  during  difficult  labor. 

Hemorrhage  from  the  uterus  occurs  also  in  cases  of  pro- 
lapse or  inversion,  and  usualh'  of  two  types.  There  may  be  a 
general  capillary  hemorrhage  from  the  entire  mucous  surface,  or 
rather  from  the  placental  surfaces  of  the  uterus,  and  there  may 
also  occur  hemorrhage  from  wounds  of  the  uterine  walls  or 
placentae  involving  large  ves.sels. 

Symptoms.  Generally  there  is  an  escape  of  blood  from  the 
vulva.  The  blood  may,  however,  be  largeh-  retained  within  the 
uterus,  and  coagulate  promptly.  In  ca.se  of  rupture  of  the  uterine 
walls,  and  especially  of  the  uterine  floor,  when  involving  large 
vessels,  a  profu.se  and  even  fatal  hemorrhage  may  occur  into 
the  peritoneal  cavity,  without  any  appreciable  amount  of  blood 
escaping  from  the  vulva.  In  these  instances  of  intra-uterine 
or  intra-peritoneal  hemorrhage,  the  symptoms,  in  general,  are 
those  of  internal  hemorrhage,  such  as  the  blanching  of  the 
raucous  membranes,  weakness  of  the  animal,  pain,  anxiety  and 
sweating.  Death  frequently  follows  quickly.  The  diagnosis 
must  be  made  by  these  symptoms,  in  conjunction  with  a  manual 
exploration  of  the  uterine  cavity. 

The  indications  in  uterine  hemmorrhage  will  depend  largely 
upon  the  cause  and  origin.  When  due  to  extensive  wounds  of 
the  uterine  walls,  involving  the  large  vessels,  and  the  uterus  is  in 
position,  it  is  well-nigh  beyond  the  obstetrist's  control,  though 


8 14  Veterinary  Obstetrics 

it  might  be  possible  iti  some  cases  to  secure  the  wounded  vessel  if 
it  could  be  identified.  In  the  milder  forms  of  hemorrhage,  where 
the  quantity' of  blood  is  not  great,  it  may  not  be  necessary  or  even 
advisable  to  interfere,  especially  if  the  uterine  cavity  is  in  an 
aseptic  condition.  When  the  hemorrhage  is  dependent  upon 
a  want  of  involution,  contraction  should  be  encouraged  by  such 
means  as  we  have  at  command. 

If  the  organ  is  intact,  we  may  hasten  involution  by  the  injec- 
tion into  it  of  a  tepid  .solution  of  an  antiseptic  or  a  normal  salt 
solution,  or  we  may  attempt  to  favor  involution  by  the  ad- 
ministration of  ergot  or  of  stimulants.  It  may  be  also  that  the 
involution  can  be  hastened  in  some  cases  by  the  introduction  of 
cold  water  or  of  ice  into  the  uterine  cavity,  and  at  the  same  time 
the  hemorrhage  somewhat  checked  by  the  cold. 

In  hemorrhage  from  the  prolapsed  uterus,  we  can  not  hope  to 
check  that  of  a  capillary  character  except  by  the  reposition  of 
the  organ;  while  that  from  any  torn  vessels  of  importance  can  be 
readily  controlled  with  the  aid  of  forceps  or  by  ligation  or  other 
means  in  common  use.  Digital  compression,  applied  for  some 
time,  may  bring  success. 

When  a  quantity  of  blood  has  accumulated  in  the  uterus  and 
coagulated,  it  should  be  promptly  removed  and  means  applied  to 
cau.se  uterine   involution. 

2.  Rupture  of  the  Uterus  and  Vagina. 

In  all  domestic  animals,  rupture  of  the  uterus  or  vagina  is 
liable  to  occur  at  any  time  during  labor,  and  especially  toward 
the  close  of  the  act,  as  the  fetus  is  being  forced  along  the  genital 
passages.  The  organs  are  again  subject  to  rupture  because  of 
their  prolap.se  or  eversion  of  the  organs. 

The  accident  occurs  in  a  great  variety  of  ways.  Frequently  it 
occurs  through  the  projection  of  some  part  or  extremity  of  the 
fetus  in  an  improper  direction,  so  that  it  is  forced  through  the 
wall  of  the  organ  because  of  a  concentration  of  pressure  upon  a 
small  area.  Ruptures  from  this  cause  naturally  occur  most  fre- 
quently in  the  mare  and  cow,  where  the  fetus  has  long  and  rigid 
extremities,  which  are  capable  of  inducing  great  injury  when 
they  become  misdirected. 

In  transverse  presentations  in  the  mare,  when  version  is  at- 
tempted   without   embryotomy,   there   is   always   danger   of   an 


Rjiptiire  of  the  Uterus  and  Vagina  815 

extremity  becoming  so  misdirected  that,  during  the  expulsive 
efforts  of  the  mother,  it  may  be  forced  through  the  uterine  wall 
and  bring  about  a  perforating  wound  of  the  peritoneal  cavity. 

In  the  anterior  presentation,  with  the  two  posterior  limbs  ex- 
tended beneath  the  body  of  the  fetus  and  lodged  just  in  front  of 
the  pubic  brim  upon  the  uterine  floor,  the  forcing  of  the  fetus 
into  the  passage  brings  about  a  great  concentration  of  pressure 
upon  the  uterine  floor  by  the  feet.  The  croup  and  thighs  are 
rigidly  and  firmly  pressed  against  the  sacrum  and  lumbar  verte- 
brae, while  the  extended  limbs  are  forced,  under  enormous  pres- 
sure, downward  and  forward  against  the  floor  of  the  uterus. 
Such  pressure  is  constantly  liable  to  cause  the  toes  of  the  fetus 
to  force  their  way  through  the  uterine  floor. 

When  the  fetus  presents  anteriorly  in  thedorso-sacral  position, 
with  a  foot  crossed  over  the  head,  or  a  foot  misdirected  upward 
from  other  causes,  the  misplaced  extremity  tends  constantly  to 
push  upward  and  force  its  way  through  the  roof  of  the  vagina. 
So  with  other  misdirections  of  the  anterior  or  posterior  ex- 
tremities. 

In  the  bicornual  development  of  the  fetus,  as  already  described 
on  page  716,  extensive  and  fatal  rupture  of  the  uterus  is  very 
liable  to  occur  when  traction  is  applied  in  order  to  bring  about 
delivery. 

In  torsion  of  the  uterus,  as  already  related  on  page  704,  trans- 
verse rupture  is  a  common  result  of  the  displacement,  and  follows 
regularly  when  the  torsion  has  acquired  an  extreme  degree. 

A  further  and  not  rare  cau.se  of  uterine  rupture  is  the  attempt 
of  the  veterinarian  to  force  a  fetus  through  a  constricted  passage, 
or  a  fetus  which  is  too  large  or  presents  improperh^  through  a 
normal  passage.  In  discussing  the  question  of  atresia  or  indu- 
ration of  the  cervex  uteri,  we  related  an  experience  in  which,  in 
a  heifer,  we  attempted  to  force  the  fetus,  normal  in  size  and  posi- 
tion, through  a  very  narrow  cervical  canal,  with  the  result  that 
we  ruptured  the  cervix  for  its  entire  length. 

Another,  and  highly  important,  way  by  which  rupture  of  the 
uterus  may  be  caused  during  traction  consists  in  tearing  and 
rupturing  the  walls  of  the  organ  by  forcing  it  against  some  pro- 
jecting portion  of  the  pelvis,  as  already  described  on  page  676. 
We  meet  occasionally  in  the  mare  and  cow  with  projections  or 
eminences  upon  the  pelvic  inlet,  which  assume  such  a  form  that,  if 


8i6  Veterifiary  Obstetrics 

the  uterine  wall  is  forced  against  them,  it  is  liable  to  become  seri- 
ously injured  or  even  punctured.  In  some  instances  there  occurs, 
first,  severe  maiming  or  contusion  of  the  organ,  of  such  a  char- 
acter that  its  vitality  is  destroyed  over  a  small  area,  the  devi- 
talized area  becomes  infected,  and  eventually  a  small  slough  takes 
place,  which  establishes  a  communication  between  the  uterine 
and  peritoneal  cavities. 

In  other  cases,  when  forced  extraction  is  attempted  with  a  fetus 
in  an  improper  position,  such  as  a  deviation  of  the  head,  the 
uterine  wall  may  be  caught  by  some  projecting  portion  of  the 
fetus,  and  dragged  along  in  such  a  way  that  it  doubles  upon  itself 
and  thus  tends  to  bring  about  its  rupture. 

Of  all  the  ruptures  of  the  uterus,  the  most  embarrassing  and 
unfortunate  are  those  which  are  brought  about  by  improper 
manipulation  or  accident  upon  the  part  of  the  obstetrist  himself 
or  through  the  meddling  of  laymen  or  empirics.  In  discussing 
the  general  subject  of  obstetric  work  upon  page  623,  we  have 
already  suggested  that  it  is  to  the  professional  and  legal  interests 
of  the  veterinary  obstetrist  to  examine  very  carefully  each  case 
of  dystokia  to  which  he  is  called,  and  determine  whether  or  not 
the  animal  has  been  subjected  to  injurious  meddling  before  his 
arrival,  and  discover,  if  possible,  any  important  injuries  which 
may  have  taken  place,  before  he  attempts  to  handle  the  case. 

Again,  in  discussing  the  method  or  plan  for  overcoming  dys- 
tokia or  accomplishing  obstetric  work,  we  have  urged  on  page 
630  that  the  veterinarian  should  always  use  care  and  judgment 
and  that  he  should  especially  husband  his  strength  to  conserve 
his  efficiency.  In  one  instance,  in  our  own  practice,  we  had 
labored  long  and  ineffectively  to  correct  a  lateral  deviation  of  the 
head,  in  a  case  of  wry-neck,  when  we  should  at  once  have  re- 
sorted to  embryotomy.  Finally,  after  becoming  exhausted,  we 
made  an  attempt  to  secure  the  head  by  means  of  a  long,  blunt 
hook,  and  in  our  exhausted  condition  failed  to  properly  control 
the  direction  of  the  instrument,  caught  it  in  the  uterine  wall  and 
tore  a  large  opening,  which  at  once  demanded  the  destruction  of 
the  patient. 

Sometimes,  in  cases  of  prolapse  of  the  uterus,  the  animal  gets 
the  prolapsed  organ  caught  upon  obstacles  of  various  kinds  and, 
dragging  upon  it,  brings  about  a  more  or  less  serious  rupture. 
It  is  not  very  rare  for  the  prolapsed  uterus  to  be  torn  and  lace- 


Rupture  of  the  Uterus  and  Vagina  817 

rated  by  other  animals.  Especially  is  this  true  of  the  cow  when 
she  suffers  from  eversion  of  the  uterus  in  an  enclosure  where 
swine  can  get  to  her,  as  these  animals  at  once  pounce  upon  the 
prolapsed  organ  and  begin  to  devour  it,  if  it  is  within  reach.  In 
one  case  cited  by  Fleming,  almost  the  entire  organ  had  been  de- 
voured. Just  as  the  condition  was  discovered  the  cow  got  up,  and 
the  remnant  of  the  organ  suddenly  returned  to  its  place.  The 
animal  recovered. 

At  the  normal  time  for  parturition,  or  when  abortion  occurs, 
the  uterus  may  become  ruptured  from  emphysema  of  the  fetus, 
or  rupture  may  follow  dropsy  of  the  amnion. 

The  symptoms  of  rupture  of  the  iiterus  are  perfectly  obvious 
in  the  prolap.sed  organ.  When  the  organ  in  its  normal  position 
becomes  ruptured,  the  symptoms  will  vary  according  to  the  posi- 
tion and  extent  of  the  rupture,  the  degree  of  hemorrhage,  and  the 
character  and  volume  of  substances  which  may  escape  from  the 
uterine,  into  the  peritoneal  cavity.  If  the  rupture  is  very  exten- 
sive, and  a  large  amount  of  liquids,  especially  if  infected,  escape 
into  the  peritoneal  cavity,  there  is  at  once  a  profound  collapse, 
under  which  the  animal  is  liable  to  die  very  suddenly.  If  the 
rupture  is  extensive,  and  immediately  after  the  extraction  of  the 
fetus  the  veterinarian  is  so  unfortunate  as  to  inject  into  the 
uterine  cavity  a  large  volume  of  antiseptics  for  the  purpose  of 
irrigating  the  organ,  and  these  escape  instead  into  the  peritoneal 
cavity,  the  collapse  is  sudden  and  death  may  ensue  in  the  course 
of  an  hour  or  two. 

When  the  rupture  involves  the  division  of  voluminous  blood 
ves.sels,  the  chief  symptoms  may  be  due  to  the  hemorrhage,  as 
already  described  in  the  preceding  chapter.  If  the  rupture  oc- 
curs in  the  roof  of  the  organ,  or  so  high  along  the  sides  that  it 
does  not  cause  the  escape  of  large  volumes  of  liquids  into  the 
peritoneal  cavity,  there  may  be  no  symptoms  presented  at  first, 
and  it  may  pass  undiscovered  except  through  the  medium  of 
manual  exploration.  Later,  infection  may  gain  admission  into 
the  peritoneal  cavity,  through  the  rupture,  and  bring  about  a 
septic  peritonitis,  with  all  the  symptoms  of  that  disease. 

When  the  rupture  is  very  small  and  amounts  to  a  mere  perfo- 
ration, or  when  a  small  area  of  the  organ  is  so  contused  that  it 
looses  its  vitality  to  later  become  necrotic,  and  the  peritoneal 
cavity  becomes  secondarily  opened,  the  definite  symptoms,  septic 
52 


8i8  Veterinary  Obstetrics 

peritonitis  and  its  accompaniments,  are  slow  to  become  estab- 
lished. It  may  be  several  days  after  parturition  before  they  be- 
come apparent,  and  the  definite  diagnosis  may  be  made  only  upon 
post-mortem  examination. 

In  one  instance  occurring  in  our  clinic,  the  owner  of  a  mare 
had  inhumanly  drawn  away  a  foal  while  the  head  was  com- 
pletely deviated  to  the  side,  and,  in  doing  so,  had  caused  a  com- 
plete rupture  of  the  perineum.  When  the  mare  was  presented 
at  our  clinic  because  of  this  injury,  the  afterbirth  was  still  re- 
tained. This  was  removed,  and  the  ruptured  perineum  was  reg- 
ularly cleansed  and  disinfected.  xVlthough  we  had  examined 
the  uterus  carefully,  we  had  failed  to  find  any  injury  of  its  walls, 
and  concluded  that  we  had  only  to  deal  with  the  retained 
placenta  and  the  ruptured  perineum,  but  we  were  in  error.  The 
mare  perished  three  days  after  entrance  into  our  clinic,  under 
symptoms  of  septic  peritonitis.  Upon  post-mortem  examination 
there  was  revealed  a  small  rupture  of  the  uterus  along  the  floor, 
just  anterior  to  the  pubic  brim  and  located  upon  the  median  line. 
The  opening  was  barely  sufficient  to  admit  the  passage  of  a  pen- 
cil ;  its  edges  w^ere  necrotic  ;  and  it  could  not  be  determined  from 
its  appearance  whether  the  rupture  had  been  direct  or  complete 
at  the  time  of  the  dystokia  or  whether  it  had  first  consisted  of  a 
contusion,  which  had  been  later  followed  by  gangrene  and  a 
sloughing  of  the  uterine  floor.  Most  probably  it  had  at  first  con- 
sisted of  a  contusion,  the  result  of  impingement  of  a  uterine  fold 
betw^een  the  fetus  and  a  bony  prominence  of  the  maternal  pelvis, 
during  the  inhuman  forced  extraction. 

In  another  instance  occuring  in  our  clinic,  some  stablemen  had 
delivered  a  cow  without  any  anti.septic  or  other  reasonable  pre- 
cautions, and  the  delivery  was  followed  by  retention  of  the  pla- 
centa. Though  we  removed  this  carefully  and,  as  we  believed, 
judiciously,  the  cow  exhibited  the  general  symptoms  of  perito- 
nitis, to  which  .she  succumbed.  A  post-mortem  examination  re- 
vealed a  small  perforation  of  the  uterine  floor,  just  in  front  of  the 
pubic  brim,  in  the  same  position  essentially  as  in  the  preceding 
case  of  the  mare. 

Again  it  was  impossible  to  determine  if  the  perforation  was 
immediate  or  .secondary.  In  each  ca.se  we  were  criticised  be- 
cau.se  of  the  death  of  the  patient. 

These  ca.ses  suggest  the  importance  of  care  in  examining  the 


Rupture  of  the  Uterus  ayid  Vagina  819 

uterus  in  all  instances  where  there  has  possibly'  been  tampering 
before  the  veterinarian  has  been  called,  and  should  clearly  im- 
press the  practitioner  with  the  importance  of  using  all  due  pre- 
cautions in  any  manipulations  which  he  undertakes.  It  must  be 
evident  to  him  that,  when  he  is  attempting  to  adjust  a  retained 
foot,  he  should  be  very  careful  not  to  bring  excessive  pressure 
upon  this  point  of  danger  at  the  pubic  brim,  because  of  the  con- 
stant possibility  of  causing  a  small  perforation  of  the  uterine 
floor.  We  have  suggested  that,  in  the  extension  of  a  foot  which 
has  been  retained,  the  operator  should  always  grasp  the  toe 
in  the  palm  of  his  hand,  and  cause  it  to  glide  over  the  pubic  brim 
without  coming  in  contact  with  the  uterine  floor.  This  point  is 
highly  important,  not  only  because  it  actually  facilitates  the  ope- 
ration, but  also  because  it  affords  a  highly  necessary  security 
against  serious  or  fatal  injury  to  the  organ. 

The  handling  of  rupture  of  the  uterus  must  be  adapted  to 
each  individual  case.  When  the  uterus  is  in  position,  it  is  rarely 
possible  to  close  a  rupture  by  means  of  sutures  or  otherwise.  It 
should  always  be  remembered  that  the  involution  of  the  uterus 
brings  about  a  great  decrease  in  the  size  of  a  rupture  in  its 
walls. 

When  the  organ  is  prolapsed  and  ruptured,  it  is  comparatively 
simple  to  close  the  opening  by  means  of  sutures  under  proper 
aseptic  precautions.  The  sutures  should  be  of  silk,  and  of  the 
intestinal  type,  that  is,  the  peritoneal  surfaces  should  be  brought 
in  contact  with  each  other  while  the  wound  margins  project  into 
the  uterine  cavity.  When  the  rupture  is  in  the  roof  of  the  uterus 
or  well  up  on  its  side,  there  is  always  a  pos.sibility  of  spon- 
taneous recovery,  and  every  opportunity  should  be  allowed  for 
its  occurrence. 

In  all  ca.ses  of  uterine  rupture  it  is  clearly  inadvisable  to  inject 
liquid  antiseptics  or  other  fluids  into  the  uterus,  and  take  the  risk 
of  their  escaping  into  the  peritoneal  cavity.  If  it  is  essential  to 
remove  blood  clots,  fetal  envelopes  or  disease  excretions,  this 
should  be  accomplished  without  irrigating  the  organ.  The  opera- 
tor may  largely  remove  these  with  the  hand,  which  can  be  used 
somewhat  as  a  scoop,  and  the  cleansing  may  be  completed  by 
means  of  a  piece  of  gauze  saturated  with  an  antiseptic. 

Rarely  it  may  be  practicable  to  grasp  a  ruptured  uterus, 
and  by  traction,  with  the  patient  under  general  anaesthesia,  draw 


820  Veterinary  Obstetrics 

the  ruptured  part  out  through  the  vulva,  where  the  injury  ma}- 
be  properly  sutured. 

When  the  ruptured  organ  is  prolapsed,  and  the  rupture  is  so 
extensive  that  recovery  is  very  doubtful,  the  organ  should  be  am- 
putated, which  operation  is  described  under  "  Eversion  of  the 
Uterus." 

3.  Rupture  of  the  Bladder. 

Rupture  of  the  bladder  during  parturition  is  a  very  rare  acci- 
dent. Fleming  cites  two  cases,  one  by  Furnivall  (Veterinarian, 
Vol.  33,  page  377),  in  which  a  mare  died  very  quickly  after  the 
expulsion  of  the  fetus,  and  a  post-mortem  examination  revealed 
nothing  pathologic  except  rupture  of  the  bladder.  In  the  other, 
recorded  by  Overed,  the  mare  was  not  seriously  unwell  after  foal- 
ing, but  it  was  noted  that  she  urinated  more  frequently  than  usual 
and  the  act  was  accompanied  by  pain.  However,  she  was  well 
enough  that  she  was  bred  to  a  stallion  on  the  9th  daj',  and  it  was 
only  after  four  weeks  had  elapsed  that  Overed  was  called  to  ex- 
amine the  animal.  She  later  died  under  symptoms  of  peritonitis, 
and,  upon  opening  the  abdomen,  a  large  quantity  of  fluid,  said 
to  be  about  12  gallons,  escaped,  which  was  supposed  to  be  urine. 
Diffuse  peritonitis  was  present,  and  a  rupture  existed  in  the 
bladder,  which  communicated  with  the  peritoneal  cavity.  It 
was  assumed  that  the  fundus  of  the  bladder  was  injured  during 
parturition,  and  that  it  later  sloughed  through. 

4.  Rupture  of  Intestines. 

In  rare  instances,  rupture  of  the  intestines  may  occur  during 
parturition,  either  because  they  are  over-filled  or  weakened  at 
the  time,  or  because  an  intestinal  loop  becomes  engaged  between 
the  pelvic  inlet  and  an  unyielding  portion  of  the  fetus  as  it  ad- 
vances along  the  birth  canal.  Fleming  cites  Schaack  as  having 
observed  one  instance  of  a  rupture  of  the  intestine  by  its 
becoming  compressed  between  the  fetus  and  the  pelvic  bones. 

The  symptoms  of  such  an  injury,  especially  in  the  mare,  would 
be  those  common  to  rupture  of  the  intestine,  and  would  con.sist 
chiefly  of  collapse,  with  very  feeble  or  indistinguishable  pulse, 
trembling,  and  cold  .sweats.  It  is  well-nigh  impos.sible  to  make 
a  positive  diagnosis  of  this  condition  during  the  life  of  the  ani- 
mal, and  it  can  merely  be  suspected  from  the  general  symptoms. 
It  is  not  possible  to  apply  any  effective  method  of  treatment. 


Ruphire  of  the  Diaphragm  821 

5.  Rupture  of  the  Diaphragm. 

It  has  been  claimed  that  rupture  of  the  diaphragm  occurs  rarely 
as  a  complication  or  accident  of  parturition,  in  some  cases  of 
dropsy  of  the  amnion  or  allantois,  or  from  other  causes  which 
may  induce  extraordinary  weight  or  volume  of  the  gravid  uterus. 
The  few  cases  which  are  recorded  are  not  very  significant,  and 
exhibit  no  definite  symptoms  by  which  the  accident  is  to  be 
diagnosed. 

The  diagnosis  has  been  made  post-mortem.  It  is  quite  possi- 
ble that  some  of  the  cases  diagnosed  as  rupture  of  the  diaphragm 
as  a  parturient  accident  may  have  been  post-mortem  lesions,  such 
as  frequently  occur  an  hour  or  two  after  death. 

7.  Rupture  of  the  Sacro-Sciatic  Ligaments. 

Fleming  cites  one  case  of  rupture  of  the  sacro-sciatic  ligaments 
in  the  mare,  during  the  expulsion  of  the  fetus,  but  the  symptoms 
which  he  relates  are  very  vague  in  so  far  as  establishing  the 
character  of  the  alleged  injury  is  concerned.  A  filly  was  un- 
able to  rise  after  parturition,  and  an  examination  led  the  attend- 
ing veterinarian,  Naylor,  to  conclude  that  the  sacro-sciatic 
ligament  had  been  ruptured.  We  fail  to  see  how  a  rupture  of 
the  .sacro-sciatic  ligaments  could  prevent  an  animal  from  rising 
or  standing,  or  why  the  rupture  should  have  caused  an  extreme 
atrophy  of  the  muscles  of  the  affected  hip,  as  was  recorded  in 
this  case.  The  symptoms  recorded  point  rather  to  an  injury  of 
the  gluteal  nerves,  to  which  we  shall  refer  later. 

8.  Prolapse  of  the   Intestine  through  the 

Ruptured  Walls  of  the  Uterus 

OR   Vagina. 

When  a  perforating  wound  or  rupture  of  the  walls  of  the  uterus 
or  vagina  occurs  at  any  point,  it  is  possible  for  a  protrusion  of 
the  intestines  to  follow.  This  prolapse,  however,  does  not  ordi- 
narily follow  when  a  wound  is  made  through  the  walls  of  the 
vagina  or  uterus  in  the  non-pregnant  animal.  The  prolapse  is 
probable  onl}^  in  those  cases  where  there  is  violent  straining,  as 
seen  in  parturition  or  immediately  following  it.  In  spaying  the 
mare  or  cow  through  the  vagina,  though  the  veterinarian  habitu- 
ally makes  a  more  or  less  extensive  wound,  large  enough  in  the 
mare  to  admit  the  entire  hand,  there  is  virtually  no  danger  of 


822  Veterinary  Obstetrics 

the  protrusion  of  the  intestine.  In  uterine  or  vaginal  rupture  in 
difficult  parturition,  where  the  intra-abdominal  pressure  is  enor- 
mously increased  by  the  straining,  a  portion  of  the  intestine  fre- 
quently passes  into  the  uterus  or  vagina,  and  finally  beyond  the 
vulva. 

We  have  already  noted  that  in  some  cases  a  rupture  of  the 
uterus  is  caused  by  the  meddling  of  empirics,  by  whom  some 
rude  instrument  is  used,  and  that  through  this  rupture  the  in- 
testines protrude,  if  the  fetus  is  prevented  from  escaping.  In 
one  instance  which  we  observed,  an  effort  had  been  made  to 
catch  some  portion  of  the  fetus  by  means  of  a  hooked  stick, 
and  in  .so  doing  a  large  rent  had  been  caused  in  the  wall  of  the 
vagina.  The  fetus  was  retained  within  the  uterine  cavity 
because  of  bad  position.  The  expulsive  efforts  of  the  mare  forced 
the  floating  colon  through  the  rent  in  the  vagina,  so  that  upon 
my  arrival  the  intestine  had  protruded  beyond  the  vulva  .so  far 
that  it  dragged  upon  the  ground. 

The  indications  usually  are  to  at  once  destroy  the  patient, 
since  the  prognosis  must  necessarily  be  extremely  bad.  The 
protrusion  generally  occurs  before  the  expulsion  of  the  fetus,  and 
it  then  becomes  almost  impossible  to  extract  the  fetus  without 
incidental  injury  to  the  intestine  and  infection  of  the  peritoneal 
cavity.  If  it  be  po.ssible  to  return  the  intestines  with  hope  of 
saving  the  life  of  the  patient,  this  should  be  done,  and  measures 
taken  to  keep  the  intestines  out  of  the  way  until  the  fetus  has 
passed  beyond  the  point  of  injury.  After  the  fetus  has  been  re- 
moved, it  may  in  some  cases  be  possible  to  suture  the  wound  in 
the  uterus  or  vagina  in  order  to  guard  against  further  prolapse 
and  decrease  the  danger  of  infection. 

9.  Prolapse  of  the  Bladder  through  a  Rupture 
IN  THE  Floor  of  the  Vagina. 

When  the  floor  of  the  vagina  becomes  ruptured  during  partu- 
rition, there  is  a  somewhat  remote  possibility  that  the  urinary 
bladder  may  be  forced  out  through  this  rupture  and  extend  into 
the  vagina  or  vulva.  Necessarily  such  a  prolapse  involves  the 
bending  of  the  organ  upon  itself  to  an  extent  which  tends 
to  cause  an  obstruction  to  the  passage  of  urine  through  the  ure- 
thra, and  thereby  favors  an  accumulation  of  urine  in  the  bladder. 
The  accident  is  an  exceedingly  rare  one,  and  has  occurred  only 
with  sufficient  frequency  to  establish  the  possibility. 


Prolapse  of  the  Bladder  823 

The  symptoms  consist  of  the  presence  of  the  prolapsed  organ 
in  the  vagina  or  vulva,  with  its  fundus  turned  backward  toward 
the  vulvar  opening,  or  protruding  through  it,  according  to  the 
degree  of  distension.  The  organ  is  right  side  out,  and  shows  the 
peritoneum  upon  its  surface.  A  careful  examination  of  the  floor 
of  the  vagina  will  reveal  the  presence  of  a  rupture,  through  which 
the  organ  protrudes.  In  the  mare  or  cow,  a  further  test  of  the 
character  of  the  injury  may  be  made  by  inserting  a  finger  into 
the  urethra  and  passing  it  along  that  canal  until  it  turns  upward, 
to  reappear  again  in  the  vagina  inside  the  prolap.sed  organ. 

The  indications  in  such  cases  are  to  return  the  bladder  to  its 
proper  position,  under  aseptic  precautions,  and  suture  the  wound 
in  the  floor  of  the  vagina,  bringing  the  peritoneal  surfaces  of  the 
vagina  in  contact.  If  the  bladder  should  be  so  greatly  distended 
that*  it  is  exceedingly  difficult  or  impossible  to  return  it  through 
the  rupture,  the  urine  may  be  drawn  off  by  pa.ssing  a  small  trocar 
or  hypodermic  needle  into  the  distended  organ  and  allowing  the 
urine  to  escape. 

10.  eversion  of  the  uterus.     inversion  of  the 
Uterus.     Uterine  Prolapse. 

Eversion  or  prolapse  of  the  uterus  is  a  common  and  formidable 
obstetric  accident,  especially  liable  to  occur  in  cows,  chiefly  in 
those  which  are  largely  confined  in  stables  for  dairying  purposes. 
It  is  possible  in  any  domestic  animal,  though  not  common  in  the 
smaller  species. 

The  accident  consists  at  first  of  an  invagination  of  the  anterior 
extremity  of  a  cornu  into  the  succeeding  portion,  essentially  in 
the  same  manner  as  intussusception  of  an  intestine.  Should  the 
invagination  continue,  the  invaginated  portion  finally  appears  at 
the  vulva,  and,  passing  beyond,  constitutes  a  prolapse  or  evagina- 
tion.  When  the  eversion  becomes  complete,  there  is  necessarily 
involved  with  it  a  prolap.se  of  the  vagina  as  well.  In  the  incom- 
plete forms,  and  in  the  beginning  of  the  displacement,  there 
exists  merely  an  intu.ssusception  or  invagination  of  one  of  the 
horns  to  a  limited  degree,  and  it  is  only  by  the  extension  of  this 
that  the  accident  becomes  complete.  In  uniparious  animals, 
only  the  gravid  cornu  becomes  everted,  but  the  non-gravid  cornu 
is  prolapsed  along  with  the  everted  gravid  one,  hidden  from 
view  and  recognizable  only  as  a  diverticulum  extending  inwards. 


824  Veterifiary  Obstetrics 

In  multipara  but  one  horn  is  usually  involved,  because  its  prolapse 
through  the  body  of  the  uterus  prevents  the  other  horn  from 
becoming  everted. 

Symptoms.  The  inversion  usually  begins  in  one  of  the 
cornua,  whether  in  a  uniparous  or  a  muciparous  animal.  When 
the  displacement  has  proceeded  to  only  a  very  limited  degree,  the 
chief  symptom  observed  is  that  of  expulsive  efforts,  which 
differ  very  little,  except  in  intensity,  from  tho.se  of  parturition. 
There  is  more  or  less  uneasiness  on  the  part  of  the  animal,  with 
some  symptoms  of  colic,  as  .shown  by  kicking  at  the  belly  and 
looking  toward  the  side.  These,  combined  with  expulsive  efforts, 
should  direct  attention  at  once  to  the  uterus. 

In  the  larger  domestic  animals,  where  the  uterus  can  be  readily 
examined  with  the  hand,  a  careful  search  at  this  stage  will  reveal 
the  gravid  cornu  occluded  at  some  point  in  its  length  by  a  rather 
hard  projection  into  its  canal.  Upon  examining  this  projection 
it  will  be  found  that  there  is  an  opening  in  its  center,  and  also 
that  the  fingers  may  be  passed  around  between  the  tumor  and  the 
direct  wall  of  the  cornu.  A  further  study  of  the  conditions 
pre.sent  will  show  the  obstetrist  that  he  is  dealing  with  a  begin- 
ning inversion  of  the  cornu. 

If  measures  are  not  at  once  taken  to  remedy  the  displacement, 
the  constant  tendency  is  for  the  intu.ssusception  to  extend  toward 
and  involve  the  body  of  the  uterus  and  the  vagina,  and  later  ap- 
pear at  the  vulva,  to  soon  pass  beyond  and  project  as  a  large 
bleeding  mass.  The  prolapsed  uterus  is  characteristic  in  ap- 
pearance, and  should  not  be  mistaken  for  any  other  organ.  It 
may  still  be  covered  by  retained  fetal  membranes,  which  should 
be  readily  distinguished.  In  ruminants  the  cotyledons  are  very 
x:onspicuous,  and  serve  to  fully  reveal  the  character  of  the 
accident. 

In  the  mare  the  mucous  surface  of  the  uterus  has  a  dark  red, 
velvety  appearance,  and  is  studded  thickly  over  with  the  placental 
villi.  To  the  inexperienced,  the  appearance  of  the  chorion  may 
cause  confusion  between  this  membrane  and  the  mucous  surface 
of  the  uterus.  They  are  well-nigh  identical  in  their  general  ap- 
pearance, and  can  be  distinguished  only  by  a  careful  examination. 
Especially  is  this  true  when  the  chorion  is  being  expelled 
right  side  out,  instead  of  being  everted,  as  usual,  during 
its  expulsion. 


Eversion  of  the  Uterus  825 

In  all  cases,  a  careful  examination  reveals  the  exact  character 
of  the  accident,  by  the  fact  that  the  protruding  organ  is  continu- 
ous with  the  vulva  and  vagina.  When  the  eversion  is  extensive 
and  complete,  it  forms  a  characteristic  tumor,  varying  in  its  ap- 
pearance somewhat  according  to  species.  In  the  mare  and  cow  it 
constitutes  an  immense  pear-shaped  tumor,  which,  when  the 
animal  is  standing,  hangs  down  to  the  neighborhood  of  the 
tarsus.  The  mucous  surface  has  become  external,  and  capillary 
hemorrhage  occurs  upon  its  surface.  Litter  and  other  foreign 
substances  may  be  adherent  to  its  exterior. 

If  the  eversion  has  existed  for  a  considerable  period  of  time, 
the  organ  becomes  dark,  and  occasionally  covered  with  an  exu- 
date, or,  if  it  is  of  very  long  standing,  with  pus.  It  may  be  badly 
torn  and  abraded,  or  even  gangrenous. 

The  position  of  the  uterus  causes  an  intense  mechanical  con- 
gestion and  an  enormous  increase  in  size. 

The  general  symptoms  are  by  no  means  uniform,  and  one  will 
occasionally  observe  a  cow,  with  her  uterus  quite  completely 
prolapsed,  grazing  or  ruminating  almost  as  though  nothing  had 
occurred.  In  some  instances  the  condition  produces  such  de- 
bility that  the  animal  is  unable  to  rise  ;  or  perhaps  in  more  cases 
it  might  be  said  that  prolapse  of  the  uterus  frequently  occurs  in 
animals  which  are  so  weak  that  this  additional  disturbance 
weakens  them  to  such  a  degree  that  they  can  no  longer  rise. 
In  other  cases  the  animal  is  recumbent  because  the  displacement 
constitutes  one  of  the  symptoms  of  parturient  paresis,  and  not 
becau.se  of  the  presence  of  the  prolapsed  organ.  When  gangrene 
of  the  organ  occurs,  the  extreme  debility  and  collapse  from  the 
septicaemia  may  bring  about  a  paralysis  which  prevents  the 
animal  from  standing. 

The  symptoms  may  be  modified  and  complicated  by  the  rela- 
tions of  neighboring  organs,  which  tend  also  to  become  displaced. 
The  vagina  has  necessarily  been  involved  in  each  case  of  com- 
plete prolap.se,  and  even  the  vulva  is  involved  to  a  degree  because 
of  the  great  weight  of  the  protruding  organ  dragging  upon  it,  so 
that  in  many  cases  in  the  mare  or  cow,  if  the  hand  is  inserted 
into  the  vulva,  it  can  scarcely  reach  the  boundary  line  of  the 
vagina  until  it  comes  in  contact  with  the  recurved  wall  of  the 
prolapsed  organ.     Naturally  the   bladder  and  rectum  are  more 


826  VeterJiai-y  Obstetrics 

or  less  displaced,  and  tend  to  be  drawn  into  the  pelvic  canal,  to 
occupy  a  position  somewhat  in  the  center  of  that  cavity,  and  the 
urethra  becomes  doubled  upon  itself  in  such  a  way  as  to  interfere 
with  the  escape  of  urine,  while  inside  the  uterus  one  or  more 
loops  of  the  intestine  may  extend  down  to  the  fundus  of  the  pro- 
lapsed organ. 

We  have  already  referred,  on  page  8 1 6,  to  the  danger  of  rupture 
of  the  prolapsed  uterus  in  various  ways. 

The  interference  with  the  circulation  in  the  organ,  and  the 
irritation  of  the  atmospheric  air,  constantly  accentuate  the  ten- 
dency to  congestion  and  inflammation  of  the  organ,  while  its 
denuded  surface  offers  an  excellent  avenue  for  the  introduction 
of  infection.  Thus  we  may  observe  uterine  prolapse  ending  in 
gangrene,  abscesses  or  tetanus.  The  usual  form  of  infection 
which  supervenes  upon  this  exposure  is  that  of  metritis.  Flem- 
ing, citing  Funk,  records  an  instance  where,  in  the  bitch,  the 
prolapse  of  one  cornu  prevented  the  expulsion  of  fetuses  which 
still  remained  in  the  other  horn,  necessitating  Caesarian  section 
for  their  removal. 

The  prognosis  of  prolap.se  of  the  uterus  is  exceedingly  vari- 
able, and  must  always  be  highly  unfavorable  except  artificial 
a.ssi.stance  is  given,  since  there  is  no  possibilit}-  of  spontaneous 
reduction.  Fleming  cites  one  case  in  a  cow  in  which  the  organ 
was  devoured  by  pigs,  after  which  she  recovered.  Generally 
speaking,  death  is  inevitable,  unless  the  case  has  judicious  at- 
tention. Even  then  the  mortality  is  high.  The  rapidity  with 
which  death  occurs  will  vary  according  to  circumstances  and 
complications.  In  ordinary  cases  the  animal  may  live  for  several 
days,  while  in  special  instances,  as  in  parturient  paresis  in  the 
cow,  death  may  ensue  within  a  very  few  hours,  rather  because 
of  the  paresis  than  of  the  prolap.se. 

The  prognosis  depends  very  largely  upon  the  promptness  with 
which  competent  assistance  is  given.  It  is  always  unfavorable 
in  neglected  cases,  and  very  much  more  favorable  where  prompt 
attention  is  given. 

The  prognosis  is  very  greatly  influenced  by  species,  being 
very  much  more  favorable  in  the  cow  than  in  the  mare.  Flem- 
ing, citing  Deneubourg,  states  that  in  an  extensive  experience 
he  had  not  lost  a  case  ;  and  the  same  author  cites  Moens  as  hav- 
ing had  27  ca.ses  without   a   fatality.      Other  writers   have   lost 


Inversion  of  the  Uterus  827 

as  high  as  25  to  30%  of  cases  in  the  cow.  The  statistics  regard- 
ing fatalities  in  this  accident  are  not  reliable  because,  like  in  too 
many  other  instances,  there  is  a  tendency  for  veterinarians  to 
record  their  successful  experiences  and  remain  silent  regarding 
those  where  the  termination  has  proven  fatal.  In  the  mare  the 
accident  is  highly  fatal.  Saint-Cyr,  from  statistics  given,  re- 
cords a  mortality  of  74%,  and  Zundel  of  50 ^/r.  These  figures 
are  probably  misleading,  due  to  the  fact  that  the  successful  and 
not  the  fatal  cases  have  been  recorded. 

In  our  own  experience,  prolapse  of  the  uterus  in  the  mare  has 
been  very  rare.  One  or  two  instances  occurred  where  the  pro- 
lapse appeared  immediately  upon  the  expulsion  of  the  fetus,  when 
the  mare  was  in  a  dying  condition,  and  where  death  followed 
within  a  few  minutes.  In  only  one  instance,  in  the  mare,  did  pro- 
lapse of  the  uterus  occur  in  such  a  way  as  to  call  for  definite 
treatment,  and  this  animal  survived.  She  was  unable  to  stand 
after  the  reduction  of  the  prolapse,  and  required  slings.  Before 
she  had  become  .strong  enough  to  warrant  our  removing  these, 
tetanus  .set  in,  and  the  slings  were  retained  until  she  recovered 
from  that  disea.se. 

Repeatedly  after  dystokia  we  have  recognized  a  beginning  in- 
version of  the  gravid  cornu  in  the  mare.  Having  given  it  imme- 
diate attention,  we  have  been  able  to  promptly  correct  the  posi- 
tion of  the  organ,  and  the  animal  remained  well.  However  we 
cannot  count  these  as  cases  of  prolapse,  but  simply  as  begin- 
ning cases,  in  which  a  certain  degree  of  inversion  had  occurred. 

In  the  cow  our  experience  on  the  whole  has  been  unfavorable, 
because  we  have  encountered  a  number  of  cases  of  this  accident 
as  a  complication  of  parturient  paresis,  in  which  it  has  proven 
universally  fatal.  In  other  instances  the  results  have  been  more 
satisfactory,  with  recovery  in  more  than  80 ^f  of  cases.  In  the 
smaller  animals,  inv^ersion  of  the  uterus  is  highly  unfavorable,  in 
so  far  as  replacement  is  concerned,  but  they  very  largely  recover 
after  amputation  of  the  organ. 

The  relation  of  prolapse  of  the  uterus  to  the  breeding  of  the 
animal  has  not  been  very  carefully  studied.  As  a  general  rule, 
if  the  organ  is  promptly  returned  it  seems  to  have  little  or  no  in- 
fluence upon  the  fecundity  of  the  patient  so  far  as  has  been  ob- 
served. 


828  l^eterinary  Obstetrics 

Once  the  accident  has  occurred,  its  recurrence  is  probable  at 
the  next  parturition,  and  when  such  animals  are  rebred  thej' 
should  be  watched  the  next  time  they  give  birth  to  young. 

Causes.  Prolapse  of  the  uterus  has  been  attributed  to  a 
variety  of  causes.  The  accident  necessarily  demands  the 
presence  of  a  freely  dilated  os  uteri,  and  con.sequentlj'  occurs 
very  soon  after  parturition.  It  frequently  appears  immediately 
after  the  expulsion  of  the  fetus,  in  both  the  cow  and  the  mare. 
In  some  instances  in  the  mare,  the  organ  has  followed  the  fetus, 
and  has  required  immediate  replacement.  In  these  instances  it 
seems  that  the  closely  investing  uterine  walls  adhere  more  or 
less  to  the  fetal  body,  and  tend  to  be  dragged  out  with  it,  so  that, 
as  the  last  portion  of  the  fetus  escapes  from  the  vulva,  the  uterus, 
apparently  adherent  to  it,  follows  immediately.  In  other  cases 
in  our  experience,  the  foundation  for  the  later  prolapse  is 
apparently  laid  at  the  time  of  the  act  of  birth,  by  the  apex 
of  the  gravid  cornua  becoming  inverted.  We  suspect  that  many 
of  the  cases  of  inversion  of  the  uterus  have  their  foundation  in 
such  accident  at  the  time  of  the  expulsion  of  the  fetus,  and 
that,  if  the  uterus  were  carefully  examined  at  the  time,  the 
beginning  of  what  is  later  to  constitute  a  prolapse  would  be  found, 
though  the  prolapse  itself  may  not  be  complete  until  after  one 
or  more  days.  Exhaustion  of  the  contractile  powers  of  the  uter- 
us, and  the  expulsion  of  the  fetus  wholly  through  contraction 
of  the  abdominal  walls,  or  with  traction,  tend  to  produce  the 
prolapse. 

Aside  from  a  derangement  in  the  contractile  power  of  the  or- 
gan, by  which  a  partial  intussusception  occurs  in  the  gravid 
cornu,  a  very  prominent  cause  is  tardy  involution  of  the  uterus, 
with  failure  of  the  cervix  to  contract,  consequently  leaving  the 
organ  more  or  less  open  and  flaccid. 

A  further  cause  of  prolapse  of  the  uterus  is  the  presence  of  an 
irritant  in  the  body  of  the  organ,  such  as  infection  or  retained 
placenta,  each  of  which  may  cause  expulsive  efforts,  and  at  the 
.same  time  may  delay  a  proper  involution  of  the  organ. 

Closely  allied  to  tardy  involution  is  the  question  of  the  com- 
parative amplitude  of  the  genital  passages  in  the  so-called  roomy 
animal,  and  especially  one  of  a  more  or  less  phlegmatic  tempera- 
ment. In  this  relation  we  find  general  influences  at  work,  such 
as  close  confinement  with  overfeeding,  which  is  so  often  .seen  in 


Inversion  of  the  Uterus  829 

dairy  stables,  where  the  accident  is  far  more  common  than  in  the 
field.  In  our  experience,  among  cows  which  are  kept  for  rais- 
ing beef  cattle  and  constantly  run  at  large,  the  accident  is 
almost  never  seen. 

Anatomical  peculiarities  exert  some  influence  upon  the  proba- 
bility of  inversion  of  the  uterus.  We  have  already  related,  on 
page  29,  that  the  broad  ligaments  of  tlie  uterus  of  the  cow  are 
attached  to  the  abdominal  walls  more  posteriorly  than  those  of 
the  mare,  and  hence  the  uterus  is  not  held  so  far  forward  in  the 
peritoneal  cavity.  When  pregnancy  occurs,  the  broad  ligaments 
become  greatly  amplified,  and  when  parturition  occurs  these  bands 
are  so  greatly  elongated  that  the  uterus  can  readily  become  pro- 
lapsed, so  far  as  these  attachments  are  concerned,  without  their 
becoming  ruptured  or  even  veiy  greatly  stretched.  In  spaying 
the  non-pregnant  cow  we  can  draw  the  ovary  very  nearly  to  the 
vulva.  From  this  standpoint,  the  cow  is  more  liable  to  prolapse 
than  is  the  mare.  On  the  other  hand,  the  cervix  of  the  uterus 
in  the  cow  is  more  narrow  and  contracts  more  promptly  than 
that  of  the  mare,  so  that,  if  the  contraction  takes  place  normally 
in  each,  the  mare  would  be  more  subject  to  the  accident  from  this 
standpoint  than  the  cow. 

We  must  constantly  recognize,  as  a  contributory  cause  of  pro- 
lapse, anything  which  greatly  debilitates  the  animal.  Difficult 
and  prolonged  labor  is  so  frequently  followed  by  prolapse  of  the 
organ  that  it  must  be  regarded  as  one  of  the  causes  of  the  acci- 
dent, although  it  by  no  means  follows  that  dystokia  should 
directly  cause  this  displacement.  We  repeatedly  see  cases  where 
powerful  traction  has  been  employed  without  inducing  any  dis- 
placement of  the  uterus.  On  the  other  hand,  we  meet  with 
cases  of  prolapse  of  the  organ  where  the  parturition  has  been 
natural  and  easy. 

When  the  fetal  membranes  are  abnormally  retained,  and  cause 
irritation  and  expulsive  efforts,  they  are  liable  to  cause  a  prolapse 
of  the  organ.  Eversion  is  further  facilitated  by  the  fact  that,  in 
the  presence  of  the  membranes,  the  cervix  of  the  uterus  does  not 
undergo  its  normal  constriction.  Very  naturally,  any  injudi- 
cious traction  upon  retained  membranes  tends  to  cause  prolapse 
of  the  organ.  For  example,  when  the  chorion  of  the  mare  is 
separated  from  all  parts  except  the  apex  of  the  gravid  cornu, 
.severe  traction  upon  the  membranes  is  liable  to  cause  the  beginning 


830  Veteruiary  Obstetrics 

of  an  inversion  of  the  horn,  and  the  irritation  causes  a  continua- 
tion of  the  displacement  until  the  prolapse  results. 

Parturient  paresis  acts  as  a  distinct  and  not  very  rare  cause  of 
prolapse  of  the  uterus.  Apparently  this  cause  has  been  over- 
looked by  many  veterinary  obstetrists.  In  these  instances  we 
have  the  ordinary  symptoms  of  parturient  paresis,  such  as  coma, 
coupled  with  a  sub-normal  temperature,  and  a  general  state  of 
unconsciousness  in  the  recumbent  animal.  In  the  cases  which 
we  have  observed,  three  in  all,  we  could  not  determine  from  their 
history  whether  the  ordinary  symptoms  of  paresis  occurred  first 
or  the  prolapse  was  the  initial  symptom.  Naturally,  when 
uterine  prolapse  complicates  parturient  paresis  the  animal  is 
found  in  recumbency,  usually  lying  prone  upon  her  side.  This 
induces  tympan}',  by  which  the  paresis  is  complicated  and  the 
replacement  of  the  prolapsed  organ  is  prevented. 

Handling.  In  all  ca.ses  of  dystokia,  the  obstetrist  should  ex- 
amine the  uterus  after  the  extraction  of  the  fetus,  in  order  to 
determine  if  the  organ  has  assumed  its  proper  position  and  rela- 
tions, and  especially  to  determine  if  any  inversion  of  the  organ 
has  begun.  If  such  beginning  inversion  is  present,  as  has  re- 
peatedly been  observed  by  the  writer,  the  obstetrist  should  reduce 
the  intussusception  at  once,  by  applying  pressure  upon  the  ad- 
vancing portion  of  the  organ,  either  with  the  clenched  fist  or  with 
the  ventral  surface  of  the  fingers  of  the  open  hand,  taking  care 
at  all  times  not  to  wound  or  otherwise  injure  the  organ.  After 
the  replacement  of  the  organ,  unless  there  are  reasons  to  the  con- 
trary, such  as  a  rupture  of  the  uterus,  the  obstetrist  should  inject 
into  the  uterine  cavity  a  large  volume  of  normal  salt  solution  or 
a  very  weak  disinfecting  solution,  by  which  means  the  uterus  is 
cleansed  from  any  irritants  which  may  be  present.  The  expul- 
.sion  of  the  liquids  also  causes  energetic  contractions  of  the  mus- 
cular walls  of  the  organ,  which  lead  to  a  prompt  and  normal  in- 
volution, after  which  the  danger  from  prolapse  is  usually,  if  not 
always,  eliminated.  The  same  rules  should  be  applied  when  the 
veterinarian  is  called  to  attend  an  animal  because  of  retention 
of  the  fetal  envelopes,  and  great  care  should  be  taken  not  to  leave 
the  organ  partly  everted  after  the  removal  of  the  membranes. 

In  these  cases,  the  position  of  the  patient  is  not  highly  essen- 
tial ;  but  it  is  very  desirable  that  she  should  be  in  the  standing 
position,  with  the  hind  parts  higher  than  the  fore  parts. 


Inversion  of  the   Uterus  831 

The  handling  of  complete  prolapse  or  inversion  of  the  uterus 
offers  two  different  plans — replacement  and  amputation. 

The  replacement  of  the  organ,  and  its  retention  in  position,  is 
always  the  most  conservative  and  desirable,  and  should  be  applied 
in  the  vast  majority  of  cases,  including  all  those  in  which  it  is  pos- 
sible to  replace  and  retain  it,  and  in  which  the  state  of  the  uterus 
is  such  that  the  veterinarian  ma}'  reasonably  hope  that  it  may  re- 
cover from  any  injury  or  disease  existing  at  the  time  of  its  pro- 
lapse or  acquired  as  a  result  of  the  accident. 

For  the  replacement  of  the  organ  it  is  important  that  the 
animal  should  be  placed  in  the  most  favorable  position  pos- 
sible. In  the  larger  domestic  animals,  where  the  prolapse  has 
not  existed  for  a  very  great  period  of  time,  the  standing  position 
of  the  animal  is  frequently  preferred.  Whether  the  animal  is 
standing  or  lying,  it  is  always  to  the  advantage  of  the  obstetrist 
that  its  body  should  be  more  or  less  sharply  inclined  from  be- 
hind downwards  and  forwards,  so  as  to  throw  the  weight  of  the 
abdominal  viscera  against  the  diaphragm  and  away  from  the  pel- 
vis, in  such  a  way  as  to  favor  a  spontaneous  reduction  of  the  pro- 
lapsed organ. 

When  the  prolapse  is  complete,  the  position  of  the  body  of  the 
patient  becomes  of  the  very  greatest  importance.  Though  many 
veterinarians  prefer  to  have  the  animal  standing,  those  who  have 
had  extensive  experience  in  very  severe  and  difficult  cases  are 
very  much  inclined  to  prefer  that  the  animal  be  placed  in  the 
recumbent  position,  but  never  in  sternal  recumbency.  If  the 
animal  is  to  be  handled  in  the  recumbent  position,  it  is  desirable 
that  it  be  placed  upon  its  side.  Some  hold  that  it  is  even  better 
to  place  the  animal  upon  her  back. 

The  attitude  of  the  patient  should  be  borne  in  mind,  in  every 
ca.se  of  uterine  prolapse,  because  it  modifies  the  difficulties  to 
be  overcome,  to  a  degree  which  almost  surpasses  belief.  We 
might  well  illustrate  this  fact  by  an  occurrence  in  our  practice, 
where  we  had  worked  long  and  hard  to  return  the  prolapsed 
organ  in  a  cow.  We  had  worked  with  the  patient  in  the  stand- 
ing position,  and  several  times  had  progressed  far  enough  that 
almost  the  entire  organ  had  been  returned  through  the  vulva. 
Then  violent  expulsive  efforts  would  come  on,  and  the  cow  would 
throw  herself  to  the  ground  and  undo  all  our  work.  When  this 
had  occurred   several  times,  and    we   had  worked  more  than  an 


832  Veterinary  Obstetrics 

hour,  we  had  once  more  almost  completely  returned  the  organ, 
when  the  cow  again  threw  herself  violently  to  the  ground.  This 
time,  by  accident,  she  fell  into  an  excavation,  and  lay  with  her 
head  down  hill  upon  as  steep  a  bank  as  would  permit  her  to  re- 
tain her  position  without  sliding  downward.  When  we  grasped 
the  uterus  and  again  attempted  to  return  it,  it  fairly  fell  back 
into  place  after  one  or  two  minutes  of  work,  and  the  operation,  at 
which  we  had  worked  in  vain  for  an  hour  or  two,  was  completed. 
The  smaller  animals,  when  suflfering  from  prolapse  of  the  uterus, 
are  regularly  to  be  more  or  less  completely  suspended  by  the 
hind  legs.  Where  extreme  difficulty  is  encountered  in  the  mare 
or  cow,  she  too  may  be  partially  suspended  with  ropes  and 
pulleys  from  a  beam. 

Having  secured  the  animal  in  a  proper  position  for  the  return 
of  the  organ,  or  having  made  the  necessary  arrangements  for 
placing  the  patient  in  the  proper  position,  the  obstetrist  should 
proceed  to  put  the  organ  in  proper  condition  for  its  return  into 
the  normal  position. 

If  the  placenta  remains  attached,  this  should  be  removed  if  at 
all  practicable.  In  this  everted  state,  the  operation  of  the  re- 
moval of  the  placenta  is  undertaken  under  the  very  best  possible 
conditions,  so  that  it  is  nearly,  if  not  always,  perfectly  practi- 
cable and  easy  to  remove  it.  It  is  needless  to  say  that  this  should 
be  done  with  very  great  caution,  since  any  abrasions  or  lacera- 
tions of  the  uterus  in  this  prolapsed  state  tends  to  produce  very 
profuse  hemorrhage. 

In  almost  all  cases  of  prolapse  of  the  uterus,  the  organ  has  be- 
come more  or  less  befouled  with  dirt  of  various  kinds,  and  espe- 
cially with  manure  and  bedding,  bearing  abundant  and  serious 
infection,  which  it  is  the  province  of  the  veterinarian  to  overcome 
as  far  as  possible. 

In  order  to  properly  cleanse  the  uterus,  the  organ  must  first  be 
protected  from  further  contamination  by  being  placed  upon  a 
clean  sheet,  tray,  or  other  suitable  apparatus.  Having  pro- 
vided ample  protection,  the  operator  should  next  proceed  to 
cleanse  the  organ,  chiefly  by  irrigating  it  with  a  tepid  saline 
solution,  .so  as  to  remove  most  of  the  dirt  by  mechanical  wash- 
ing, without  irritating  the  organ.  We  may  use  in  this  .solution 
a  very  small  quantity  of  carbolic  acid,  not  to  exceed  0.5%. 
The  washing  with  this  solution  should  be  very  abundant,  and 


Inversio7i  of  the  Uterus  833 

should  be  accompanied  b}'  gentle  massage,  which  will  tend  to 
overcome  the  congestion  of  the  organ,  thereby  decreasing  its 
volume. 

It  should  be  constantly  borne  in  mind  by  the  obstetrist  that 
the  position  of  the  organ,  as  related  to  the  body  of  the  patient, 
affects  its  size,  and  that,  if  the  organ  can  be  held  somewhat  above 
the  level  of  the  vulva,  or  at  least  as  high  as  that  organ,  the  blood 
tends  to  pass  back  into  the  body,  thus  relieving  to  an  appreciable 
degree  the  engorgement  of  the  organ,  and  rendering  it«  replace- 
ment more  practicable. 

If  the  uterus  has  been  torn  or  abraded,  the  wounds  should  be 
given  proper  attention.  If  any  perforations  have  occurred  in  the 
organ,  the}'  should  be  closed  by  means  of  sutures,  in  such. a 
manner  that  the  two  peritoneal  surfaces  of  the  organ  are  brought 
in  contact.  Should  any  blood  vessels  be  wounded,  they  should 
be  ligated  or  twisted,  or  the  hemorrhage  should  be  otherwise 
controlled  before  it  is  attempted  to  return  the  organ  to  its  position. 

In  some  cases  it  may  become  necessary  or  desirable,  before  at- 
tempting replacement,  to  reduce  the  volume  of  the  organ  by 
removing  a  portion  of  the  blood  from  it.  Two  plans  for  decreas- 
ing the  volume  of  blood  in  the  organ,  and  thereby  lessening 
its  size,  have  been  proposed. 

The  most  direct  and  radical  of  these  is  .scarification  of  the 
mucous  surface  of  the  organ.  While  some  writers  upon  veterinary 
obstetrics  recommend  this,  they  do  not  seem  to  speak  from  the 
standpoint  of  experience,  but  rather  theoretically.  There  can  be 
no  question  but  that  the.se  scarifications  will  reduce  the  volume 
of  the  congested  organ,  but  the  safety  of  the  operation  does  not 
.seem  so  clear.  Saint-Cyr  relates  that  early  in  his  experience  he 
applied  scarification  in  a  case  of  uterine  prolapse  in  a  mare,  and 
she  died  from  bleeding.  This  would  seem  to  be  a  very  natural 
con.sequence  of  such  an  operation.  It  would  be  well-nigh  im- 
possible to  perform  very  extensive  scarification  without  injuring 
vessels  of  large  size,  and  when  this  is  done  in  an  organ  which  has 
become  weakened  by  displacement  the  control  of  the  hemorrhage 
would  become  difficult,  if  not  impossible.  Aside  from  the  ques- 
tion of  hemorrhage,  however,  scarification  opens  up  an  extensive 
avenue  for  the  entrance  of  infection, and  the  conservative  obstetrist 
would  avoid  making  these  wounds.  The  extraction  of  the  blood 
53 


834  Veterinary  Obstetrics 

may  not  be  advisable  either, because  if  a  very  large  amount  escapes, 
even  though  it  does  not  result  fatally,  it  tends  to  seriously 
weaken  the  animal.  The  scarification  of  the  prolapsed  organ  is 
inadvisable. 

A  second  method  of  reducing  the  volume  of  the  organ  is  by 
causing  the  blood  to  return  into  the  vessels  of  the  body.  This  ma}- 
be  accomplished  by  a  variety  of  means.  We  have  already'  sug- 
gested that  the  elevation  of  the  organ  above  the  level  of  the  vulva, 
accompanied  by  massage  during  the  cleansing  of  the  organ,  tends 
to  distinctly  reduce  its  volume.  Others  suggest  that  they  get 
most  excellent  effects  from  immersing  the  organ  in  cold  water, 
and  still  others  advise  the  use  of  ice.  While  cold  may  re- 
duce the  volume  of  the  organ  more  than  the  application  of  a 
tepid  solution,  it  also  renders  it  somewhat  more  hard  and  firm, 
while  the  tepid  solution  makes  it  soft  and  pliable. 

Others  recommend  the  application  of  pressure  by  means  of  a 
bandage,  beginning  at  the  fundus  of  the  organ  and  continuing 
toward  the  vulva.  The  plan  suggested  below  for  reducing  the 
prolapse  also  efficiently  reduces  the  congestion  and  volume. 

The  reduction  or  replacement  of  the  uterus  is  next  to  be 
undertaken.  We  have  already  suggested  that,  when  the  inver- 
sion is  incomplete,  and  consists  merely  of  an  intus.sesception  of 
the  apex  of  the  gravid  cornu  into  the  succeeding  portion,  the 
operation  is  very  simple  and  consists  merely  in  placing  the 
clinched  fist  or  open  hand  against  the  advancing  or  central  por- 
tion of  the  displaced  mass,  and  pushing  toward  the  apex  of  the 
horn,  causing  it  to  become  unfolded  and  to  resume  its  normal 
position. 

When  the  inversion  is  complete,  and  prolapse  has  occurred,  the 
operation  becomes  far  more  complicated  and  difficult.  If  possi- 
ble, there  should  always  be  an  abundance  of  help  at  hand  to  give 
any  necessary  aid  to  the  operator.  Fleming  suggests  that  at  least 
four  assistants  are  necessary,  but  in  our  experience  we  have  usu- 
ally succeeded  with  two  or  three  persons,  though  admittedly  in 
severe  cases  it  is  very  much  better  if  more  persons  are  at  hand 
in  case  of  emergency.  If  the  animal  can  stand,  and  will  do  so, 
and  it  is  practicable  to  return  the  organ  with  the  patient  in  this 
position,  it  is  not  essential  to  have  very  many  assistants,  but 
even  then  it  is  usually  convenient  to  have  as  many  as  Fleming 
suggests.     Fleming  would   place   one   attendant  at  the  animal's 


Inversio7i  of  the  Uterus  835 

head  to  hold  it  firmly,  and  in  case  of  the  cow  to  pinch  the  nasal 
septum  in  order  to  control  the  movements  of  the  animal  and  dimin- 
ish the  straining.  One  man  would  stand  upon  each  side  of  the 
animal  and,  with  a  sheet  or  other  cloth,  hold  and  elevate  the  or- 
gan while  it  is  being  returned.  The  fourth  man  would  hold  the 
tail  away,  and  at  the  same  time  pinch  the  back  of  the  cow  so  as 
to  prevent  her  straining. 

Great  assistance  can  be  rendered  by  two  to  four  assistants,  in 
exerting  pressure  upon  the  prolapsed  uterus.  A  piece  of  sterile 
muslin  or  other  suitable  tunic  is  passed  beneath  the  tumor,  and  one 
or  two  assistants  grasp  each  end  as  near  to  the  organ  as  will  per- 
mit the  operator  to  work.  They  then  lift  the  organ  at  least 
as  high  as  the  vulva,  and  press  it  firmly  against  the  vulvar  open- 
ing, thus  tending  at  the  same  time  to  push  the  prolapse  back  in- 
to the  vulva  and  to  reduce  the  congestion  and  size  by  forcing  the 
blood  back  into  the  body  vessels. 

Different  operators  suggest  different  methods  for  returning  the 
organ.  The  plan  which  we  have  uniformly  followed  is  that  of 
exerting  pressure  upon  the  extremity  of  the  prolapsed  organ,  or 
as  some  would  say,  against  its  fundus.  The  pressure  is  thus 
made  against  that  part  of  the  organ  which  first  began  to  evert, 
so  that  in  replacing  it  the  operator  simply  reverses  the  process 
by  which  the  prolapse  took  place.  In  this  operation  the  obstet- 
rist  seeks  that  point  in  the  gravid  cornu  where  it  has  ceased  to 
evert,  a  point  which  is  recognized  at  the  fundus  or  extremity  of 
the  mass,  in  the  center  of  which  there  is  an  excavation  or  passage 
representing  the  apex  of  the  gravid  cornu,  which  has  not  become 
everted,  but  has  prolapsed  wathin  the  everted  portion. 

Placing  the  clinched  fist  or  open  hand  against  this  portion,  the 
operator  gradually  and  carefully  pushes  his  hand  forward,  toward 
and  into  the  vulva,  as  far  as  he  can  readily  reach.  Holding 
the  advanced  hand  in  this  position,  with  the  other  he  grasps 
the  portion  of  the  organ  immediately  surrounding  the  in.serted 
arm  and  holds  the  uterus,  while  he  withdraws  the  arm  which  has 
been  advanced,  and  prevents  the  replaced  portion  from  follow- 
ing his  arm  out.  He  now  carries  the  other  arm  up  to  and 
through  the  vulva,  pressing  with  it  a  succeeding  portion  of 
the  prolapsed  mass.  He  continues  in  this  way  to  pass  first  one 
hand  and  then  the  other  into  the  mass  of  the  organ,  and  thence 
through  the  vulva,  carrying  with   it  the  distal  or  ovarian   end 


836  Veterinary  Obstetrics 

of  the  cornii,  until  finally  the  entire  horn  and  body  have 
been  pushed  in,  and  have  thus  become  replaced  in  the  order 
of   the  original  displacement. 

It  is  essential  in  this  operation  that  great  care  be  taken  not  to 
lacerate  or  abrade  the  organ  with  the  finger  nails,  push  a  pro- 
jecting finger  through  the  walls  of  the  organ,  or  otherwise  injure 
it.  Throughout  the  operation  the  prolapsed  organ  should  be 
kept  soft  and  pliable  b}'  frequent  irrigation  with  warm  water  or 
saline  solution. 

Some  have  suggested  that,  instead  of  returning  the  apex  of  the 
gravid  or  everted  horn  first,  the  obstetrist  should  begin  at  that 
part  of  the  organ  which  is  nearest  the  vulva,  and  by  this  means 
press  the  uterus  back  through  the  vulvar  opening.  By  this 
method  the  assistants  hold  the  organ  in  the  same  position  as  the 
preceding,  and  the  operator,  acting  upon  the  proximal  portion  of 
the^prolapsed  mass,  presses  his  hands  on  either  side  of  the  tumor, 
between  it  and  the  lips  of  the  vulva,  and  thus  acts  first  upon 
the  vagina,  then  upon  the  cervix  and  bod)'  of  the  uterus,  and 
finally  upon  the  everted  cornu,  until  the  replacement  becomes 
complete. 

A  third  method  is  that  of  Coquelet,  although  it  apparently 
does  not  merit  the  designation  of  being  distinct  from  the  two 
preceding.  It  consists  essentially  of  applying  a  pressure  bandage 
of  a  peculiar  form  until  the  organ  is  considerably  reduced  in  size, 
when  one  of  the  two  preceding  methods  is  applied  for  replacing 
the  mass.  C  takes  a  clean  piece  of  cloth  about  one  yard  in 
length  and  28  to  30  inches  in  width,  and  passes  this  beneath  the 
prolapsed  organ  up  close  to  the  vulva.  Its  lower  border  is  carried 
up  over  the  distal  end  of  the  organ,  and  the  ends  are  then  carried 
up  over  the  sides  of  the  organ,  until  all  are  folded  together  on 
top  of  the  uterus,  completely  enveloping  it.  While  tepid  water 
is  kept  constantly  applied  to  the  bandage,  it  is  gradually  tightened 
by  pressing  upon  the  mass  underneath  and  pulling  the  corners  of 
the  bandage  tighter  and  tighter  until  the  desired  amount  of  re- 
duction has  been  brought  about.  The  prolapsed  organ  is  then 
replaced  by  the  method  described  above,  or  otherwise.  Other 
methods  for  reducing  the  size  of  the  organ,  due  to  some  peculiar 
way  of  applying  a  bandage,  have  been  described. 

After  the  uterus  has  been  returned  through  the  vulva,  it  is 
essential  that   the   operation   should   immediately   be   continued 


I?iversi07i  of  the  Utertis  837 

until  the  replacement  is  fully  completed,  since  otherwise  expul- 
sive efforts  recur  and  the  organ  is  almost  certain  to  again  become 
everted  and  prolapsed.  When  the  uterus  returns  into  the  vagina, 
the  operator's  hand  should  follow  it  and  should  trace  out  each 
part  of  the  cavity.  Especially  should  he  clearly  distinguish  the 
two  cornua  of  the  organ  and  make  a  careful  .search  of  the  gravid 
horn  to  see  that  the  invagination  of  that  part  has  been  com- 
pletely overcome.  As  a  rule  it  will  be  found  that  some  invagi- 
nation still  exists,  and  this  must  be  overcome  by  placing  the 
clinched  fist  or  the  open  hand  against  the  invaginatiug  mass  and 
pushing  upon  it  until  the  intussusception  has  been  completeh' 
overcome. 

When  the  complete  replacement  has  been  accomplished,  it  is 
well  to  keep  the  hand  in  the  cavity  of  the  organ  for  a  few  min- 
utes, until  straining  and  uneasiness  cease,  and  the  organ  has  un- 
dergone some  contraction  and  begins  to  recover  its  tone. 
Sometimes  severe  straining  continues,  with  the  probability 
of  a  recurrence  of  the  prolapse.  The  most  efficient  means  for 
overcoming  these  expulsive  efforts  is  the  introduction  into  the 
uterine  cavity  of  a  large  volume  of  a  warm  y{^/c  solution  of 
carbolic  acid,  which  not  only  completes  the  replacement  but 
also  soothes  the  organ,  washes  away  an}-  blood  clots  or 
extraneous  matter,  and  favors  a  normal  involution  of  the  organ. 
As  soon  as  the  uterine  cavity  is  well  filled,  the  fluid  ex- 
cites expulsive  efforts,  by  which  the  solution  is  thrown  out,  and 
the  contractions  aroused  in  the  uterine  walls  cau.se  each  part  to 
become  properly  replaced. 

If  the  straining  is  v^xy  persistent,  after  the  organ  has  been  re- 
placed as  well  as  possible,  and  the  measures  above  suggested 
have  been  carried  out,  it  ma}-  be  necessary  to  resort  to  the  u.se  of 
narcotics  or  anaesthetics.  zVmong  the  various  remedies  to  over- 
come the  straining,  we  should  not  forget  tho.se  which  may  act 
locally.  The  tepid  saline  solution  or  the  very  weak  solution  of 
carbolic  acid  acts  as  a  local  soothing  agent,  and  tends  to  decrease 
the  irritation  and  overcome  the  straining.  Iodoform  also  acts 
well  as  a  local  anaesthetic,  and  at  the  same  time  tends  to  guard 
against  infection  of  the  uterus,  and  consequently  becomes  of  very 
great  importance  in  retaining  the  organ  in  position.  The  pow- 
dered iodoform  should  be  introduced  into  the  uterine  cavity  in  a 
gelatin  capsule,  the  capsule  opened  and  the  powder  scattered 
thoroughly. 


838  Veterinary  Obstetrics 

Among  the  remedies  which  have  a  powerful  influence  in  con- 
trolUug  the  straining,  chloral  hydrate  occupies  an  important 
place.  It  may  be  administered  in  a  variety  of  ways  ;  in  draught, 
in  enema,  or  intra- peritoneally.  Some  obstetrists  have  advised  the 
use  of  ether  as  a  general  anaesthetic,  while  others  have  advised 
the  use  of  opium  as  a  narcotic.  Morphine  and  opium  are  not 
reliable  agents,  however,  in  ruminants  and  solipeds,  and  may 
excite  rather  than  soothe.  Others  advise  large  doses  of  alcohol 
to  the  point  of  inducing  narcosis,  and  this  we  would  believe  use- 
ful, even  though  given  only  as  a  stimulant,  thus  arousing  the 
contractile  powers  of  the  organ. 

In  the  smaller  animals,  where  the  uterus  is  so  small  that  the 
hand  cannot  be  introduced,  the  reposition  of  the  prolap.sed  organ 
is  rendered  difficult  and  somewhat  dangerous,  and  very  frequently 
fails.  To  a  certain  degree,  the  finger  may  be  used  to  replace  the 
organ  in  small  animals,  but  cannot  follow  it  to  assure  complete 
replacement.  In  order  to  bring  this  about,  it  may  be  necessary 
to  use  a  sound,  which  needs  be  of  large  size  and  well  rounded  at 
the  end  in  order  to  guard  against  puncture  of  the  organ.  For 
this  purpose  a  large  instrument,  like  a  horse  catheter,  may  be 
used  to  push  the  organ  into  its  position  ;  or,  as  Fleming  suggests, 
one  might  use  a  candle,  properh' rounded  at  one  end,  for  pushing 
the  organ  back  into  its  place.  If  the  small  animal  is  suspended 
by  its  hind  legs,  and  warm  water  poured  into  the  vagina  through 
a  funnel,  the  weight  of  the  water,  with  the  position  of  the  patient, 
tends  to  complete  the  replacement  of  the  organ. 

In  most  cases  when  the  prolap.sed  uterus  has  been  promptly 
reduced  and  properly  replaced,  the  animal  becomes  calm  and 
ceases  to  strain,  and  a  recurrence  of  the  prolapse  is  not  probable. 
This  especially  holds  true  in  all  cases  where  the  animal  can  stand. 
Many  obstetrists  deem  it  essential,  nevertheless,  that  some 
mechanical  appliance  should  be  used  to  prevent  a  recurrence  of 
the  eversion.  However  advisable  this  may  be,  it  should  not  tend 
in  any  way  to  decrease  the  attention  of  the  obstetrist  to  the 
measures  which  we  have  already  suggested  for  bringing  about  a 
thorough  replacement  of  the  organ  in  every  detail,  its  proper 
cleansing  and  soothing  by  irrigation,  and  the  stimulation  of  the 
uterus  to  normal  involution.  When  these  are  done,  and  thor- 
oughly done,  it  is  only  in  a  minorit}'  of  cases  that  any  mechanical 
appliances  are  essential  for  the  retention  of  the  organ.     Admit- 


Inversion  of  the   Uteriis  839 

tedly,  however,  it  is  very  unfortunate  to  leave  an  animal  without 
adequate  protection,  and  permit  the  recurrence  of  the  prolapse 
after  the  obstetrist  has  left  the  premises.  A  variety  of  appli- 
ances for  the  retention  of  the  uterus  in  position  have  been  de- 
vised and  applied,  and  are  recommended  or  condemned  by  this 
or  that  veterinary  obstetrist,  largely  according  to  his  personal 
experience  or  prejudice. 

I.  Pessaries  have  long  been  used  for  the  purpose  of  retaining 
in  position  a  uterus  which  has  once  been  prolapsed  or  threatens 
to  become  so.  They  consist  essentially  of  an  elongated  and  rigid 
shaft,  which  may  be  passed  through  the  vulva  and  vagina  into 
the  uterus,  and  retained  there  by  some  form  of  external  bandage 
or  other  mechanism,  thus  preventing  the  uterus  from  becoming 
everted.  The  uterine  end  needs  be  large  and  smooth  in  order  to 
avoid  po.ssible  injury  to  the  uterus.  They  are  constructed 
of  a  great  variety  of  materials,  and  upon  different  models. 

The  pad  pessary  is  made  of  a  stick  of  wood  20  or  25  inches  in 
length,  with  a  pad  of  as  large  a  size  as  can  readily  be  introduced 
through  the  vulva,  fixed  to  the  uterine  end.  This  is  firmly  se- 
cured to  the  wooden  stem,  so  that  it  cannot  become  dislodged, 
while  through  the  other  end  of  the  shaft  a  cord  is  passed  by  which 
it  can  be  fastened  to  a  bandage,  so  that  the  instrument  cannot  be 
forced  out  of  the  organ. 

Others  construct  a  pessary  of  metal,  with  a  small  ring  upon 
the  uterine  end.  This  is  introduced  and  retained  in  the  same 
way  as  the  pad  pessary.  A  rude  pessary  is  sometimes  made  by 
attaching  a  pig's  bladder,  filled  with  water,  to  a  round  stick,  thus 
producing  an  instrument  similar  to  the  pad  pessary.  Others 
have  suggested  a  rubber  bag,  attached  to  a  tube  to  act  as  the 
stem  of  the  pessary,  and  inflated  by  air  forced  through  the  tube 
into  it  and  retained  by  means  of  a  stop-cock.  Still  others  take 
a  large  wine  or  beer  bottle,  fasten  a  stick  in  its  mouth,  intro- 
duce the  large  end  of  the  bottle  into  the  uterus  and  retain  it 
there  with  a  bandage. 

The  value  of  the  pessary  in  veterinary  obstetrics  is  very  question- 
able. It  almost  inevitably  causes  discomfort  to  the  patient,  and 
tends  to  induce  expulsive  efforts.  If  for  any  rea.son  the  pe.s.sary 
becomes  disconnected,  such  as  the  pad  slipping  off  the  end  of  the 
shaft,  the  naked  stem  is  liable  to  be  forced  through  the  uterine 
wall  and  cause  serious  injury.     The  most  formidable  objection  to 


840  Veterinary  Obstetrics 

the  pessary  is  from  the  standpoint  of  inducing  uterine  infection. 
It  exerts  a  concentrated  pressure  upon  a  small  area  of  the  organ, 
which  weakens  the  tissues  and  renders  them  more  susceptible 
to  infection,  while  the  stalk  of  the  instrument  constitutes  a  high- 
way from  the  exterior  to  the  cavity  of  the  organ,  along  which 
bacteria  may  freely  pass.  It  is  no  longer  much  used  in  any 
country,  so  far  as  we  can  determine,  and  has  never  acquired  an 
extensive  foothold  in  American  practice. 

From  the  standpoint  of  efficiency  in  preventing  the  recurrence 
of  the  prolapse,  the  pessary  naturally  occupies  a  prominent  place, 
but  it  seems  that  the  dangers  which  surround  its  use  tend  to 
completely  outweigh  this  one  advantage. 

Sutures  in  a  variety  of  forms  have  been  recommended  by 
veterinary  obstetrists,  and  are  generally  preferred  to  the  pessary. 

The  sutures  may  con.sist  of  silk,  linen,  hemp  or  other  vegetable 
fiber,  or  of  metal.  The  metallic  sutures  may  be  in  the  form  of 
wire,  or  special  metal  bands  may  be  used.  The  sutures  are  usually 
passed  directly  through  the  lips  of  the  vulva,  but  they  may  be  in- 
serted through  the  skin  near  the  point  of  the  hip,  thus  avoiding 
the  wounding  of  the  vulvar  mucosa  itself.  They  must  neces- 
sarily be  strong  and  deeply  inserted,  in  order  to  afford  that  amount 
of  security  which  the  obstetrist  desires.  The  number  of  sutures 
to  be  inserted  need  not  be  great.  Usually  a  single  suture  will 
suffice,  if  placed  sufficiently  deep  in  the  vulva,  and  in  no  case 
need  there  be  more  than  two  deep  sutures. 

Veterinary  obstetrists  are  by  no  means  agreed  as  to  the  com- 
parative merits  of  the  sutures  placed  directly  through  the  vulvar 
lips  and  of  those  passing  over  the  vulva  and  through  the  skin  of 
the  hips.  The  former  are  known  as  labial  sutures,  and  the  latter 
as  hip  sutures.  Some  practitioners  claim  that  the  labial  suture 
is  painful  ;  that  the  tissues,  being  infiltrated  and  swollen,  may 
readily  yield  to  expulsive  efforts,  tear  out,  and  the  prolapse  recur; 
and  that  consequently  the  hip  suture  is  preferable.  The  latter 
is  applied  by  lifting  up  a  piece  of  skin  near  the  tuberosity  of  the 
ischium,  passing  the  suture  through  this  fold,  carrying  it  across 
the  vulva  to  the  opposite  side,  and  passing  it  through  another 
skin  fold  at  a  corresponding  point.  Four  to  six  of  these  sutures 
are  advised,  in  sufficienth^  close  proximity  to  prevent  any  portion 
of  the  uterus  from  pas.sing  out  between  them. 


Inversion  of  the  Uterus  841 

The  efficiency  of  sutures  in  preventing  a  recurrence  of  prolapse 
of  the  uterus  is  high,  but  not  perfect.  In  our  experience,  if  the 
straining  of  the  animal  is  very  violent,  the  sutures  are  ineffective 
and  are  promptly  torn  out  by  the  great  force  applied  by  the 
animal.  When  there  is  little  or  no  straining,  they  remain  in 
position,  and  are  effectiv^e;  at  least  the  prolapse  does  not  recur. 
Perhaps  this  is  partly  because  the  sutures  do  not  readily  permit 
it,  but  largely  because  the  animal  does  not  strain.  This  especially 
applies  to  the  sutures  through  the  lips  of  the  vulva,  which  we 
have  seen  torn  out  very  promptly,  especially  in  the  mare,  under 
violent  straining.      The  labial  sutures  have  the  further  disad- 


FiG.  139b.     RoPK  Truss  of  Raixard.     (de  Bruin.) 

vantage  that  they  produce  wounds  in  the  birth  canal  at  a  time 
when  it  is  highly  susceptible  to  infection,  which  may  readily 
extend  deeper  and  constitute  a  menace  to  the  uterus  itself. 

It  is  claimed  that  the  hip  sutures  have  a  much  higher  efficiency 
in  preventing  the  prolapse  of  the  organ,  and  they  certainly  are 
highly  superior  from  the  standpoint  of  danger  of  causing  infection 
to  the  uterus.  The  sutures  necessarily  cause  pain,  and  suture 
infection  inevitably  ensues.  It  must  consequently  be  confessed 
that  sutures,  like  the  pessary,  have  objections,  although  not  the 
same  in  each  case. 

The  bandage  or  truss  constitutes  a  third  method  for  retaining 
the  uterus.    These  appliances  consist  essentially  of  some  apparatus 


842  Veierhiary  Obstetrics 

which  can  be  held  firmly  against  the  vulva  of  the  patient,  in  a 
way  to  compress  the  opening  and  to  offer  thereby  a  more  or  less 
effective  obstacle  against  the  protrusion  of  the  uterus  or  vagina. 
They  are  made  in  a  great  variety  of  patterns,  and  of  various 
materials.  Usually  they  are  constructed  of  cord.  For  this 
purpose  two  pieces  of  cord  about  ^4.  inch  in  diameter  and  12  to 
15  feet  in  length  are  used.  Each  is  double  in  the  center,  and 
the  two  are  united  by  a  loop  in  their  middle,  in  a  way  to  leave 
an  oval  space  somewhat  in  the  form  of  a  ring,  which  will  sur- 
round and  include  the  vulvar  opening,  but  not  completely  close 
it.  The  two  free  ends  of  one  of  these  cords  are  then  passed 
downward  between  the  hind  legs,  on  either  side  of  the  udder, 
and  thence  forward  to  be  attached  to  a  collar  placed  about  the 
neck.  The  free  ends  of  the  other  cord  are  carried  upward,  one 
on  either  side  of  the  tail,  and  then  forward  along  the  back,  and 
secured  to  the  collar  at  the  top  of  the  neck.  The  cords  are  then 
drawn  sufficiently  tight  to  exert  compression  upon  the  vulva. 

Such  a  truss  will  remain  in  position  better  if  another  cord 
be  passed  around  the  loins,  firmly  attached  to  each  of  the 
longitudinal  cords  at  the  point  of  cro.ssing,  and  then  tied  tightly 
around  the  body. 

Such  a  cord  not  only  retains  the  others  in  position,  but  when 
drawn  tight  about  the  loins  tends  to  stop  straining.  A  second 
cord,  passed  around  the  chest  in  a  similar  manner,  further  aids 
in  keeping  the  truss  in  position. 

Other  forms  of  the  rope  truss  are  suggested  in  great  variety 
by  different  obstetrists.  Some  construct  a  truss  from  a  band  of 
leather,  in  which  they  make  openings  corresponding  approxi- 
mately to  the  anus  and  vulva.  The  appliance  is  retained  in 
position  in  a  similar  manner  to  the  rope  truss.  Other  obstetrists 
prefer  a  metallic  loop,  through  which  compression  is  to  be  exerted 
upon  the  vulva.  This  apparatus  is  maintained  in  position  by 
cords  somewhat  similar  to  the  rope  truss. 

With  most  veterinary  obstetrists  the  truss  holds  first  place  as 
a  means  for  retaining  the  uterus,  after  it  has  once  been  pro- 
lapsed. Its  efficiency  is  somewhat  questionable  in  so  far  as  its 
direct  influence  is  concerned.  If  the  cord  about  the  loins  is 
kept  quite  tight,  it  may  prevent  the  animal  from  straining,  and 
con.sequently  tend  to  obviate  the  prolapse  of  the  organ.  In 
our  experience,  if  an  animal  strains  .severely  the  truss  is  wanting 


Inversio7i  of  the   Utertis  843 

in  efficiency,  and  the  prolapsed  organ  may  push  it  aside  and 
escape.  According  to  our  observations,  trusses  generally  become 
relaxed  and  loosened  when  the  patient  arches  her  back  in  order 
to  strain.  Should  we  desire  to  prevent  this  relaxation,  it  is 
advisable  in  our  judgment  to  carry  the  two  inferior  cords  upward 
and  forward  over  the  flanks,  and  cross  them  over  the  loins  of  the 
animal,  from  whence  they  are  to  be  carried  downward  and 
forward  along  the  sides  of  the  chest  to  pass  between  the  fore-legs, 
and  attached  in  such  a  manner  that,  if  the  animal  arches  her 
back  in  order  to  make  an  expulsive  effort,  the  tension  upon  these 
cords  is  increased  rather  than  decreased. 

In  any  event,  however,  the  most  important  point  is  to  have  the 
truss  very  carefully  adjusted,  and  then  to  watch  it  very  closely. 
The  truss  cannot  prevent  the  inversion  of  the  organ  and  its  pas.s- 
age  into  the  vagina  and  vulva,  but  can  only  tend  to  prevent  its 
prolapse  through  the  vulvar  opening.  This  is  equally  true  of 
sutures.  While  this  tru.ss  is  recommended  by  one  and  that 
truss  by  another,  the  best  one  always  is  that  one  which  is  best 
applied.  The  actual  value  of  the  truss  is  not  so  great  as  many 
suppose,  but  after  all  it  has  an  important  influence  from  a  .senti- 
mental standpoint,  and  has  none  or  few  of  the  objections  which 
can  be  raised  against  sutures  and  pessaries.  Since  the  owner  of 
an  animal  which  has  suffered  from  prolapse  of  the  uterus  is  con- 
stantly afraid  of  its  recurrence,  it  is  good  practice  to  apply  the 
truss  in  the  majority  of  cases  simply  to  allay  his  fears,  if  it 
accomplishes  nothing  else.  Should  the  truss  become  displaced 
somewhat,  and  the  prolapse  recur,  the  owner  still  considers  that 
the  veterinarian  has  at  least  attempted  the  retention  of  the 
organ. 

We  prefer  to  show  the  owner  how  to  apply  the  tru.ss, 
should  it  become  necessary,  then  have  him  watch  the  patient 
and  so  care  for  her  that  the  truss  will  not  be  needed.  We 
have  in  mind  here  the  patient  which  is  able  to  stand.  If 
the  patient  is  recumbent,  the  case  is  graver,  and  retention  appar- 
atus usually  imperative.  She  should  be  kept  with  her  hind  parts 
elevated  and  abdominal  pressure  reduced  to  a  minimum. 

The  handling  of  prolap.se  of  the  uterus,  after  the  organ  has  been 
replaced  and  the  precautions  against  a  recurrence  taken  as  sug- 
gested, demands  little  except  to  care  for  the  general  well-being 
of  the  animal.      It  is  well  to  bear  in   mind   that   any   increase    of 


844  ]''eterinary   Obstetrics 

the  intra-abdominal  pressure  tends  constantly  to  force  the  organ 
backward.  This  may  be  largely  avoided  by  unloading  the 
alimentary  canal  with  one  of  the  prompt-acting  hypodermic 
cathartics  like  eserine  and  arecoline.  The  abdomen  should  be 
kept  somewhat  empty,  by  allowing  a  concentrated  and  laxative 
diet  and  avoiding  bulky  foods. 

If  the  weather  is  suitable,  the  animal  will  be  more  quiet,  and 
will  not  show  the  same  tendency  to  strain,  if  given  its  freedom 
in  the  pasture,  where  it  can  constantly  move  about  in  search  of 
food.  In  many  cases  when  the  animal  seems  to  be  very  much 
irritated  and  shows  a  great  tendency  to  straining,  if  it  is  led 
about  gently  for  a  time  and  its  attention  attracted,  the  irritation 
may  soon  abate.  This  movement  may  further  tend  to  bring 
about  a  more  thorough  adjustment  of  the  organ,  while  it  stimu- 
lates normal  circulation  and  involution  of  the  uterus. 

It  is  needless  to  say  that  any  food  which  may  tend  to  cause 
tympany  should  be  carefully  avoided,  or  that  constipation  should 
not  be  permitted  to  occur.  If  an  animal  becomes  tympanic, 
that  alone  may  suffice  to  bring  about  the  prolapse  of  the  organ, 
simply  as  a  result  of  the  increased  intra-abdominal  pressure. 

When  there  is  reason  to  fear  metritis  following  prolapse,  its 
avoidance  should  be  attempted  by  frequent  antiseptic  irrigations 
and  the  liberal  application  of  powered  iodoform  in  the  uterine 
cavity.  When  metritis  follows  replacement  and  retention  of  the 
prolapsed  organ,  it  should  be  handled  according  to  the  directions 
for  handling  that   malady. 

The  truss  or  sutures  may  be  retained  in  position  for  one  to 
three  days,  according  to  conditions,  or,  if  straining  continues, 
po.ssibly  for  even  a  longer  period  of  time. 

Amputation  of  the  Uterus.  When  it  becomes  impractica- 
ble or  impossible  to  return  the  prolapsed  uterus  or,  after  reduc- 
tion, to  retain  it  in  position,  the  question  of  its  amputation  arises 
with  a  view  of  saving  the  life  of  the  patient,  minus  its  power  of 
breeding.  The  reasons  for  resorting  to  amputation  of  the  uterus 
are  chiefly  three. 

I.  The  impo.ssibility  of  bringing  about  a  reposition  of  the  or- 
gan. In  practically  all  cases  of  eversion  and  prolapse  of  the 
uterus  in  large  animals,  it  is  possible  to  return  the  organ  into  its 
former  position  and  retain  it  in  place.  It  is  claimed,  however, 
that  cases  do  occur  in  which  reposition  cannot  be  attained,  and 


Amputation  of  the  Uterus  845 

this  is  especially  true    in    the  smallerdomestic  animals  with  very 
long  uterine  horns. 

2.  In  some  cases  of  prolapse  of  the  uterus,  when  the  organ  has 
remained  extruded  for  a  considerable  period  of  time  and  has  be- 
come more  or  less  necrotic  and  seriously  infected,  its  return  into 
its  usual  position  is  followed  by  serious  and  even  fatal  conse- 
quences to  the  patient.  If  the  uterus  has  been  prolapsed  for  a 
few  hours  only,  it  is  not  gangrenous  as  a  rule,  because  the  ever- 
sion  of  the  organ  does  not  wholly  cut  off  the  circulation  in  it,  but 
only  interferes  somewhat  by  doubling  the  vessels  in  their  course, 
so  that  the  blood  supply  may  be  maintained  for  a  long  time,  and 
in  some  cases  almost  indefinitely.  As  soon  as  the  organ  hangs 
down  from  the  vulva  in  a  complete  state  of  prolapse,  the  inter- 
ruption to  the  circulation  is  important,  since  in  addition  to  the 
doubling  of  the  vessels  there  is  also  the  impediment  of  gravity, 
which  causes  the  organ  to  become  greatly  engorged  with  blood 
and  interferes  in  an  important  manner  with  its  circulation.  If 
the  organ  has  been  seriously  injured  by  rough  handling  during 
dystokia,  has  been  prolapsed  for  a  number  of  hours  and  has  been 
bruised  or  crushed  against  the  floor  or  wall,  or  has  for  a  long  time 
been  greatly  soiled  by  highly  infectious  manure,  gangrene  is 
frequently  inevitable.  It  is  inadvisable  to  return  such  a  uterus 
into  position.  The  condition  may  cause  a  recurrence  of  the  pro- 
lapse, in  spite  of  any  precautions  to  the  contrary;  or,  if  the  organ 
is  retained  in  its  position,  it  may  undergo  gangrene,  and  cause 
the  death  of  the  animal. 

3.  Wounds  of  the  uterus  of  large  extent  usually  call  for  ampu- 
tation, especially  when  complicated  with  extensive  infection  of  the 
peritoneal  surface.  When  only  a  small  wound,  or  even 
a  large  one  which  is  moderately  clean,  occurs,  amputation  is 
not  necessary.  It  is  by  no  means  essential  that  the  entire  uterus 
should  be  amputated  because  a  small  portion  or  even  half  of  it  has 
been  more  or  less  damaged.  It  is  presumably  just  as  safe  to  am- 
putate ^  or  Y2  as  to  amputate  all  of  the  organ,  and  it  may  at 
times  be  of  fundamental  importance  that  we  should  save  a  portion 
of  it,  if  by  so  doing  we  may  retain  the  power  of  breeding.  Con- 
sequentl3%  when  a  wound  is  present  and  we  can  close  it  accurately 
by  means  of  sutures,  we  have  performed  an  operation  which  is 
quite  as  safe  as  the  ablation  of  the  organ.  The  principal  ob- 
jection   to    this   is  the    fact    that  some  infection  will  probably 


846  Veterinary  Obstetrics 

occur  at  the  seat  of  the  sutures,  which  may  readily  involve  the 
general  surface  of  the  uterus. 

The  prognosis  of  amputation  of  the  uterus  varies  in 
different  animals,  and  under  different  conditions.  In  the  mare  it 
is  usually  unsuccessful.  In  the  cow  it  is  a  fairly  successful 
operation,  if  undertaken  indue  season  and  carried  out  with  proper 
care.  In  the  smaller  domestic  animals  it  is  usually  quite  success- 
ful, especially  in  the  sow  and  carnivora. 

Technic.  Before  proceeding  with  amputation,  the  entire 
prolapsed  organ  is  to  be  carefully  cleansed  and  disinfected,  and 
placed  upon  a  sheet  of  sterile  gauze  or  other  material,  where  it 
may  be  well  protected  during  the  operation.  As  far  as  possible, 
the  blood  accumulated  in  the  organ  should  be  forced  back  into 
the  circulatory  system  by  compression  with  the  bandage  of 
Coquelet  as,  described  on  page  836,  or  by  other  means. 

Great  care  should  also  be  taken  that  other  viscera  are  not  in- 
cluded in  the  operation.  The  bladder  may  extend  out  into  the 
prolapsed  organ,  and  be  caught  or  damaged  in  the  operation. 
Very  frequently  a  loop  of  intestine  projects  out  into  the  peritoneal 
sac  of  the  prolapsed  organ,  and  numerous  instances  have  oc- 
curred where  veterinarians  have  carelessly  ligated  the  organ  and 
included  the  intestine,  causing  the  death  of  the  patient.  In  order 
to  safely  determine  whether  any  viscera  extend  into  the  cavity 
of  the  prolapsed  organ,  the  veterinarian  should  incise  the  uterine 
wall  under  aseptic  precautions,  and  insert  a  finger  or  his  hand 
into  its  peritoneal  cavity. 

Amputation  is  to  be  carried  out  by  the  ligation  or  suturing 
of  the  entire  organ.  Some  operators  advise  that  it  be 
ligated  in  parts,  while  others  strongly  insist  that  the  organ 
should  be  ligated  in  toto.  The  latter  is  the  usual  cu.stom, 
and  probably  the  best.  The  material  for  the  ligature  may  vary 
according  to  availability  in  a  given  case.  One  of  the  best  and 
most  satisfactory  materials  is  silk  tape,  which  is  soft  and  very 
strong,  so  that  it  will  admit  of  being  drawn  very  tight.  Others 
use  a  heavy  cord  of  almost  any  character,  and  some  veterinary 
obstetrists  advise  the  use  of  a  moderately  thick  and  strong  pure- 
gum  tubing. 

In  the  larger  domestic  animals,  the  ligature  should  usually  be 
placed  about  the  cervix  of  the  uterus,  near  to  the  external  os, 
while  in  the  smaller  multiparious  animals,    in   which   generally 


Amputation  of  the  Uterus  847 

but  one  horn  is  involved,  it  may  be  placed  as  close  as  possible 
to  the  point  of  bifurcation.  The  ligature  must  be  applied  very 
tightly,  and  for  this  purpose  powerful  traction  is  required.  The 
ligated  portion  necessarily  becomes  sharply  plicated,  and  unless 
the  ligature  is  drawn  very  tightly  there  will  be  an  open  avenue 
for  infection  to  pass  through  the  amputated  stump  into  the 
peritoneal  cavit}-.  Unless  very  tightly  ligated  also,  the  partial 
disappearance  of  the  engorgement  loosens  the  ligature  and  per- 
mits the  stump  of  the  organ  to  .slip  away. 

The  principle  of  the  application  of  the  ligature  should  be  to 
apply  it  so  tight  that  the  nutrition  of  the  portion  of  the  stump 
beyond  the  ligature  shall  be  completely  cut  off,  so  as  to  cause 
immediate  necrosis  and  prompt  sloughing  away. 

The  elastic  ligature  is  highly  efBcient,  because  it  continues  to 
contract  as  the  tissues  of  the  organ  give  way,  and  so  tends  to 
continue  tight  instead  of  becoming  loosened  by  the  yielding  of 
theti-ssues.  In  applying  this  ligature,  a  piece  of  stout  cord  should 
be  placed  lengthwise  upon  the  uterus,  and  the  ligature  applied 
tightly  around  the  uterus  and  over  the  cord.  The  cord  is  then 
tied  over  the  ligature  to  hold  it.  The  ligature  may  be  passed 
two  or  more  times  around  the  organ,  according  to  its  strength  in 
comparison  to  the  size  of  the  uterus. 

When  the  ligature  has  been  securely  applied,  the  uterus  may 
be  cut  off  at  a  safe  distance  beyond  it — in  the  cow  usually  about 
3  to  4  inches.  Care  should  be  taken  to  leave  a  sufficiently  large 
stump  to  insure  the  ligature  against  slipping  when  the  vagina 
returns  into  its  position.  On  the  other  hand,  it  is  inadvis- 
able to  leave  an  unnecessary  amount  of  tissue,  which  must  inevi- 
tably undergo  decomposition  and  consequently  prove  a  danger 
from  the  standpoint  of  infection. 

The  ligature  should  come  away  ordinarily  after  5  to  10  days, 
along  with  the  necrotic  stump  of  the  uterus.  Pending  this  time, 
the  vagina  should  be  irrigated  daily  with  antiseptics. 

In  the  amputation  of  the  organ,  the  veterinarian  should  aim,  in 
all  cases  where  practicable,  to  include  the  ovaries  in  order  to  ob- 
literate estrum  along  with  the  power  of  breeding. 

Closing  the  amputation  wound  by  means  of  sutures  is  more 
surgical,  and  safer  than  the  ligature.  After  thorough  cleansing 
of  the  prolapsed  organ,  it  should  be  grasped  and  extended  by  an 
assistant.     A  piece  of  heavy  braided  silk,  about  one  yard  long, 


848  Veterinary  Obstetrics 

should  be  armed  at  each  end  with  a  heavy  straight  needle.  The 
suturing  should  begin  at  the  top,  that  is,  opposite  the  superior 
vulvar  commissure,  and  the  two  needles  inserted  at  approxi- 
mately opposite  points,  about  I/2  in.  from  the  superior  border  of 
the  organ,  each  needle  emerging  at  the  point  where  the  other 
entered.  By  drawing  firmly  upon  the  ends  of  the  ligature,  the 
included  portion  of  the  uterus  is  strangulated.  The  needles  are 
then  turned  back,  and  reinserted  at  a  point  about  i<  in.  farther 
down,  and  the  process  repeated  until  the  inferior  wall  or  floor  of 
the  prolapsed  organ  is  reached  and  included,  when  the  ends  of 
the  suture  are  firmly  tied  together.  In  this  manner  the  circula- 
tion in  the  organ  to  be  amputated  is  completely  cut  off,  and 
hemorrhage  rendered  impossible. 

The  uterus  may  now  be  excised  at  a  point  2  or  3  in.  beyond 
the  suture  line,  but  the  incision  should  not  beat  once  completed. 
The  incision  may  be  begun  at  either  end  of  the  suture  and  ex- 
tended for  a  short  distance,  followed  by  the  application  of  a 
second  ordinary  continuous  suture,  closing  the  margins  of  the 
new-made  wounds.  When  the  suture  has  reached  the  point  to 
which  the  excision  has  been  carried,  the  cut  may  be  extended, 
the  attachments  of  the  organ  serving  merely  as  a  means  for  hold- 
ing the  stump  while  it  is  being  sutured.  The  excision  could  be 
completed  at  once,  and  the  stump  held  with  forceps.  The  same 
precautions  are  to  be  taken  in  this  operation  as  in  ligation,  to  not 
wound  or  include  the  urinary  bladder,  intestine,  or  other  viscera. 

When  the  operation  is  completed,  and  all  blood  clots  have  been 
removed,  the  stump  may  be  permitted  to  return  into  the  vagina. 
Whether  amputated  by  ligature  or  suture,  the  vagina  should  be 
kept  as  nearly  aseptic  or  antiseptic  as  possible  during  the  heal- 
ing of  the  wound.  It  should  be  irrigated  daily  and  dressed  with 
pt)wdered  iodoform. 

EVERSION    OF    THE    VaGINA.      VAGINAL    PrOLAPSE. 

Prolapse  or  eversion  of  the  vagina  may  occur  in  any  domestic 
animal  after  parturition.  We  have  already  dealt  with  pro- 
lapse of  the  vagina,  as  related  to  sterility,  on  page  199,  and 
as  occurring  during  pregnancy,  on  page  449.  The  character  of 
prolapse  of  the  vagina  after  birth,  in  a  large  proportion  of  cases, 
is  essentially  different  from  that  seen  before  or  during  pregnancy. 
Prolap.se  of  the  vagina  consists  of  the  displacement  of  .some  por- 


Eversion  of  the  Vaguia  849 

tion  or  the  entire  circumference  of  the  vaginal  wall,  backward 
into  or  through  the  vulva.  According  to  some  authors,  the  pro- 
lapse consists  chiefly  or  wholly  of  a  displacement  of  the  upper  or 
lateral  walls  of  the  vagina,  but  this  does  not  always  hold  true. 
In  many  cases  the  entire  circumference  of  the  vagina  is  pro- 
lapsed in  a  way  closely  analogous  to  the  eversion  of  the  uterus. 
Occasionally  the  vaginal  prolapse  includes  also  the  prolapse  of 
the  vaginal  portion  of  the  uterus,  exposing  to  view  the  os  uteri 
externum. 

In  other  cases  \ve  have  observed  in  the  mare,  cow  and  bitch  the 
displacement  of  the  floor  of  the  vagina  upward  and  backward 
until  it  protrudes  through  and  beyond  the  vulva  and  carries 
along  with  it  the  urinary  bladder,  which  becomes  turned  upon 
its  transverse  axis  so  that  its  fundus  is  directed  upward  and 
backward  instead  of  downward  and  forward,  to  constitute  vesico- 
vaginocele. 

Prolapse  of  the  vagina  occurs  chiefly  in  rumiflants,  and  largely 
because  of  anatomical  peculiarities.  The  uterus  of  the  cow 
is  more  readily  pushed  backward  than  that  of  any  other  animal, 
because  its  broad  ligaments  are  attached  more  posteriorly,  which 
permit  a  ready  posterior  displacement  of  the  vagina. 

Prolapse  of  the  vagina  in  ruminants  is  further  favored  by  the 
fact  that  the  organ  is  not  so  closely  attached  by  means  of  the 
pelvic  connective  tissue,  and  especially  by  the  fact  that  the 
prolongations  of  the  peritoneum  constituting  the  vesico-vaginal 
and  recto-vaginal  excavations  extend  more  posteriorly  in  these 
animals  than  in  others,  so  that  a  greater  part  of  the  vagina  is 
covered  with  peritoneum,  and  it  is  consequently  more  free  to 
move  in  any  direction.  In  addition  to  these  causes,  the  other 
essential  conditions  which  tend  to  determine  the  prolapse  of  the 
organ  exist  more  frequently  in  ruminants  than  in  other  animals. 

Etiology.  Various  causes  have  been  assigned  to  account  for 
prolap.se  of  the  vagina.  One  of  the  very  common  and  fundamental 
causes  is  a  relaxation  of  the  parts,  which  must  be  attributed 
partly  to  the  manner  in  which  the  animal  is  kept,  very  largely 
to  the  debilitating  influences  of  long-continued  and  clo.se  con- 
finement, with  high  feeding.  The  disease  is  far  more  common 
in  closely-housed  dairy  cows  and  in  closely- hou.sed  ewes  than  in 
any  other  domestic  animals. 
54 


850  Veterinary  Obstetrics 

In  addition  to  these  predisposing  causes,  there  may  occur  in- 
filtration of  the  walls  of  the  vagina  and  surrounding  connective 
tissue,  at  the  time  of  birth,  which  causes  the  vagina  to  become 
more  readily  displaced.  The  tendency  is  further  heightened  by 
increased  intra-abdominal  pressure,  and  especially  by  increased 
intra-pelvic  pressure.  Animals  which  are  highly  fed,  especially 
upon  bulky  food,  must  inevitably  suffer  to  some  degree  from  the 
consequences  of  exalted  intra-abdominal  pressure,  and  if  we  add 
to  this  a  floor  sloping  backward,  upon  which  the  animal  is  con- 
stantly kept,  the  pressure  becomes  most  effective  upon  the  pelvic 
organs,  tending  constantly  to  press  them  backward  toward  the 
vulva,  and  finally  to  cause  their  prolapse. 

A  very  fruitful  cause  of  prolapse  of  the  v^agina  following  par- 
turition consists  of  some  form  of  chronic  irritation,  either  in  the 
vagina  itself  or  in  the  uterine  cavity. 

The  most  important  and  common  cause  of  post-parturient 
prolapse  of  the  vagina  is  a  chronic  metritis,  caused  by  retained 
placenta.  Such  irritation  will  cause  expulsive  eflforts,  which 
may  produce  prolapse  of  the  vagina  or  uterus,  or  both. 

Symptoms.  vSometimes  the  prolapse  appears  as  a  reddish, 
somewhat  spherical  tumor,  between  the  lips  of  the  vulva,  which 
may  be  visible  only  when  the  animal  is  lying  down  or  when,  for 
any  reason,  she  is  making  expulsive  efforts.  In  other  instances 
the  prolap.se  is  much  greater,  and  the  everted  organ  appears  be- 
yond the  lips  of  the  vulva.  In  the  larger  animals,  the  prolapsed 
mass  may  be  as  great  as  8  or  10  inches  in  diameter.  The  exter- 
nal covering  consists  of  mucous  membrane,  which  may  be  more 
or  less  disguised  by  the  adherence  of  dirt  or  of  blood  clots.  Its 
surface  may  be  blackened  as  a  result  of  long  exposure,  or  ulcera- 
tion, suppuration  or  gangrene  may  be  present. 

As  the  case  progres.ses,  the  tendency  is  for  the  prolapse  to  be- 
come more  and  more  constant,  so  that  finally  the  displacement  of 
the  organ  is  continuous.  The  tumefaction  and  enlargement  of 
the  prolapsed  organ  may  become  so  great  that  its  replacement  is 
difficult.  The  inflammation  and  swelling  render  the  prolapsed 
organ  more  friable  and  easily  torn,  and  contact  with  the  tail, 
floor  or  walls  tends  to  cause  abrasions  and  lacerations. 

The  patient  may  eat  well  and  her  general  condition  remain 
good,  or  there  may  be  difficulty  in  defecation  and  urination, 
with  more  or  less  persistent  straining.     If  the  prolapse  is  de- 


Eversion  of  the  Vagiyia  851 

pendent  upon  disease  of  the  uterine  cavity,  the  symptoms  of 
general  disease  will  depend  upon  the  uterine  affection  rather  than 
upon  the  prolapse  of  the  vagina.  In  vesico-vaginocele,  the 
irritation  is  very  great,  and  the  difficulty  in  urinating  tends  to 
further  complicate  the  course  of  the  disease,  leading  as  a  general 
rule  to  more  or  less  continuous  and  violent  expulsive  efforts. 

A  manual  exploration  should  be  made  by  the  veterinarian  to 
determine  the  condition  of  the  vagina,  uterus  and  neighboring 
organs. 

Referring  to  differential  diagnosis,  de  Bruin  suggests  the 
possibility  of  confusion  between  prolapse  of  the  vagina, 
vaginal  tumors,  retention  cysts  of  Bartholini's  glands,  and  in- 
version of  the  bladder.  A  careful  examination,  however,  will 
reveal  the  characters  of  each  in  such  a  way  as  to  bring  about  a 
differentiation.  Tumors  of  the  vagina  are  necessarily  attached 
to  some  portion  of  the  wall. 

Bartholini's  glands  lie  upon  the  lateral  portions  of  the  floor  of 
the  vestibule,  and,  when  they  become  distended  with  retained 
contents,  appear  as  fluctuating  tumors.  The  prolapsed  bladder 
may  readily  be  recognized  by  its  point  of  attachment,  the  drib- 
bling of  urine  from  its  surface  at  the  point  of  opening  of  the 
ureters,  and  the  absence  of  the  urethral  opening. 

The  prognosis  of  the  disease  is  largely  dependent  upon  the 
cause.  As  a  general  rule  it  is  not  dangerous  for  the  life  of  the 
animal,  but  when  caused  by  chronic  inflammation  of  the  uterus, 
complicated  by  retained  afterbirth,  it  should  be  regarded  as 
serious.  The  condition  has  the  further  danger  of  consequent 
sterility. 

In  some  cases  the  patient  may  suffer  from  prolapse  of  the 
vagina  for  days  and  even  weeks,  with  great  swelling  and  ulcera- 
tion or  necrosis  of  the  mucous  membrane,  though  with  little 
danger  for  the  life  of  the  animal.  One  of  the  most  unfavorable 
features  of  the  disease  is  its  tendency  to  recur. 

Handling.  The  first  aim  is  the  replacement  of  the  organ, 
which  should  always  be  preceded  by  thorough  cleansing  and 
disinfection.  In  bringing  about  the  cleansing  of  the  prolapsed 
organ,  care  should  be  taken  to  decrease  rather  than  increase  the 
irritation  present,  in  order  that  when  it  is  returned  the  method  of 
handling  shall  not  cause  pain,  and  thereby  expulsive  efforts. 
De  Bruin  advises  the  use  of  a  2  to  3%  creolin  solution  or  a  2% 
carbolic  acid  or  alum  solution,  placing  special  emphasis  upon  the 


852  Veterinary  Obstetrics 

latter  because  of  its  cheapness  and  great  astringency.  In  our 
experience  so  strong  a  solution  of  creolin  or  carbolic  acid  as 
suggested  by  this  author  tends  to  excite  straining,  and  thereby 
to  defeat  the  object  in  view. 

The  replacement  of  the  organ  is  to  be  brought  about  in  a  way 
somewhat  analogous  to  the  reduction  of  prolapse  of  the  uterus. 
The  position  of  the  animal  should  be  the  same.  Great  advantage 
may  be  gained  by  having  the  posterior  parts  more  or  less  ele- 
vated. The  smaller  animals  may  be  suspended  by  the  posterior 
limbs.  After  having  properly  secured  the  animal  and  cleansed 
the  organ,  the  protruded  mass  may  be  replaced  by  pressure  with 
the  open  hands. 

The  finger  nails  should  be  well  trimmed  in  order  to  avoid 
abrading  the  organ,  and  the  hands  carefully  placed  in  a  manner 
to  insure  the  parts  against  injur3^  After  the  return  of  the 
organ  into  place,  the  hand  should  be  introduced  into  the 
cavity,  and  the  walls  straightened  out  and  replaced  carefully  in 
detail. 

De  Bruin  recommends,  in  cases  of  long-standing  prolap.se  of 
the  vagina,  after  cleansing  the  organ,  that  a  2%  alum  solution 
should  be  applied  to  it  for  10  or  15  minutes,  after  which  a  piece 
of  cloth  about  i^  by  2  feet  should  be  applied  to  the  prolap.sed 
organ  and  wound  about  it  as  a  bandage.  This  is  to  be  kept 
saturated  with  the  alum  solution,  while  firm  and  careful  pre.ssure 
is  applied  to  the  outside  of  the  mass  with  both  hands,  until 
finally  the  prolapsed  organ  is  replaced.  During  reposition  the 
animal  often  .strains  violently,  and  renders  the  operation  far 
more  difficult.  It  may  be  necessary  or  advisable  to  take 
measures  to  overcome  the  expulsive  efforts.  An  assistant  can 
do  much  by  attracting  the  animal's  attention  or  by  pinch- 
ing the  back  so  as  to  prevent  the  expulsive  efforts.  In  the  mare 
the  straining  may  be  overcome  to  some  extent  by  the  applica- 
tion of  the  twitch.  After  the  replacement  of  the  organ  it  is  some- 
times of  importance  to  move  the  animal  gently  for  a  time  in 
order  to  attract  its  attention  and  to  overcome  the  tendency  to 
straining. 

Where  the  prolapse  is  referable  to  irritation  in  the  uterine 
cavity,  our  efforts  must  be  directed  to  overcoming  it.  The  uterus 
should  be  thoroughly  examined,  and  no  intra-uterine  infection 
or  disease  overlooked.     After  the  reposition  of  the  va  gina,  the 


Eversion  of  the  Vagina  853 

cervical  canal  should  be  dilated,  and   the   uterus  irrigated  with 
antiseptics. 

Hess  recommends  in  these  cases  in  the  cow  that  we  search  for 
and  press  out  any  persistent  yellow  bodies  from  the  ovaries,  and 
then  apply  massage  per  rectum  to  the  uterus  .  By  this  method 
he  reports  excellent  results. 

In  other  instances  the  prolapse  is  directly  referable  to  some 
irritation  in  the  walls  of  the  vagina,  and,  before  one  may  reasona- 
bl)^  hope  to  overcome  the  straining  and  recurrence  of  the  prolapse 
the  irritation  must  be  removed.  On  page  267  we  have  related 
a  case  of  vaginal  prolapse  due  to  vaginal  adhesions  which  could 
not  be  mechanically  controlled  but  was  cured  b}-  chloral  narcosis. 

All  the  various  means  that  have  been  advised  for  preventing 
recurrence  of  uterine  prolapse  have  alike  been  suggested  for  that 
of  the  vagina.  The  pessary  is  ineffectual,  constantly  irritates 
the  organ,  and  tends  to  increase  rather  than  decrease  the  straining. 

Many  veterinarians  recommend  vulvar  sutures  as  already  de- 
scribed for  prolapse  of  the  uterus. 

It  is  inadvisable  to  apply  sutures  until  after  the  cause  of  the 
prolapse  has  been  removed,  since  such  a  closure  of  the  vulva  can 
only  result  in  harm  in  those  instances  where  ovarian,  intra- 
uterine or  intra-vaginal  disease  is  the  cause. 

The  application  of  the  bandage,  such  as  advised  for  prolapse  of 
the  uterus,  has  a  v^xy  low  efficiency  in  prolapse  of  the  vagina, 
because  the  organ  can  readily  be  pushed  out  beneath  the  bandage 
whenever  severe  straining  occurs. 

Whatever  value  anj^  retention  apparatus  may  possess,  it  is 
more  important  to  overcome  the  cause  of  the  prolapse  than  it  is 
to  force  the  organ  back  in  its  position  and  hold  it  there  by 
mechanical  means.  If  infection  is  the  cause,  and  it  usualh'  is, 
then  disinfection  must  constitute  the  basis  of  handling,  and 
should  be  applied  with  that  thoroughness  which  will  secure 
efficiency.  The  alum  solution  so  strongly  recommended  by  de 
Bruin  and  others  is  commendable,  because  it  has  high  value  as 
an  antiseptic,  is  very  astringent,  and  induces  but  little  irritation. 

Iodoform  is  a  valuable  remedy  in  such  cases,  because  it 
possesses  high  efficiency  as  a  disinfectant,  along  with  a  distinct 
local  anaesthetic  effect.  Where  the  straining  is  very  violent, 
because  of  great  irritation  in  the  vagina,  it  may  be  temporarily 


854  Veterinary  Obstetrics 

controlled  by  the  aid  of  cocaine,   eucaine  or  other  local  anaes- 
thetics. 

Where  the  irritation  is  acute  and  exceedingly  difficult  of  con- 
trol, we  may  secure  excellent  results  by  complete  chloral  narcosis, 
extending  over  several  hours.  During  this  period  of  respite 
from  severe  straining,  the  organ  may  resume  its  normal  condition. 

12.  PkolapvSE  of  the  Rectum. 

Prolapse  of  the  rectum  occurs  rarely  as  a  result  of  expulsive 
efforts  during  or  immediately  after  the  act  of  parturition.  In 
the  horse  the  anus  becomes  .somewhat  everted  normally  with 
each  defecation,  but  returns  at  once  to  its  position  when  the  act 
has  been  completed.  This  peculiarity  is  regarded  as  a  predis- 
posing cause  of  prolapse. 

In  dystokia  in  the  mare,  the  rectum  tends  to  become  everted 
on  account  of  the  violent  expulsive  efforts.  In  some  cases,  where 
difficulty  in  parturition  has  occurred  and  the  animal  is  not  con- 
stantly attended,  the  eversion  or  prolapse  of  the  rectum  may 
become  very  great,  and  seriously  imperil  the  animal's  existence. 

In  one  case  occurring  in  our  practice,  a  valuable  mare,  suffer- 
ing from  dystokia,  was  found  with  the  rectum  prolap.sed  to 
the  extent  of  3  feet,  involving  about  6  feet  of  the  organ.  With 
some  difficulty  it  was  replaced  in  position,  and  the  extraction  of 
the  foal  accomplished  without  material  delay  or  visible  injury  to 
the  rectum  or  genital  organs,  but  the  patient  perished  a  few 
hours  later.  Extreme  prolapse  of  the  rectum  is  sometimes 
observed  in  the  sow  during  parturition. 

During  labor  the  obstetrist  should  take  note  of  any  threatened 
eversion  of  the  rectum,  especially  in  the  mare,  and  should  take 
all  nece-ssar}^  precautions  against  its  occurrence.  This  may 
be  best  accomplished  by  having  an  assistant  press  upon  the  anus 
with  a  towel  or  other  cloth  saturated  with  disinfectant.  When 
the  organ  has  already  become  prolapsed,  it  should  be  replaced  as 
promptly  as  possible,  and  retained  in  position.  It  should  be  care- 
fully cleansed,  but  does  not  call  for  very  thorough  disinfection, 
since  it  nuist  again  become  infected  as  soon  as  feces  pass 
back  into  the  portion  which  has  been  prolapsed.  It  should,  how- 
ever, be  quite  well  cleansed,  and  preferably  bathed  in  a  normal 
salt  or  soda  solution,  and  then  returned  into  its  place,   followed 


Prolapse  or  Evorsio?i  of  the  Bladder  855 

by  the  hand  to  make  sure  that  all  parts  of  the  walls  are  straight- 
ened out. 

The  prognosis  of  prolapse  of  the  rectum  in  the  mare  during 
parturition  is  highly  unfavorable.  In  other  animals  the  prog- 
nosis is  more  favorable. 

13.  Prolapse  or  Eversion  of  the  Bladder. 

Eversion  of  the  bladder  may  occur  in  any  animal,  but  has  been 
noted  chiefly  in  the  mare,  though  it  has  also  been  recorded  in 
the  cow  and  sow.  The  very  wide  urethral  opening  of  the  bladder 
of  the  mare  tends  to  make  the  eversion  of  the  organ  in  that  ani- 
mal more  probable,  because  more  room  is  afforded  through 
which  the  organ  may  pass. 

The  eversion  of  the  bladder  may  occur  at  any  time  immedi- 
ately prior  to,  during,  or  following  labor.  When  prolapse  occurs 
prior  to  the  expulsion  of  the  fetus,  the  integrity  of  the  organ  may 
be  endangered  during  the  passage  of  the  fetus  through  the  vulva. 
The  accident  does  not  constitute  any  great  impediment  to  the 
expulsion  of  the  fetus,  but  greatly  imperils  the  integrity  of  the 
organ  and  the  life  of  the  patient  if  the  fetus  passes  over  the  pro- 
lapsed organ.  When  eversion  occurs  after  the  passage  of  the 
fetus,  the  danger  to  the  patient  is  less. 

The  causes  of  eversion  of  the  bladder  are  chiefly  the  exalted 
intra-abdominal  pressure  due  to  expulsive  efforts,  the  relaxed 
and  weakened  state  of  the  circular  muscles  of  the  urethra,  and 
in  the  mare,  the  very  large  urethral  opening. 

The  symptoms  of  eversion  of  the  bladder  are  of  such  a  char- 
acter as  to  render  diagnosis  easy  and  clear  in  the  majority  of 
cases.  A  tumor  appears,  which  is  somewhat  pear-shaped  and 
has  its  attachment  on  the  median  line  of  the  floor  of  the  vulva, 
at  the  point  where  the  urethra  normally  exists.  In  eversion  the 
urethral  opening  has  disappeared,  and  its  place  has  been  taken 
by  the  everted  organ.  The  tumor  varies  in  size,  according  to 
its  degree  of  congestion,  which  is  largely  dependent  upon  the 
duration  of  the  eversion.  If  the  eversion  is  recent,  or  if  it  has 
not  protruded  beyond  the  vulva  to  any  great  extent,  or  has  not 
been  seriously  abraded  or  injured,  it  presents  a  fresh  mucous 
surface,  and  upon  either  side  near  the  neck  of  the  tumor  may  be 
observed  the  two  uretral  openings,  from  which  urine  escapes 
drop  by  drop,  or  sometimes  in  small  jets  during  an  expulsive 


856  Veterinary   Obstetrics 

effort.  If  not  much  swollen,  the  bladder  may  remain  almost  or 
completely  hidden,  especially  when  the  animal  is  standing,  to 
become  exposed  when  the  patient  is  lying  down  or  straining. 

It  is  to  be  differentiated  chiefly  from  hernia  of  the  bladder 
through  a  rent  in  the  vaginal  floor,  and  from  hematoma  or  tu- 
mors in  the  vagina  or  vulva.  In  rupture  of  the  vaginal 
floor  with  hernia  of  the  bladder,  the  peritoneal  surface  of  the 
bladder  remains  external,  and  the  ureters,  still  emptying  inside 
the  organ,  may  cause  it  to  become  distended  with  urine.  The 
rupture  in  the  vaginal  floor  is  recognizable.  The  urethra  is 
present  in  its  normal  position  on  the  vulvar  floor,  and  through  it 
the  finger  or  a  catheter  may  be  passed  into  the  herniated  organ. 
'X:\\^  mucous  swxidLQS:  oi  X.\\^ everted  bladder,  is  external,  and  the 
ureters  open  upon  the  external  surface.  The  viscus  does  not 
become  dilated  with  urine,  and  the  meatus  urinarius  is  absent. 

In  the  handling  of  eversionof  the  bladder,  the  organ  should  first, 
be  thoroughly  cleansed  by  washing  with  a  non-irritant  fluid, 
such  as  a  normal  saline  solution.  The  organ  should  be  examined 
and  proper  attention  given  to  any  injuries.  If  any  perforations 
of  the  walls  of  the  organ  exist,  these  should  be  carefully  closed 
by  means  of  sutures,  so  applied  that  the  peritoneal  surfaces  of 
the  lips  of  the  w^ounds  are  brought  into  contact.  If  a  portion 
of  the  wall  of  the  organ  has  been  severel}'  lacerated  or  contu.sed 
or  has  become  .so  badly  infected  or  otherwise  damaged  that  its 
recovery  cannot  well  be  expected,  the  damaged  portion  should 
be  removed  and  the  edges  of  the  w^ound  brought  together,  thus 
amputating  as  much  of  the  organ  as  may  be  necessary.  In  such 
an  operation  it  is  essential  to  preserve  the  outlet  of  each   ureter. 

After  due  preparation  the  organ  is  to  be  returned  into  its 
normal  position,  through  the  urethral  opening.  The  operation 
is  usually  not  difficult,  especially  if  the  organ  has  not  been  long 
everted.  Grasping  the  organ  in  the  hollow  of  one  or  both  hands, 
the  operator  should  press  firmly  and  evenly  over  the  entire  mass 
until  it  gradually  returns  into  its  position.  The  operation  can- 
not generally  be  carried  out  hastily.  Firm  and  evenly  applied 
pressure  with  the  hands  gradually  forces  the  blood  out  of  the 
organ,  and  reduces  its  volume,  until  finally,  when  the  engorge- 
ment has  largely  disappeared,  the  organ  is  usually  returnable 
through  the  urethal  opening. 


Riiphire  of  the  Perhietim  857 

After  replacement,  an}'  irritation  present  may  be  ameliorated 
to  some  extent  by  irrigating  the  cavity  with  a  warm  saline  solu- 
tion. If  this  does  not  suffice,  local  anaesthetics  may  be  applied, 
such  as  cocaine  with  adrenalin  chloride.  General  anaesthetics 
or  narcotics,  like  chloral  and  morphine,  may  also  be  used  in  order 
to  overcome  the  expulsive  efforts,  b}'  which  the  replacement  or 
retention  of  the  organ  is  made  difficult. 

The  prognosis  in  prolapse  of  the  bladder  is  usually  favorable, 
if  it  is  handled  early  and  properl^^ 

14.    Rupture  of  the  Perineum. 

Ruptures  of  the  perineal  tissues  may  consist  of  a  rupture  of  the 
vulvo-vaginal  roof  and  ano-rectal  floor  in  front  of  the  sphinc- 
ter muscles  of  these  two  openings,  to  constitute  recto- vaginal  or 
ano-vulvar  fistula.  The  lesion  may  extend  backward  from  this 
opening  and  involve  a  complete  division  of  all  the  tissues  com- 
prised between  the  floor  of  the  anus  and  the  superior  commissure 
of  the  vulva,  so  that  the  two  openings  are  converted  into  one 
cavity,  into  which  the  rectum,  the  vagina  and  the  bladder  empty 
in  a  common  cloaca.  In  other  cases  it  maj-  consist  of  a  more  or 
less  extensive  rupture  at  the  superior  commissure  or  other  part 
of  the  vulva,  without  involving  the  anus. 

The  symptoms  of  a  rupture  extending  from  the  vulva  or  va- 
gina into  the  anus  or  rectum,  without  involving  the  sphincter 
muscles,  are  not  well  marked  externally  at  first,  but  may  be  fol- 
lowed .soon  by  swelling.  At  the  time  of  the  accident  the  obstet- 
rist  or  attendant  may  observe  that  .some  portion  of  the  fetus  has 
passed  from  the  vulva  or  vagina  upward  into  the  anus  or  rectum. 
Later  feces  occasionally  drop  from  the  vulva.  The  relative 
amounts  of  feces  which  may  escape  from  the  vulva  and  anus  re- 
spectively will  depend  upon  the  size  of  the  opening  between  the 
two  passages.  There  is  frequently  an  involuntary  passage  of 
flatus,  especially  when  the  animal  is  driven  at  a  trot. 

When  the  rupture  of  the  perineum  is  complete,  and  involves 
the  floor  of  the  anus  and  roof  of  the  vulva,  the  symptoms  are  well 
defined  and  very  evident.  At  first  there  is  more  or  less 
hemorrhage  from  the  lacerated  tissues.  The  tissues  are  greatly 
lacerated  and  befouled  with  feces,  which  drop  into  the  wound, 
and  thence  into  the  vulva.  There  is  intense  infection,  followed 
by  extensive  swelling  and  suppuration,  accompanied  by  necrosis 


858  Veterhiary  Obstetrics 

of  the  lacerated  tissues.  After  a  time  the  lacerated  wounds  heal, 
with  cicatricial  deformity.  There  is  uo  reunion  of  the  divided 
parts,  but  each  portion  separately  granulates  and  heals,  leaving 
the  perineum  divided.  The  feces  constantly  fall  into  the  vulva, 
from  which  they  drop  in  an  involuntary  manner,  after  causing  a 
chronic  irritation  and  thickening  of  the  mucous  membrane.  If 
the  animal  is  moved  at  a  rapid  pace,  there  is  an  involuntary  pas- 
sage of  air  in  and  out  of  the  cloaca,  which  causes  a  repulsive 
sound,  and  as  the  air  is  involuntarily  forced  out  it  usually  carries 
with  it  particles  of  fecal  matter. 

The  causes  of  rupture  of  the  perineum  may  be  divided  into  three 
important  groups. 

1.  The  misdirection  of  a  fetal  extremity,  by  which  it  becomes 
deviated  upward  and  is  forced  through  the  roof  of  the  vagina 
into  the  rectum,  to  eventually  appear  in  most  cases  through  the 
anal  opening.  The  other  fetal  extremities  pass  through  the  vulva, 
and  thus,  as  the  fetus  is  forced  along  by  the  expulsive  efforts, 
the  complete  rupture  of  all  tissues  between  the  vulva  and  anus 
posterior  to  the  perforation  inevitably  follows.  When  the  owner 
or  obstetrist  is  present,  and  notes  the  threatened  injury  in  time, 
the  diverging  foot  or  head  may  be  pushed  back  into  the  vagina 
from  the  rectum,  and  the  delivery  brought  about  in  the  usual 
way,  leaving  a  more  or  less  extensive  tear  in  the  recto- vaginal 
partition.  Cases  are  recorded  in  which  the  entire  fetus  has 
passed  into  the  rectum  and  been  expelled  through  the  anus,  thus 
leaving  a  very  wide  and  extensive  rent  between  the  rectum  and 
vagina.  The  mare  is  far  more  liable  to  this  accident  because  of 
her  spacious  rectum,  often  filled  with  large,  hard  fecal  masses, 
and  the  tendency  for  the  long  and  rigid  feet  of  the  foal  or  its 
long  and  pointed  nose  to  become  displaced  upward  toward  the 
rectum,  to  be  forced  through  the  recto- vaginal  wall.  The  mare 
is  further  rendered  liable  to  this  injury  because  of  the  stormy 
character  of  her  labor  pains  and  the  rapidity  of  the  passage  of 
the  fetus  through  the  birth  canal.  The  rupture  of  the  perineum 
in  this  manner  is  therefore  es.sentially  an  accident  of  the  mare, 
and  is  rarely,  if  ever,  observed  in  other  domestic  animals. 

2.  Rupture  of  the  perineum  may  be  caused  in  any  animal  by 
overstretching  of  the  parts  as  the  result  of  forcing  through  the 
birth  canal  a  fetus  of  too  large  dimensions,  and  especially  a  fetus 
with  one  or  more  extremities  di.splaced,  forming  a  projection  and 


Rupture  of  the  Perineum  859 

abrupt  increase  of  diameter,  which  may  cause  an  increased 
tension  to  bear  upon  some  portion,  especially  the  superior  com- 
missure of  the  vulva.  We  have  seen  complete  rupture  of  the 
perineum  in  the  mare,  where  the  foal  had  been  torn  away  by 
powerful  traction  exerted  upon  the  two  anterior  limbs,  while  the 
head  and  neck  of  the  foal  were  completely  deviated  to  the  side. 

The  prognosis  of  rupture  of  the  perineum  depends  chiefly  upon 
the  character  and  degree  of  the  lesion.  When  the  rupture  results 
in  a  recto-vaginal  fistula,  the  prognosis  is  favorable  for  the  life 
of  the  animal,  and  moderately  favorable  as  to  her  usefulness,  but 
as  a  general  rule  the  animal  makes  an  objectionable  noise  when 
being  trotted,  owing  to  the  involuntary  escape  of  flatus  from  the 
rectum  through  the  vulva.  It  is  possible  for  such  animals  to  breed , 
providing  the  fistula  is  of  such  a  character  that  the  penis  of  the 
stallion  will  not  become  engaged  in  the  opening  during  coition. 

The  probability  of  bringing  about  a  recovery  in  such  cases, 
that  is  a  complete  recovery  by  obliteration  of  the  fistula,  is  re- 
mote. We  have  made  repeated  efforts  to  bring  about  a  closure 
of  the  fistula  in  two  cases  in  the  mare,  and  in  each  instance  not 
only  failed  absolutely  in  our  object,  but  left  the  fistula  rather 
larger  than  smaller.  A  few  cases  of  complete  recovery  from  this 
injury  appear  to  be  recorded,  but  the  failures  are  apparently  left 
unpublished. 

When  the-  rupture  involves  the  complete  destruction  of  the 
sphincters  of  the  anus  and  vulva,  and  includes  the  floor  of  the 
rectum  and  roof  of  the  vagina  for  some  inches  forward,  the 
prognosis  is  again  highly  favorable  in  respect  to  the  life  of 
the  animal.  As  in  the  preceding  condition,  there  have  ap- 
peared from  time  to  time  records  of  complete  recovery  follow- 
ing sutures,  but  here  again  there  has  been  ominous  silence  in 
reference  to  the  failures.  How  great  the  proportion  of  failures 
we  do  not  know,  but  it  must  certainly  be  very,  very  high, 
probably  more  than  909^ .  Personally  we  have  neither  obtained  a 
recovery  nor  had  the  privilege  of  observing  one  in  the  hands  of 
other  veterinarians. 

In  almost  all  cases  the  wounds  granulate  and  finally  cicatrize, 
but  the  lips  of  the  wound  do  not  unite,  and  the  anal  and  vulvar 
cavities  remain  one,  with  the  feces  dropping  into  the  vulva.  An 
animal  with  complete  perineal  rupture  which  has  failed  to  unite, 
is  usually  sterile.      The   conditions   are    such    that    successful 


86o  Veterinary  Obstetrics 

copulation  cannot  readily  occur,  because  the  penis  of  the  stallion 
becomes  deflected  upward  into  the  rectum.  As  work  animals 
they  are  wholly  worthless  for  purposes  of  pleasure,  because  of 
the  repulsive  sound  of  the  involuntary  passages  of  air  in  and  out 
of  the  cloaca  and  the  fragments  of  feces  accompanying  the  ex- 
pelled air,  which  scatter  in  every  direction.  Unless  complete 
recovery  can  be  obtained,  the  value  of  the  animal  is  virtuall}^ 
ruined  except  for  the  temporary  purpose  of  nursing  the  foal 
should  it  be  born  alive.  After  this  service  has  been  rendered 
the  mare  usually  passes  into  the  hands  of  low  dealers,  l^uless 
complete  recovery  can  be  attained,  it  is  usually  better  for 
.sentimental  and  humane  reasons  to  destroy  the  animal. 

3.  The  third  group  of  lesions,  which  consists  chiefly  of  the  tear- 
ing of  the  lips  of  the  vulva  at  or  near  the  superior  commissure  or 
el-sew^here,  without  involving  extensively  the  sphincter  of  the 
anus,  the  prognosis  is  highly  favorable.  Under  proper  surgical 
attention,  the  animal  should  be  completely  restored  to  usefulness 
in  the  va.st  majority  of  cases. 

The  handling  of  these  very  serious  accidents  calls  for  judg- 
ment and  patience  upon  the  part  of  the  veterinarian.  In  the  two 
first  groups,  in  spite  of  the  very  unfavorable  prognosis,  attempts 
should  be  made  to  bring  about  complete  recovery,  always  giving 
to  the  owner  an  unfavorable  prognosis,  and  thus  placing  the 
operator  in  a  proper  position  before  the  handling  is  undertaken. 
There  is  nothing  to  lose,  and  if  success  follows  the  effort,  the 
gain  is  the  value  of  the  recovered  animal. 

Views  vary  as  to  the  most  opportune  time  at  which  an  opera- 
tion should  be  undertaken.  Some  recommend  operating  im- 
mediately after  the  injury,  while  others  counsel  delay  until  the 
lacerated  tissues  have  sloughed  away  and  granulation  is  estab- 
lished over  the  entire  wound  surface.  In  this  the  operator 
should  be  guided  somewhat  by  circumstances.  If  called  im- 
mediately, before  a  serious  infection  of  the  wound  accompanied 
by  great  swelling  has  taken  place,  we  consider  it  preferable  to 
operate  at  once. 

If  the  operation  has  been  delayed  until  the  wound  margins 
have  healed,  it  becomes  necessary  to  entirely  denude  them  of 
epithelium. 

Prior  to  undertaking  the  operation,  the  alimentary  tract 
should  be  thoroughly  and  completely  evacuated,  .so   that   there 


Rupture  of  the  Perineuyn  86 1 

may  be  no  necessity  for  the  passage  of  feces  over  the  freshly 
closed  wound.  Such  unloading  is  best  accomplished  with  re- 
peated small  doses  of  eserine  or  arecoline.  A  mare  of  medium 
size  may  take  0.75  to  i  grain  of  either  alkaloid,  which  should  be 
repeated  every  45  to  60  minutes  until  the  intestines  are  appar- 
ently completelj^  empty. 

The  vulva,  anus,  perineum,  buttocks  and  tail  should  be 
thoroughly  scrubbed  with  hot  water,  soap  and  brush  for  half  an 
hour  or  more  and  bathed  thoroughly  with  ether  to  dissolve  the  fats 
in  the  skin.  The  parts  should  then  be  thoroughly  scrubbed  with 
a  hot  i-iooo  corrosive  sublimate  solution  for  15  to  30  minutes. 
This  should  be  completed  before  casting  the  patient  or  placing 
her  on  the  table. 

The  animal  is  to  be  placed  in  lateral  recumbency,  for  which 
purpose  the  operating  table  furnishes  by  far  the  best  means  and 
places  the  patient  in  the  best  possible  position  for  the  conveni- 
ence and  efficiency  of  the  operator.  If  a  table  is  not  available, 
the  patient  may  be  secured  upon  an  improvi.sed  platform  of 
boards  or  straw,  and  sufficient  elevation  acquired  to  render  the 
operation  field  available. 

The  patient  is  then  to  be  placed  under  complete  general  anaes- 
thesia with  chloroform  or  chloral.  Local  anaesthesia  does  not 
fully  answer,  because  the  animal  will  resist  the  confinement  and 
interfere  with  the  operation  even  in  the  absence  of  surgical  pain. 

The  vagina  and  rectum  are  to  be  thoroughly  washed  and  dis- 
infected. The  rectal  and  vaginal  mucosa  will  not  withstand 
concentrated  disinfectants,  without  inducing  an  irritation  which 
will  later  cause  swelling  and  straining.  The  operator  should 
accordingly  do  much  of  the  cleansing  by  means  of  irrigations 
with  warm  normal  salt  solution,  followed  by  copious  irrigations 
with  a  1%  solution  of  carbolic  acid,  creolin  or  lysol.  The  weak- 
ness of  the  disinfecting  solution  needs  be  counterbalanced  by 
careful  and  extended  application. 

The  tail  should  be  completely  enclo.sed  in  an  antiseptic  band- 
age, and  securely  tied  out  of  the  operator's  way.  Antiseptic 
towels  or  cloths  should  be  spread  in  abundance  over  the  but- 
tocks and  thighs,  and  secured  in  position  b}'  means  of  safety- 
pins.  The  table  or  floor  just  beneath  the  field  of  operation 
should  also  be  carefully  covered  with  antiseptic  towels  or  gauze. 

These  precautions  having  been  taken,  the  vagina   and   rectum 


862  Veterinary  Obstetrics 

are  to  be  carefully  wiped  drj'  with  sterile  gauze.  If  the  opera- 
tion is  upon  a  fresh  case,  any  necrotic  or  maimed  tissue  fragments 
are  to  be  carefully  excised  with  scissors.  If  the  case  is  an  old  one 
and  the  wound  margins  are  covered  with  epithelium,  this  must 
be  carefully  and  completely  removed. 

The  recto-vaginal  cloaca  is  to  be  widely  dilated  by  means  of 
retractors,  and  the  recto-vaginal  walls  upon  either  side  of  the 
wound  grasped  with  double  tenaculum  forceps  and  drawn  back- 
wards as  far  as  possible,  bringing  them  essentially  external  to  the 
vulvar  lips. 

The  sutures  may  be  applied  by  any  reliable  method.  A  good 
plan  is  to  take  heavy  braided  silk  sutures  about  two  feet  in  length, 
armed  at  either  end  with  a  full-curved  needle.  Carry  one  of  the 
needles  into  the  rectum  and,  if  the  operator  is  right  handed, 
insert  the  needle  into  the  right  side  of  the  recto-vaginal  parti- 
tion about  }{,  inch  from  the  anterior  end  of  the  wound  and  an 
equal  distance  from  its  lateral  margin.  Pass  the  needle  down 
to  but  not  through  the  vaginal  muco.sa,  carry  it  across,  insert  it 
in  the  opposite  margin  of  the  wound  between  the  vaginal  mucosa 
and  mu.scular  tissue,  carry  it  up  through  into  the  rectum  at 
a  point  opposite  the  entrance  on  the  left  side,  and  remove  the 
needle.  Insert  the  other  needle  in  the  same  manner  about  % 
inch  posterior  to  the  first,  and  pass  through  the  tissues  and  back 
into  the  rectum  in  the  same  way.  Tie  the  extreme  ends  of  the 
suture  together,  and  have  an  assistant  hold  it  upward  out  of  the 
way. 

Apply  a  second  suture  in  the  same  manner,  and  repeat  until  the 
posterior  or  external  end  of  the  wound  is  reached.  Drop  all  the 
sutures  along  the  floor  of  the  rectum,  or  have  an  assistant  hold 
them  aside.  Divide  the  first  suture  by  clipping  away  the  knot, 
and  then  close  the  engaged  portion  of  the  wound  by  drawing  the 
sutures  gently  and  tying.  Do  not  draw  the  sutures  too  tightly,  lest 
they  cause  necrosis,  infection,  swelling  and  tearing  out.  Repeat 
the  process  with  each  succeeding  suture. 

After  the  sutures  have  all  been  tied,  and  the  ends  clipped 
away,  begin  at  the  anterior  end  of  the  wound,  and  apply  a  con- 
tinuous suture  close  to  the  margins  to  secure  accurate  apposition. 
The  wound  margins  on  the  vaginal  side  should  be  closed  by 
accurate  continuous  sutures  in  the  .same  manner  as  the  second 
suture  in  the  rectum. 


Vesica-  Vagitial  Fishila  863 

The  external  wounds  are  then  to  be  closed  by  appropriate  deep 
interrupted  sutures.  Because  of  the  great  danger  from  suture 
infection  in  this  part,  the  sutures,  before  introduction,  should 
be  thoroughl}'  saturated  with  a  disinfectant,  preferably  by  im- 
mersion of  the  sutures  for  a  day  in  tincture  of  iodine.  The  ex- 
ternal sutures  may  be  rendered  safer  by  applying  to  each,  after 
insertion,  a  drop  of  the  tincture  of  iodine. 

When  the  suturing  has  been  completed,  the  rectum  and  vagina 
should  be  carefully  wiped  with  sterile  cotton  or  gauze,  and  the 
wound  line,  especially  in  the  rectum,  liberallj^  sprinkled  with 
iodoform. 

When  recto-vaginal  fistula  exists,  the  operation  is  analogous. 
The  sutures  are  to  be  made  in  the  same  manner.  The  anus 
should  be  widely  dilated  with  retractors,  and  the  margins  of  the 
fistula  grasped  and  drawn  out  through  the  anus. 

The  after-handling  of  the  wound  is  highly  important.  The 
chief  concern  of  the  operator  is  the  prevention  of  the  befouling 
of  the  wound  by  means  of  contact  with  the  fecal  matter,  followed 
by  swelling,  infection  and  tearing  out  of  the  sutures.  The  ani- 
mal should  not  be  allowed  any  solid  food,  but  may  have  gruels 
or  liquid  foods,  especially  milk.  The  bowels  may  be  largeh- 
blocked  up,  and  the  passage  of  feces  into  the  rect%im  decreased, 
by  small  doses,  ]A  to  i  gr.  of  morphia  repeated  every  3  or  4  hours. 
The  expulsion  of  such  feces  as  may  gain  the  rectum  should  be 
facilitated  by  injections  of  warm  antiseptic  solutions,  especially 
of  weak  solutions  of  \yso\  or  of  a  weak  carbolized  oil  warmed  to 
the  temperature  of  the  body. 

The  handling  of  the  third  group  of  injuries  to  the  perineum, 
the  external  lacerations  which  do  not  divide  the  sphincters,  offers 
nothing  special,  and  consists  in  the  closure  of  the  wound  by 
means  of  sutures,  in  accordance  with  general  surgical  principles. 

15.  Vesico- Vaginal  Fistula. 

Fleming,  citing  Dupont,  records  an  instance  of  vesico-vaginal 
fistula,  but  fails  to  give  exact  data  in  regard  to  it.  Rupture  of 
the  bladder  in  an  ordinary  case  of  birth,  due  to  the  passage  of 
the  fetus  over  it,  is  improbable,  since  normally  the  bladder  is 
completely  emptied  before  the  fetus  enters  the  birth  canal,  and 
the  empty  organ  lies  in  a  depressed  and  smooth  area  upon  the 
pelvic   floor,    covered   over  by  the  floor  of  the  vagina.     Should 


864  Veterinary  Obstetrics 

there  be  present,  within  the  bladder,  a  calculus  or  tumor,  the 
danger  to  the  viscus  would  be  very  great.  Should  the  floor  of 
the  vagina  and  the  upper  wall  of  the  bladder  become  very  severely 
contused,  and  the  two  adhere,  there  might  well  occur  a  sloughing 
of  the  injured  portions,  and  eventually  an  artificial  communication 
between  the  bladder  and  the  vagina.  Chronic  purulent  cystitis, 
see  page  900,  which  is  not  a  very  rare  disease  in  the  mare,  fol- 
lowing vaginitis  and  other  maladies,  should  not  be  mistaken  for 
vesico-vaginal  fistula. 

The  handling  of  vesico-vaginal  fistula  should  be  based  upon 
general  surgical  principles,  adjusted  to  each  individual  case. 
The  fistula  cannot  be  overcome  unless  the  urethra  remains  open. 
In  such  a  lesion,  as  a  general  rule,  there  would  be,  in  addition, 
a  chronic,  purulent  cystitis,  with  an  accompanying  precipitation 
of  the  urinary  salts  upon  the  walls  of  the  bladder,  causing  the 
latter  to  become  very  greatly  thickened  and  paretic,  while  they 
give  to  the  finger  the  sensation  of  being  covered  with  fine  sand 
which  has  formed  into  crusts.  This  condition  needs  be  overcome 
by  repeated  irrigations  with  warm  water,  wuth  possibly  very  mild 
anti.septics  as  recommended  on  page  900. 

16.    Hematoma  of  the  Vulva. 

During  or  about  the  period  of  parturition,  there  occasionally 
appear  in  the  vulva  more  or  less  extensive  hematoma,  due  to  the 
rupture  of  blood  ves.sels,  causing  a  hemorrhage  beneath  the 
mucous  membrane  in  the  loose  connective  tissue. 

The  date  of  their  appearance  varies.  In  one  instance  w^e  noted 
a  hematom  of  considerable  size  in  a  mare,  following  parturition, 
in  which  no  dystokia  had  occurred  so  far  as  was  known.  In  a 
.second  instance  we  noted  the  development  of  a  hematom  which 
contained  about  }4  pound  of  coagulated  blood,  in  a  mare  not  yet 
due  to  foal.  In  this  animal  there  had  been  a  somewhat  severe 
colic,  which  had  continued  for  18  or  20  hours  with  some  tjanpany, 
but  she  had  not  rolled  violently  and  it  was  not  known  that  she 
had  received  any  injury.  The  owner  had  made  a  manual  ex- 
ploration of  the  vagina,  but  apparently  had  done  nothing  which 
might  cause  the  hematom  to  form.  The  great  vascularity  of  the 
part  just  prior  to  parturition  tends  to  favor  such  lesions  upon 
very  slight  provocation.     In  one  of  these  cases  the  hematom  oc- 


Hematoma  of  the    Vulva  865 

curred  along  the  floor  of   the  vulva  near  the  median  line  ;  in  the 
other  it  was  well  up  along  the  side  of  the  organ. 

The  symptoms  are  very  characteristic  when  the  blood  has  be- 
come collected  in  a  large  mass,  because  it  pushes  the  mucous  mem- 
brane outward  into  the  cavity  of  the  vulva,  so  that  the  volume 
of  the  tumor  projects  beyond  the  surface  of  the  surrounding  tis- 
sues and  may  become  pedunculated  or  pear-shaped.  It  may  pro- 
ject quite  beyond  the  lips  of  the  vulva,  especially  when  the  ani- 
mal is  lying  down,  and  may  usually  be  seen  very  well  by  parting 
the  lips  of  the  vulva  with  the  hands.  Upon  palpation  the  tumor  is 
comparatively  soft  and  painless.  When  so  situated  that  it  can 
be  seen,  it  is  observed  to  be  of  very  dark  color,  which  indicates  its 
character. 

It  is  important  to  make  a  clear  differential  diagnosis  of 
hematoma.  In  one  of  our  cases  the  tumor  was  distinctly  pedun- 
culated, and  so  extensive  that  it  protruded  beyond  the  lips  of 
the  vulva  whenever  the  animal  was  lying  down,  and  it  was  .so 
near  to  the  median  line  and  immediately  in  the  neighborhood  of 
the  meatus  urinarius  that  it  was  at  first  mistaken  for  the  everted 
bladder.  Further  examination  revealed  the  meatus,  and  estab- 
lished the  fact  that  the  bladder  w^as  in  its  normal  position. 

In  some  cases  there  may  be  a  very  general  extravasation  of  the 
blood  into  the  ti-ssues,  over  a  large  area.  This  we  frequently 
meet  with  in  practice,  where  dystokia  has  existed,  especially  if 
rudely  handled  by  laymen  or  empirics,  and  the  vulva  and  vagina 
greatly  abraded  and  irritated  by  rough  hands  and  apparatus,  or 
with  hard,  rough  cords.  vSuch  extravasations  are  not  of  a  char- 
acter generally  to  cause  serious  trouble,  but  are  after  a  time 
absorbed . 

The  handling  of  hematoma  usually  consists  merely  of  making 
a  free  opening  through  the  mucous  membrane  and  pressing  out 
the  blood  clots,  after  which  the  vulva  should  be  cleansed  with 
an  antiseptic  solution.  In  our  experience  it  is  easy  to  thrust  a 
finger  through  the  mucous  membrane,  and  thus  produce  an 
extensive  opening,  which  will  not  adhere  and  retain  discharges 
later.  This  method  of  evacuating  the  blood  coagula  has  an 
element  of  safety  in  it,  because  there  is  no  danger  of  wounding 
any  blood  vessels  which  by  chance  may  be  di.splaced  because  of 
the  lesion. 
55 


866  Veteriyiary  Obstetrics 

Fleming  advises  scarifications  in  cases  of  extensive  extravasa- 
tions, though  he  admits  that  Cartwright  had  an  unfortunate 
experience  through  the  wounding  of  a  large  vein.  Apparently 
in  this  instance  he  was  dealing  with  a  general  extravasation  of 
blood  in  the  connective  tissue,  and  here  of  course  a  single 
puncture  or  division  of  the  mucous  membrane  would  not  permit 
the  escape  of  the  blood.  As  a  general  rule,  in  these  cases,  the 
extravasated  blood  will  be  safelj'  resorbed  by  the  tissues,  if  they 
are  given  that  opportunity.  Scarifications,  on  the  other  hand, 
open  an  inviting  avenue  for  serious  infection.  They  had  best  be 
omitted  and,  in  their  stead,  careful  cleansing  and  disinfection 
maintained  until  resorption  occurs. 

17.   Relaxation  of  the  Pelvic  Svmphysi.s. 

Fleming,  citing  Gillis,  records  one  instance  of  what  was  diag- 
nosed as  relaxation  of  the  symphysis  of  the  pelvis,  as  a 
consequence  of  parturition,  but  the  diagnosis  was  not  verified 
by  post-mortem  examination  or  by  other  conclusive  evidence. 
In  this  case  a  cow  had  some  difficulty  in  expelling  a  calf,  after 
which  she  could  scarcely  ri.se  when  down,  or  walk  when  upon 
her  feet,  and  her  hind  quarters  swayed  from  .side  to  side.  The 
sacro-iliac  articulations  appeared  to  be  tender.  When  the  ani- 
mal was  moved,  there  .seemed  to  be  some  motion  in  the  ischio- 
pubic  symphysis.  The  condition  remained  permanent,  and  the 
animal  was  prepared  for  the  butcher. 

18.    Contusions  of  the  Lumbo-Sacral  Nerves. 

The  lumbo-sacral  plexus  of  nerves  is  so  disposed,  in  domestic 
animals,  that  certain  trunks  are  somewhat  subject  to  impingment 
between  the  bony  walls  of  the  pelvis  and  prominent,  unyielding 
portions  of  the  fetus,  bj'  which  the)'  may  become  more  or  less 
seriousl)'  contused  and  their  functions  interrupted.  The  prob- 
ability of  these  nerves  becoming  injured  during  parturition  is  not 
alike  for  all  the  trunks,  the  gluteal  and  obturator  nerves  being 
especially  exposed,  where  they  pa.ss  over  the  articular  eminence 
between  the  last  lumbar  and  the  first  sacral  vertebrae,  while  the 
obturator  nerve  again  becomes  exposed  to  injury  as  it  rounds  the 
margin  of  the  obturator  foramen.      See  Fig.  i,  page  4. 


ConUisioji  of  Gluteal  Nerves.      Gluteal  Paralysis  867 

a.   Contusion  of  the  Gluteal  Nerves.  Gluteal 
Paralysis. 

We  have  observed,  in  two  cases  in  draft  mares,  paralysis  of 
the  gluteal  muscles,  followed  by  atrophy  consequent  upon  par- 
turition. '  In  our  observations  neither  case  was  referable  to  dys- 
tokia,  in  the  ordinary  acceptation  of  the  term,  since  birth  took 
place  without  aid  and,  so  far  as  known,  without  observable  diffi- 
culty. The  mares  were  in  prime  condition  ;  no  injury  or  infec- 
tion was  externall}'  visible  ;  there  was  no  fever  or  loss  of  appe- 
tite or  flesh.  Yet,  when  the  mare  was  down  it  was  difficult  for 
her  to  get  up,  and  when  up  she  walked  with  an  unsteady  gait. 
In  one  case  the  paralysis  was  unilateral,  and  consequently  the 
difficulty  experienced  in  rising  was  not  great.  When  moved  she 
had  a  very  distinct  paralytic  limp  in  the  affected  limb.  After  a 
few  days  the  muscles  of  the  gluteal  region  commenced  to  atrophy 
rapidly,  which  continued  to  an  extreme  degree,  but  the  paralysis 
soon  subsided,  although  there  was  a  certain  deficiency  in  the 
strength  of  the  part.  After  the  lapse  of  several  weeks  the  mus- 
cles began  to  recover  their  volume,  but  the  recovery  was  very 
slow,  and  nearly  a  year  elapsed  before  the  parts  resumed  their 
normal  appearance. 

In  the  second  case  the  paralysis  was  very  profound  and  notable, 
because  both  hind  limbs  were  involved  and  it  was  necessary  for 
a  time  to  aid  the  mare  somewhat  when  she  attempted  to  get  up, 
although  once  she  had  gained  her  feet  she  could  walk  about  with 
some  difficulty.  The  paralytic  symptoms  subsided  in  the  course 
of  two  or  three  weeks,  while  the  atrophy  was  extreme  and  the 
restoration  of  the  muscles  was  very  slow,  though  eventually 
complete. 

The  handling  of  contusion  of  the  gluteal  nerves  must  depend 
fundamentally  upon  the  general  care  of  the  animal,  since  there 
is  nothing  very  direct  to  be  accomplished,  nor  is  it  probably  nec- 
essary as  a  rule  that  anything  definite  should  be  done.  The  an- 
imal should  not  be  permitted  to  struggle  in  getting  up,  or  other- 
wise exert  herself  violently  in  a  manner  to  increase  the  injury 
to  the  nerves  and  muscles,  but  should  be  watched  rather  closely 
and  guarded  against  further  injury.  To  this  end  she  should 
have  comfortable  quarters,  and  her  stall  should  be  so  managed 
that  she  will  have  the  best  footing  possible  in  order  to  avoid  any 


868  Vetermarr  Obstetrics 

slipping  in  attempting  to  rise.  Furthermore,  it  is  desirable,  as 
far  as  practicable,  to  aid  the  animal  by  lifting  upon  the  tail 
whenever  she  wishes  to  get  up,  unless  she  can  accomplish  the  act 
unaided  with  comparative  ease  and  safety.  Slings  may  be  ap- 
plied should  conditions  require,  but  it  is  preferable  to  avoid 
them.  Should  indications  warrant  it,  the  veterinarian  may 
apply  electricity  by  placing  one  of  the  poles  of  the  battery  over 
the  lumbar  region  and  moving  the  other  over  the  surface  of  the 
atrophied  gluteal  muscles. 

According  to  our  observations,  the  prognosis  is  highly  favor- 
able. The  paralysis  disappears  in  the  course  of  a  few  days  to 
two  or  three  weeks.  At  the  same  time  the  atrophy  is  increasing, 
but  from  this  the  animal  tends  to  recover  completely  in  from  6 
to  1 8  months,  and  in  the  meantime  may  do  light  work  if  desired, 

b.    CONTUvSION    OF    THE  OBTURATOR  NERVES.       ObTURATOR 

Paralysis. 

The  obturator  nerve  is  subject  to  injury  from  the  fetus,  at  its 
point  of  passage  over  the  eminence  of  the  lumbo-sacral  articula- 
tion and  again  at  the  point  where  it  rounds  the  lip  of  the  obtur- 
ator foramen. 

The  symptoms  of  this  accident  are  acute  and  unique.  They 
consist  essentially  of  a  loss  of  power  in  the  obturator  group  of 
muscles,  which  include  all  of  the  adductors  of  the  limb — the  ob- 
turator externus,  the  adductors  of  the  thigh,  the  pectineus  and 
the  short  adductor  of  the  leg. 

It  matters  not,  so  far  as  symptoms  are  concerned,  if  the  nerve 
is  injured  at  its  point  of  emergence  from  the  spinal  canal  or  of 
its  disappearance  through  the  obturator  foramen.  If  one  nerve 
only  is  contused,  the  animal  is  able  to  progress  with  some  diffi- 
cult)', but  the  affected  limb  is  held  in  extreme  abduction,  though 
the  power  of  bearing  weight  or  of  advancement  is  not  interrupted. 
In  advancing  the  limb,  it  is  brought  forward  in  extreme  abduc- 
tion, and  is  placed  upon  the  ground  some  inches  laterally  to  the 
normal  point  of  bearing. 

If  both  obturators  are  simultaneously  injured,  the  symptoms 
assume  an  entirely  different  phase.  Both  limbs  now  become 
sharply  abducted,  the  animal  is  unable  to  support  its  weight,  the 
two  hind  feet  slip  apart,  and  the  animal  drops  upon  its  pubis.  If 
assisted  to  its  feet,  and  the  hind  limbs  are  held  in  adduction,  the 


Contusion  of  Obhirator  Nerves.      Obturator  Paralysis        869 

animal  can  stand  without  difficult3^  but  the  moment  it  raises  one 
foot  the  two  sHp  apart  again  and  the  animal  falls. 

In  one  case  occurring  in  the  clinic  of  the  New  York  State  Vet- 
erinary College,  a  mare  had  foaled  apparently  naturally,  but  im- 
mediately afterward  it  was  seen  that  in  walking  she  carried  the 
leg  in  extreme  abduction,  so  that  it  was  exceedingly  difficult  for 
her  to  walk.  The  condition  had  existed  for  about  a  year  before  she 
was  presented  at  our  clinic.  We  promptly  diagnosed  injury  to 
the  obturator  nerve  upon  the  affected  side.  She  still  walked 
with  the  affected  limb  in  extreme  abduction,  while  the  muscles  of 
the  inside  of  the  thigh  were  greatly  atrophied.  As  we  believed  her 
incurable  after  so  long  a  duration,  she  was  destroyed,  and  a  post- 
mortem examination  revealed  all  the  muscles  supplied  by  the  in- 
jured obturator  nerve,  very  pale  and  greatly  atrophied,  so  that 
their  volume  was  only  about  '3  that  of  the  corresponding  muscles 
of  the  opposite  side.  The  other  muscles  of  the  limb  were  normal. 
The  obturator  nerve  was  apparently  normal,  except  at  its  point 
of  disappearance  in  the  obturator  foramen,  where  there  existed 
a  very  distinct  enlargement,  consisting  chiefly  of  connective 
tissue,  as  shown  in  Fig.  140. 


Fig.  140.     Contusion  of  Obturator  Nkrve. 
I,  Ilium.     Is,  Ischium.     P,  Pubis.     ON,  Obturator  nerve. 
O,  Obturator  foramen.     1,  Inflammatory  induration  of  obturator  nerve. 


Syo  Veterinary  Obstetrics 

In  a  second  case,  observed  in  our  private  practice,  an  imported 
F'rench  draft  mare,  aged  four  years,  had  given  birth  to  her  first 
foal  without  difficulty,  but  was  unable  to  get  up.  Having  been 
called,  we  placed  slings  under  the  patient  and  helped  her  to  her 
feet,  but  she  could  not  stand  on  the  hind  limbs  because  they  im- 
mediately parted  and  she  tended  to  drop  upon  her  pubis.  If  a 
man  would  hold  the  feet  in  adduction,  she  could  stand  without 
difficulty.  The  slings  were  properly  adjusted  and  the  two  hind 
feet  tied  together,  after  which  she  stood  comfortably  and  with- 
out difficulty.  After  three  days,  upon  the  removal  of  the 
slings,  it  was  found  that  she  could  walk  with  but  little  difficulty. 
She  made  a  rapid  and  complete  recovery. 

The  handling  of  contusions  of  the  obturator  nerve  should  con- 
sist of  the  application  of  slings,  and  the  feet  should  be  tied  to- 
gether to  prevent  abduction.  Later,  electricity  may  prove  use- 
ful, one  electrode  being  applied  over  the  loins,  the  other  to  the 
inside  of  the  thigh. 


PUERPERAL  INFECTIONS. 

During  the  puerperal  state,  the  great  vascularity  of  the  entire 
genital  system,  combined  with  the  denudation  of  all  that  portion 
of  the  uterus  occupied  by  the  placenta,  and  the  almost  inevitable 
abrasions  and  lacerations  of  some  of  the  parts,  tends  very  strongl}- 
to  lead  to  infections  of  a  more  or  less  serious  character.  The  de- 
tachment of  the  fetal  from  the  maternal  placenta  leaves  a  vast 
denuded  surface,  which,  in  relation  to  infection,  is  somewhat 
comparable  to  a  wound.  If  to  this  is  added  wounds,  contusions 
and  abrasions,  of  a  more  or  less  extensive  character,  the  tend- 
ency to  infection  is  still  more  increased. 

In  the  separation  of  the  placenta  there  is  inevitably  some  escape 
of  blood  and  other  fluids  into  the  uterine  cavity,  which,  if  not 
promptly  expelled,  act  as  foreign  bodies  and  invite  infection  in 
the  part.  If  the  placenta  for  any  reason  fails  to  become  detached 
and  expelled  at  the  proper  time,  it  inevitably  undergoes  decom- 
position and  leads  with  certainty  to  a  greater  or  less  degree  of  in- 
fection of  the  uterus  and  vagina,  with  possible  involvement  of 
distant  parts  and  the  general  system.  Added  to  all  this,  when 
dystokia  occurs  and  the  animal  is  weakened,  the  genital  organs 
are  debilitated,  do  not  contract  and  close  as  they  should,  and 
infection  is  directly  carried  into  the  uterus  by  the  ignorant  or 
careless  operator,  upon  the  hands,  instruments  or  apparatus. 

It  is  consequently  not  so  much  to  be  wondered  that  infection 
frequently  occurs  during  the  puerperal  state,  but  rather  that  such 
infection  does  not  occur  with  greater  frequency.  Infections  re- 
ferable to  the  puerperal  state  are  consequently  of  the  greatest 
possible  variety  in  intensity,  location,  character  and  symptoms. 
It  is  difficult  to  draw  definite  lines  between  the  various  forms, 
nor  is  it  possible  to  describe  all  forms  of  infection.  We  shall 
endeavor  to  describe  only  those  of  leading  importance,  which 
offer  some  special  train  of  symptoms,  and  permit  of  classification. 
They  all  trace  to  the  one  common  source — the  entrance  of  infec- 
tion into  some  part  of  the  genital  tract  during  the  highly  sus- 
ceptible puerperal  state.  From  the  genital  tract  the  infection 
may  extend  to  neighboring  or  distant  parts,  or  involve  the  entire 
system  in  more  or  less  grave  disease. 

871 


872  Veterinary  Obstetrics 

I.   AcuTK  Metritis. 

Foremost  among  the  puerperal  infections,  from  the  standpoint 
of  frequency  and  seriousness,  stand  the  acute  infections  of  the 
uterus.  The  infection  ma}^  involve  simply  the  mucous  mem- 
brane of  the  uterus,  to  constitute  endometritis.  When  involv- 
ing only  the  mucosa  of  the  organ,  it  may  be  largel}^  or  wholly 
confined  to  the  placenta.  In  the  mare,  so  long  as  the  infection 
is  confined  to  the  mucosa,  it  is  also  limited  to  the  placenta,  and 
might  therefore  be  called  placentitis  with  equal  propriety.  In 
endometritis  of  the  cow,  with  her  multiple  placentae,  the  infec- 
tion may  be  confined  chiefly  or  wholly  to  the  placentae  or  that 
part  of  the  mucosa  which  goes  to  elaborate  the  placentae.  Here 
again  we  might  justly  apply  the  term  placentitis,  but  in  this 
instance  it  is  probable  also  that  those  portions  of  the  mucosa 
between  the  cotyledons  may  become  involved  to  .some  extent, 
constituting  more  strictly  an  endometritis. 

If  the  infection  is  of  such  virulence  that  it  pa.sses  beyond  the 
mucosa  and,  penetrating  the  muscular  walls,  involves  the  peri- 
toneal surface  of  the  uterus,  thus  including  the  entire  uterine 
wall,  w^e  designate  it  as  metro-peritonitis.  The  difference  in 
designation  is  consequently  one  intended  to  indicate  the  degree 
of  extension  and  the  consequent  difference  in  the  gravity  of  the 
disease. 

The  causes  of  acute  metritis  consist  of  any  of  those  elements 
which  may  favor  the  introduction  into  the  uterine  cavity,  and 
the  growth  there,  of  disease-producing  bacteria. 

Standing  at  the  head  of  cau.ses  of  metritis,  is  the  retention  of 
the  fetal  envelopes.  Whenever  the  normal  period  at  which  these 
should  become  separated  and  expelled  has  passed  b)',  without  such 
expulsion,  they  immediately  constitute  a  .source  of  danger  for 
the  well-being  of  the  animal.  They  promptly  cease  to  constitute 
a  part  of  the  living  tissues,  the  circulation  of  blood  w^ithin  them 
ceases,  and  they  furnish  a  favorable  medium  in  which  bacteria 
may  multiply.  In  most  cases  the  membranes  extend  from  the 
uterus  out  through  the  vagina  and  vulva,  where  they  become 
soiled  with  feces  and  other  highly  infected  material,  and  consti- 
tute an  open  highway,  along  which  the  bacteria  may  rapidly 
travel  as  well  as  multiply,  until  they  reach  the  uterine  cavity. 
The  presence  of  the  membranes  keeps  open   the  cervix  of  the 


Acute  Metritis.  873 

uterus,  and  prevents  to  a  large  degree  the  normal  involution  of  the 
organ.  Added  to  this,  the  interference  with  the  retained  mem- 
branes, with  a  view  to  their  removal,  by  laymen,  empirics  or 
other  incompetent  persons,  serves  to  intensify  the  danger  of 
infection  by  wounding  and  abrading  the  organ. 

In  the  mare,  where  endometritis  is  by  far  the  most  connnon 
form  of  puerperal  infection,  the  disease  is  generally  attributable 
to  the  fragmental  retained  placenta,  already  described  on  page 
810. 

Another  very  fruitful  cause  of  metritis  is  the  introduction  of 
infection  into  the  cavity  of  the  organ,  upon  the  hands,  instru- 
ments or  apparatus  of  the  veterinary  obstetrist  during  the  over- 
coming of  dystokia  or  other  manipulations  of  the  organ.  The 
frequency  with  which  metritis  following  dystokia  occurs  in  ani- 
mals constitutes  a  severe  criticism  upon  the  usual  methods  em- 
ployed by  veterinary  obstetrists. 

Wounds  of  the  organ  during  manipulations  of  any  kind  greatly 
facilitate  the  entrance  into  the  tissues  of  any  infection  which  may 
gain  admi.ssion  to  the  uterine  cavity. 

The  presence  of  a  dead  fetus,  which  is  undergoing  putrid  de- 
compo.sition  in  the  uterus,  inevitably  causes  a  more  or  less  se- 
rious metritis.  In  some  instances,  where  the  death  of  the  fetus 
is  comparatively  recent  and  the  putrid  decompo.sition  has  not  pro- 
gressed far,  the  degree  of  metritis  maj-  be  comparatively  unim- 
portant, or  may  even  pass  unnoticed.  In  other  cases,  where  the 
putrid  fetus  has  remained  in  the  uterus  for  a  longer  period  of 
time  and  the  decomposition  has  become  quite  complete,  the  in- 
flammation of  the  organ  is  correspondingly  great  and  serious. 
After  a  long  period  of  fetal  decomposition,  the  uterine  walls 
may  finally  assume  the  characters  and  functions  of  absce.ss  walls. 

When  the  fetus  dies  in  the  uterus  and  does  not  become  decom- 
posed, but  undergoes  mummification  instead,  it  does  not  tend  to 
induce  inflammation  of  the  organ. 

Tardy  involution  of  the  uterus  constantly  tends  to  invite  in- 
fection. When  the  uterus  does  not  promptly  close,  and  its  walls 
fail  to  quickly  come  in  contact  with  each  other,  there  is  proba- 
bly a  similar  tardiness  in  the  contraction  of  the  vagina  and  vulva, 
so  that  the  entire  tract  remains  somewhat  freely  open,  inviting 
infection.  The  debility  of  the  organ,  of  which  the  tardy  involu- 
tion is  but  a  symptom,  decreases  its  power  of  resisting  the  infec- 


874  Veterinary  Obstetrics 

tiou.  When  the  organ  undergoes  normal  involution  and  contracts 
vigorously,  that  vigor  in  itself  acts  largely  to  prevent  or  over- 
come infection. 

Exposure  to  cold  or  wet  has  also  been  claimed  to  act  as  a  causa- 
tive agent  in  metritis.  It  no  doubt  occupies  an  important,  though 
indirect  place.  Any  sudden  chill,  or  disturbance  of  the  body  in 
general,  weakens  and  depresses  the  highly  sensitive  genital  tract, 
and  renders  infection  far  more  probable  than  though  the  animal 
were  kept  under  more  favorable  conditions. 

For  convenience  the  various  types  of  metritis  ma}-  be  con- 
sidered separately. 

a.  Acute  Endometritis  in  the  Mare. 

Inflammation  of  the  mucosa  of  the  uterus  may  develop  in  the 
mare  very  promptly  after  giving  birth  to  a  foal.  Should  the 
foal  perish  and  be  retained  in  the  uterus  to  undergo  rapid  putrid 
decomposition,  there  may  be  present  within  24  hours  a  well- 
marked  endometritis,  which  .seriously  complicates  the  handling 
of  the  dystokia. 

Many  cases  of  endometritis  in  the  mare,  do  not  follow  dys- 
tokia, but  result  from  the  retention  of  a  fragment  of  the  fetal 
placenta  in  the  non-gravid  horn,  as  already  described  on  page 
810.  In  such  cases  infection  quickly  takes  place,  and,  within 
24  to  48  hours  or  .slightly  longer  after  the  expulsion  of  the 
fetus  and  of  the  principal  volume  of  the  fetal  membranes, 
there  appears  first  of  all  a  well-marked  stiffness  in  the  gait  of 
the  animal,  with  some  disinclination  to  move  and  ver}'  marked 
tenderness  of  the  abdomen  upon  pressure.  The  pul.se  may  be 
normal  or  somewhat  quickened  ;  the  temperature  is  slightly 
elevated  ;  and  the  respiration  is  somewhat  impeded  because  of 
the  abdominal  tenderness.  The  mare  may  a.ssume  the  recum- 
bent position  much  of  the  time,  or  she  may  persistently  stand. 
The  appetite  is  variable,  and  .sometimes  remains  fairly  good,  but 
is  usually  depres.sed. 

The  lips  of  the  vulva  are  usually  swollen,  and  from  the  genital 
tract  there  issues  a  somewhat  thin,  reddish-gray,  dirty,  floccu- 
lent  discharge,  which  may  be  more  or  le.ss  fetid.  If  the  lips  of 
the  vulva  are  parted,  the  mucous  membrane  is  seen  to  be  in- 
jected and  irritated.  If  the  obstetrist  will  introduce  his  hand 
into  the  uterine  cavity,  he  will  usually  find  it  filled  with  a  dirty, 


Aaite  E7idom.etritis  in  the  Mare  875 

flocculent  discharge  of  the  same  character  as  that  which  is  ob- 
served flowing  from  the  vulva.  The  amount  of  the  accumula- 
tion in  the  uterus  is  extremely  variable  ;  there  may  be  but  two 
or  three  quarts,  or  there  may  be  4  or  5  gallons.  The  walls  of 
the  uterus  are  paretic,  so  that  they  are  unable  to  force  the  ac- 
cumulated discharge  out  of  the  uterine  cavity,  and  thus  permit 
the  great  accumulation.  Upon  palpation,  the  walls  are  found  to 
be  dense,  swollen  and  very  thick,  giving  the  examiner  the  im- 
pression of  a  diameter  of  ^i  inch  or  more. 

Examining  the  non-gravid  cornu  carefully,  the  obstetrist  will 
frequently  identify  in  it  a  retained  piece  of  the  chorion  ;  or  this 
retained  membrane  may  have  become  detached  from  the  cornu 
and  passed  out  into  the  body  of  the  uterus,  where  it  lies  free  in 
the  accumulated  pus  ;  or  it  may  have  escaped  through  the  vulva 
and  disappeared. 

In  almost  all  cases  of  acute  endometritis  in  the  mare,  there  co- 
exists parturient  laminitis.  The  occurrence  of  this  disease  as  a 
complication  is  so  uniform  that  it  might  well  be  regarded  as  a 
part  of  the  malady,  but  since  it  is  usually  described  separately 
we  shall  follow  that  custom  and   take  up   its  consideration  later. 

As  the  disease  progresses,  and  becomes  more  intense,  the  pulse, 
temperature  and  respiration  become  more  markedly  involved, 
and  the  discharge  from  the  uterus  increases  in  volume  and  becomes 
more  fetid.  As  the  laminitis  increases,  the  animal  becomes  more 
and  more  unable  to  move,  assumes  either  the  recumbent  or  the 
standing  position,  according  to  individual  temperament,  and  per- 
sistently maintains  such  position. 

The  handling  of  acute  endo-metritis  in  the  mare  consists  es- 
sentially of  the  removal  from  the  uterine  cavity  of  an)^  placental 
fragments  and  accumulated  uterine  discharges.  Special  search 
is  to  be  made  for  the  fragment  of  retained  chorion  so  common  in 
the  non-gravid  horn. 

The  accumulated  fluids  are  to  be  removed  from  the  uterine 
cavity  by  copious  irrigations  with  warm  water,  to  which  a  small 
amount  of  antiseptics,  like  0.25%  carbolic  acid,  lysol  or  bacillol 
or  o.\'/c  permaganate  of  potash  may  be  added.  This  will  not 
disinfect  the  uterine  contents  or  uterus,  but  may  serve  the  pur- 
pose of  partially  disinfecting  the  irrigating  solution.  Two,  three 
or  more  gallons  of  the  solution  may  be  introduced  at  one  time,  al- 
lowed to  escape,  and  a  like  quantity  again  injected.     The  process 


876  Veterina}-}'  Obstetrics 

should  be  continued  until  the  water  is  expelled  clear  and  odor- 
less.    This  may  require  a  total  of  six  to  ten  gallons. 

The  plan  outlined  is  mechanical  cleansing,  in  contradistinc- 
tion to  chemical  disinfection.  The  enormous  volume  of  viru- 
lently infective  discharges  is  quite  beyond  the  power  of  any  or- 
dinary disinfectant  to  overcome.  If  the  discharges  can  be  me- 
chanically removed,  the  aim  of  the  surgeon  is  fully  accomplished 
in  so  far  as  that  is  concerned.  The  walls  are  still  infected  and 
inflamed,  and  will  quickly  secrete  more  di.scharges.  We  cannot 
disinfect  the  walls  ;  any  antiseptic  capable  of  doing  this  would 
likewise  irritate,  injure  or  destroy  the  uterine  tissues. 

The  paretic  uterine  walls  do  not  contract,  and  the  fluid  must 
either  be  forced  out  by  the  contraction  of  the  abdominal  walls  or 
must  be  siphoned  out  through  the  irrigation  tube.  The  uterine 
cavity  should  be  left  empty,  except  that  y^  oz.  of  powdered  iodo- 
form may  be  introduced  in  a  gelatine  capsule,  the  capsule  opened, 
and  the  powder  scattered  over  the  surface. 

The  irrigation  should  be  repeated  one  to  three  times  daily,  ac- 
cording to  indications.  Improvement  is  indicated  by  decreased 
discharge,  disappearance  of  fetor,  and  a  gradual  change  from  the 
dirty-grayish,  flocculent,  semi-fluid  mass  to  a  transparent,  odor- 
less mucus.  At  the  same  time  the  hard,  thickened  walls  of  the 
uterus  soften  and  become  thinner,  the  mucosa  recovers  its  normal 
consistence,  the  walls  contract,  the  uterine  cavity  decreases  and 
the  walls  come  in  contact.  These  changes  mark  convalescence, 
and  warrant  the  gradual  cessation  of  irrigation. 

The  strength  of  the  patient  may  be  adv^antageously  supported 
by  a  free  allowance  of  alcohol  or  nitrous  ether  in  the  drinking 
water.  An  ordinary  sized  mare  may  take  two  to  four  ounces  of 
either  drug,  and  the  dose  may  be  repeated  frequently.  She  may 
take  either  of  them  at  the  rate  y^  to  i  oz.  per  hour  for  24  con- 
secutive hours.  Quinine  may  also  be  administered  in  large 
(ounce)  doses,  once  or  twice  daily  if  fever  is  present. 

The  handling  of  the  concurrent  laminitis  will  be  discussed 
while  dealing  separatel}'  with  that  affection. 

The  prognosis  of  acute  endo-metritis  is  highly  favorable. 
Properly  handled,  over  90'/;  recover  promptl}'  and  completely. 
The  mare  usually  remains  fertile. 


Acute  Metro-Peritonitis  in  the  Mare  877 

b.  Acute  Metro-peritonitis  in  the  Mare. 

Acute  metro-peritonitis  in  the  mare  is  most  frequently  due  to 
a  perforation  of  the  uterine  walls  during  parturition,  or  to 
lacerations  or  contusions  of  the  uterine  walls,  which  soon  lead  to 
necrosis  of  an  area,  through  which  an  avenue  is  afforded  for  the 
passage  of  infection  from  the  uterine  cavity  to  the  peritoneum. 

The  wounds  which  invite  the  infection  and  afford  an  avenue 
for  the  entrance  of  the  organisms  into  the  deeper  tissues  fre- 
quently occur  just  in  front  of  the  pubic  brim  along  the  utero- 
vaginal floor,  and  are  apparently  often  due  to  the  presence  of  a 
conical  bony  projection  on  the  symphysis  pubis,  as  indicated  in 
Fig.  113b,  page  677.  The  perforation  may  be  direct,  but  proba- 
bly more  frequentl}'  consists  of  an  irrecoverable  contusion  and 
maiming  of  the  uterine  tissues  between  an  unyielding  portion  of 
the  fetus  and  the  conical  projection  of  the  pelvis.  The  contu- 
sions may  also  be  due  to  a  portion  of  the  fetus  becoming  impacted 
against  the  pubic  brim  and  crushing  the  intervening  uterine  floor, 
especially  during  forced  extraction  with  important  deviations,  as 
already  related  on  page  818. 

It  also  results  frequently  from  the  intensity  of  infection  of  the 
uterine  walls,  from  rough  handling  during  dystokia,  from  the 
introduction  of  virulent  organisms  into  the  uterine  cavity  upon 
the  hands  of  obstetrists  or  others,  the  putrid  decomposition  of 
the  fetus  in  the  uterus,  and  other  similar  causes. 

The  symptoms  may  be  preceded  by,  or  include  in  a  measure, 
those  of  endometritis,  already  described.  Laminitis,  which  is  .so 
often  observed  in  endometritis, is  not  a  common  symptom.  The  pa- 
tient is  stiff  and  disinclined  to  move.  Pressure  upon  the  abdominal 
walls  induces  severe  pain.  Fever  and  loss  of  appetite  are  marked. 
The  vulva  and  perineum  are  usually  swollen.  As  a  general  rule, 
vaginal  discharge  is  present,  .soiling  the  tail  and  neighboring 
parts.  Manual  exploration  of  the  genital  tract  reveals  its  walls 
swollen,  more  or  less  paretic,  thickened  and  painful  to  the  touch. 
The  uterine  cavit}'  maj'  contain  a  variable  amount  of  disea.se  dis- 
charges, thick,  flocculent  and  fetid,  as  already  described  in  endo- 
metritis. 

The  prognosis  is  extremely  grave.  Few  mares  recover  from 
the  disease,  but  usually  succumb  from  gangrene  and  septicaemia 
in  from  three  to  ten  days. 


878  Veterinary  Obstetrics 

Treatment  is  of  little  avail.  Locall}-  it  should  consist  of  irri- 
gations, as  already  recommended  for  endometritis  on  page  876. 
To  the  warm  water  may  be  added  0.5%  carbolic  acid,  creolin  or 
lysol.  After  thorough  irrigation,  iodoform  powder  may  be  scat- 
tered over  the  uterine  floor. 

Internally,  quinine,  one  ounce  once  or  twice  daily,  or  potassium 
iodide  in  ounce  doses,  two  or  three  times  daily,  may  be  used  ;  or 
the  two  drugs  may  be  given  simultaneously  or  alternately. 

The  strength  of  the  patient  should  be  supported  by  large  and 
repeated  doses  of  alcohol  or  nitrous  ether,  and  by  repeated  mod- 
erate doses  of  strjxhnine.  If  the  patient  will  eat,  ample  food 
should  be  allowed  of  such  variety  as  is  usually  indicated  in  serious 
febrile    infections. 

c.    Acute  Metritis  and  Metro- Peritonitis  in  the  Cow. 

Metritis  in  the  cow  is  most  frequently  dependent  upon  retained 
placenta,  especially  when  such  retention  is  neglected,  or  still 
worse,  when  improperly  handled,  as  has  already  been  di.scussed 
when  considering  the  treatment  of  retained  placenta  on  page  799. 
The  infection  is  also  frequently  dependent  upon  perforating 
wounds,  or  ruptures,  of  the  uterus  due  to  accidents  during  par- 
turition such  as  have  already  been  related  on  page  818  while  con- 
sidering rupture  of  the  uterus.  It  varies  greatly  in  acutencss. 
In  one  instance,  where  an  acute  placentitis  occurred  within  24 
hours  after  dystokia,  apparently  due  to  infection  carried  into  the 
uterine  cavity  by  the  obstetrist,  there  was  a  sudden  elevation  of 
temperature  to  106F.,  with  the  general  symptoms  of  acute 
septicaemia,  the  cotyledons  were  enormousl}^  enlarged,  tense  and 
necrotic.  This  represents  an  exceedingly  virulent  type  of  metritis, 
more  severe  than  the  usual  form  of  the  disease.  As  usually  ob- 
served there  is  elevation  of  temperature,  loss  of  appetite,  absence 
of  milk  secretion,  torpidity  of  the  bowels,  dullness,  and  the 
general  symptoms  of  septicaemia. 

Locally  there  is  ob.served  swelling  of  the  vulva,  and  upon  in- 
troducing the  hand,  the  vulva  and  vagina  are  found  very  hot  to 
the  touch  and  tender,  and  the  mucous  membrane  swollen. 
There  is  frequent  and  severe  straining,  during  which  usually 
small  quantities  of  a  grayish-red  flocculent  pus  are  discharged. 


Aaite  Metritis  and  Metro- Peritonitis  i?i  the  Cow  879 

Mixed  with  the  discharge  from  the  uterus,  there  are  frequently 
observed  shreds  of  the  fetal  membranes,  or  necrotic  cotyledons 
which  have  sloughed  off.  The  straining  is  usually  very  intense, 
-and  in  some  cases  well-nigh  constant.  The  cow  stands  with  her 
back  arched  and  the  abdomen  compressed.  She  frequently 
grinds  her  teeth,  and  in  almost  all  cases  shows  very  great  pros- 
tration. When  the  hand  is  introduced  into  the  uterus,  the 
straining  is  usually  aggravated,  and  becomes  very  violent. 

As  the  di.sease  progresses,  the  discharge  may  vary  greatly  in 
character.  Alwa3's  somewhat  muco-purulent,  it  shows  a  constant 
variation  of  the  proportion  of  pus  to  mucus  and  of  the  degree 
of  admixture  of  blood,  which  induces  a  change  in  color  and  con- 
sistence. In  some  cases  the  discharge  becomes  diptheritic,  and 
is  expelled  in  large,  tough  grayish-white  masses.  As  the  di.sease 
progresses,  the  cow  tends  to  assume  the  recumbent  position,  and 
ere  long  is  unable  to  get  up,  as  a  result  of  the  profound  .septi- 
caemia.    The  rumen  may  become  distended  with  gas. 

Terminations.  The  course  of  acute  metritis  in  the  cow  is 
usually  very  rapid,  and  terminates  in  recovery  or  death  within 
from  two  to  six  or  eight  days.  In  some  cases  the  disease  gradually 
passes  into  the  chronic  state,  and  continues  for  weeks,  months 
or  years  unless  properly  handled. 

The  mortality  is  high,  exceeding  50%.  In  the  placental  me- 
tritis or  placentitis,  where  necro.sis  of  the  cotyledons  is  followed 
by  their  prompt  removal  and  the  thorough  disinfection  of  the 
organ,  the  prognosis  in  our  experience  is  highly  favorable. 
When,  however,  we  have  to  deal  with  the  usual  type  of  metritis 
or  metro-peritonitis,  the  prognosis  is  always  exceedingly  grave. 

The  symptoms  upon  which  our  prognosis  is  to  be  based  resolve 
themselves  into  two  principal  groups,  general  and  local. 

The  temperature  of  the  animal  is  not  always  a  reliable  index 
as  to  the  state  of  disea.se,  since  when  there  is  extensive  septi- 
caemia the  body  temperature  is  somewhat  erratic  and  at  times 
deceptive,  so  that,  while  a  high  temperature  may  always  be  re- 
garded as  indicative  of  a  serious  state,  a  low  temperature  is  not 
to  be  relied  upon  as  indicating  a  favorable  course.  In  cases  of 
very  profound  septicaemia  in  the  cow,  mare  and  other  animals, 
the  temperature  may  be  normal  or  subnormal,  but  when  such  is 
the  ca.se  there  is  a  general  depression,  coma,  or  collap.se,  which 
should  place  the  veterinarian  upon  his  guard   and    prevent   him 


88o  Veterinary  Obstetrics 

from  misinterpreting  the  gravity  of  the  disease  by  the  bodj'  tem- 
perature. The  general  appearance  of  the  animal  is  of  more  im- 
portance in  determining  the  probable  outcome  than  is  the 
question  of  temperature.  If  the  animal  looks  somewhat  bright, 
and  maintains  a  fair  appetite,  or  the  appetite,  having  been  lost, 
shows  a  tendency  to  return,  such  may  be  regarded  as  a  favorable 
omen. 

Locally  we  usually  can  determine  more  exactly  the  course  of 
the  disease  and  its  probable  termination,  by  comparing  the  con- 
ditions from  day  to  day.  The  tumefaction  of  the  vulva  and 
vagina,  if  it  increases,  indicates  an  unfavorable  course  of  the 
di.sease,  which  is  heightened  to  a  degree  if  the  mucous  membrane 
of  these  passages  becomes  darker  in  color  and  necrotic.  If,  on 
the  other  hand,  the  swelling  of  the  vulva  tends  to  di.sappear  and 
the  mucous  membrane  to  assume  its  normal  color,  the  indications 
are  favorable. 

Within  the  uterus  itself  we  meet  with  still  more  definite  signs 
as  to  the  course  of  the  disease.  If  the  case  is  progressing  favor- 
ably, the  uterine  walls  are  less  firm  and  become  thinner  ;  the  mu- 
cous membrane  graduallj'  resumes  its  normal  consistency  and  loses 
its  hard  and  smooth  character,  to  become  soft  and  velvety.  When 
the  patient  is  improving  satisfactorily,  the  uterine  walls  gradually 
regain  their  contractile  power,  and  the  uterine  cavity  conse- 
quently becomes  smaller.  The  accumulation  of  disease  products 
in  the  uterine  cavity  decreases  in  volume  ;  the  discharge  loses  its 
fetor  and  tends  to  become  more  and  more  mucous  in  character, 
until  finally  all  appearances  of  pus  cease,  and  the  discharge  is 
entirely  of  mucus,  .so  far  as  the  naked  eye  can  observe. 

On  the  other  hand,  if  the  disea.se  is  progressing  toward  a  fatal 
termination,  the  uterine  walls  beconie  more  swollen  and  paretic, 
while  the  discharge  into  the  uterine  cavity  tends  to  increase  and 
become  more  purulent  and  fetid,  and  perhaps  darker  in  color, 
owing  to  a  larger  admixture  of  blood. 

Pathology.  When  metritis  progresses  to  a  fatal  termination, 
the  post-mortem  examination  usually  shows  the  chief  lesions  to 
be  i-n  the  genital  tract,  very  largely  in  the  uterus  itself.  Accom- 
panying these  changes  there  are  general  appearances  throughout 
the  body  of  a  profound  septicaemia,  followed  by  very  rapid  decom- 
position of  the  body.  In  fact  the  decomposition  has  progressed 
to  an  unusual  degree  before  death,  so  that,  if  an  autopsy  is  made 


Actite  Metritis  in  the  Cow  88 1 

immediately  after  the  animal  succumbs,  the  decomposition  of  the 
genital  tract  has  already  advanced  to  a  very  marked  degree,  and 
involves  its  peritoneal  covering. 

The  uterus  is  usually  much  thickened,  dark  colored,  and  more 
or  less  necrotic.  The  necrosis  involves  not  only  the  mucous 
membrane,  but  the  muscular  and  peritoneal  coats,  and  even  adja- 
cent organs  in  the  abdominal  cavity,  which  have  been  in  imme- 
diate contact  with  the  diseased  organ.  In  the  vulva  and  vagina 
there  are  frequently  encountered  necrotic  patches  of  a  dark, 
dirty,  or  greenish  color,  and  the  entire  tract  and  its  contents 
are  usually  very  fetid.  The  quantity  of  fluid  in  the  uterus  may 
be  comparatively  small,  or  may  reach  several  gallons. 

The  greatly  thickened  walls  of  the  uterus  are  frequently  highly 
emphysematous  and  very  friable.  Sometimes  shreds  of  the  fetal 
membranes  are  .still  retained,  the  cotyledons  may  be  necrotic, 
and  portions  of  the  uterus  may  be  covered  with  exten.sive  dip- 
theritic  membranes. 

The  peritoneal  covering  of  the  uterus  being  involved,  permit- 
ting the  disea.se  to  extend  thereby  to  other  portions  of  the 
peritoneum,  causes  a  more  or  less  voluminous  exudate  into  the 
peritoneal  cavity.  Abscesses  may  exist  in  the  uterine  walls,  or 
in  the  surrounding  pelvic  connective  tissue. 

Whenever  metritis  is  highly  viruknt,  thrombosis  of  the  neigh- 
boring vessels  is  probable,  as  a  result  of  the  infection  extending 
to  and  involving  the  veins  and  lymphatics.  Such  a  condition  is 
greatly  favored  in  metritis,  because  of  the  fact  that,  only  a  few 
hours  before,  the  vessels  were  very  large  and  contained  a  great 
volume  of  blood.  The  large  vessels,  which  no  longer  have  their 
previous  function  to  perform,  become  inactive  and  vulnerable 
to  infection.  The  thrombi,  breaking  down  and  passing  along 
the  blood  vessels,  tend  to  cause  embolisms  in  distant  parts  of  the 
body,  such  as  the  lungs  and  the  joints.  In  the  latter  position 
they  may  produce  pyaemic  arthritis. 

The  general  post-mortem  appearances  of  the  tissue  and  organs, 
other  than  the  genital  tract,  are  those  of  septicaemia  or  pyaemia. 
The  blood  is  dark  colored,  and  does  not  readily  coagulate.  The 
muscles  are  pale,  friable  and  soft.  The  liver  and  kidneys  are 
engorged  and  soft.  The  general  appearances  of  the  bod^'  do  not 
offer  any  special  differences  from  those  observed  in  death  from 
56 


882  Veterinary  Obstetrics 

wound  infection  ;  in  fact  we  are  essentially  dealing  with  wound 
infection  of  a  particularly  virulent  type. 

The  infection  is  usually  mixed  in  character,  and  offers  no  dis- 
tinction from  that  usually  found  in  acute  wound  infection. 

Handling.  The  veterinarian  should  first  of  all  observe  care- 
fully those  general  rules  which  tend  to  prevent  the  infection. 
As  in  other  operations  of  a  surgical  character,  accompanied  by 
wounds  or  destruction  of  the  protective  epithelium,  we  know 
that  they  may  be  caused  without  being  followed  by  infection,  if 
certain  precautions  can  be,  or  are,  properly  applied.  We  have 
already  urged,  on  page  620,  that  the  veterinary  obstetrist  should 
rigidly  apply  the  rules  of  aseptic  and  antiseptic  surgery,  and  have 
there  fully  discussed  the  proper  course  to  pursue.  He  should 
remember  that  the  introduction  of  his  hand  into  the  genital  pas- 
sages of  a  breeding  female,  just  before,  during  or  after  parturi- 
tion, is  always  accompanied  by  more  or  less  grave  possibilities 
of  infection,  and  consequently  that  such  manual  exploration 
should  not  take  place  unless  there  is  ample  reason  for  it. 

A  retained  and  decomposing  fetus  should  be  removed  from  the 
uterus  as  early  and  carefully  as  possible,  because  it  must  other- 
wise eventually  induce  metritis.  If  the  fetal  envelopes  are  re- 
tained, they  should  be  carefully  handled  along  the  lines  which 
we  hav^e  suggested  on  page  793,  in  order  that  their  decomposition 
in  the  uterus,  and  the  infection  of  the  organ  therefrom,  may  be 
avoided. 

When  metritis  and  parturient  fever  have  become  established, 
the  gravity  of  the  disease  calls  for  prompt,  vigorous  and  intelli- 
gent handling.  The  first  duty  is  the  cleansing  of  the  uterine  and 
vaginal  cavities.  If  there  is  a  large  accumulation  of  purulent 
material  in  the  uterine  cavity,  its  prompt  removal  is  demanded. 
The  septic  material  may  be  flushed  out  by  overfilling  the  uterus 
with  warm  water,  as  described  on  page  875. 

It  is  not  es.sential  what  antiseptic  is  used,  but  highly  important 
how  it  is  used.  Generally  speaking,  we  desire  the  highest  effi- 
ciency with  the  least  irritation.  With  the  uterus  in  a  highly  in- 
flamed state,  the  irritation  from  antiseptics  is  not  so  great  as  in 
the  normal  organ,  and  consequently  a  comparatively  strong  solu- 
tion may  be  used.  However,  we  must  constantly  rely  far  more 
upon  the  mechanical  flu.shing  out  of  the  organ  and  the  washing 
away  of  the  micro-organisms   and   their  poisons   than   upon   de- 


Acute  Metritis  in  the  Cozv  883 

stroying  them  in  the  uterine  cavity  or  in  the  tissues  of  the  uter- 
us. Large  volumes  of  weak  antiseptic  solutions  are  therefore 
preferable  to  smaller  concentrated  ones.  During  the  entire  pro- 
cess of  irrigation,  the  operator  may  add  small  quantities  of  anti- 
septics, and  thus  exert  some  influence  upon  the  .septic  condition. 
In  our  experience  we  have  preferred  less  than  a  i '/(  solution  of 
carbolic  acid.  We  have  likewise  u.sed  a  o.  i  %  solution  of  per- 
manganate of  potash,  with  good  results. 

After  the  irrigation  of  the  uterine  cavity  has  been  completed 
and  the  liquid  has  been  expelled  or  siphoned  out,  there  may  be 
deposited  in  the  uterine  cavity  a  liberal  amount  of  powdered 
iodoform. 

The  flushing  of  the  uterus  should  be  continued  until  the  walls 
have  recovered  their  contractile  power  and  the  purulent  discharge 
has  been  replaced  by  mucus. 

Internally  the  treatment  should  consist  chiefly  of  those  reme- 
dies which  support  the  strength  of  the  animal,  and  tend  to  bring 
about  either  the  destruction  of  the  micro-organisms  and  their  pro- 
ducts, or  their  prompt  excretion  from  the  system.  The  general 
rules  of  systemic  medication  in  acute  metritis  in  the  mare  apply 
also  to  the  cow.  Potassium  iodide,  being  highly  toxic  for  the 
cow,  should  be  omitted  or  given  in  small  doses. 

In  metro-peritonitis,  and  other  puerperal  infections,  various 
anti-streptococcic  and  other  sera  have  been  used  and  highly 
lauded  by  .some  veterinarians,  but  so  far  as  we  have  been  able  to 
determine,  the  evidence  of  their  value  has  been  what  we  may 
term  circumstantial. 

The  rapid  elimination  of  poisonous  products  may  be  greatly 
favored,  when  necessary,  by  prompt  catharsis,  but  as  a  general 
rule  this  should  be  avoided  except  in  very  acute  cases,  and  in- 
stead the  excretion  by  the  bowels  should  be  favored  by  a  light, 
laxative  diet  so  long  as  the  patient  will  eat.  If,  however,  it  is 
felt  that  prompt  excretion  is  essential,  our  preference  is  decidedly 
toward  the  hypodermic  cathartics,  which  will  act  within  an  hour, 
and  thus  not  induce  a  prolonged  depression  or  threaten  to  cause 
superpurgation.  Among  these  remedies  we  favor  moderate  or 
small  doses  of  eserine  or  arecoliue,  of  such  amount  as  to  not  cause 
great  depression  of  the  animal. 


884  Veterinary  Obstetrics 

d.  Acute  Metritis  in  the  Smaller  Animals. 

In  the  smaller  animals  the  causes  and  symptoms  of  acute 
metritis  are  in  the  main  parallel  to  those  observed  in  the  cow 
and  mare,  varying  of  course  in  their  expression,  according  to 
species.  Most  small  animals,  when  suffering  from  acute  metri- 
tis, tend  to  remain  in  the  recumbent  position.  There  is  extreme 
prostration,  with  fever,  tenderness  of  the  abdomen  and  a  puru- 
lent discharge  from  the  vulva.  The  patient  shows  a  disin- 
clination to  move,  and  usually  gives  an  outcry  of  pain  when 
pressure  is  applied  to  the  abdomen. 

Since  in  the  smaller  domestic  animals  the  uterus  is  not  so 
readily  cleansed  by  flushing,  considerable  care  is  necessary  in  order 
to  bring  about  disinfection,  and  even  then  the  operation  will  not 
succeed  so  well  as  in  the  larger  domestic  animals.  In  the  smaller 
animals,  like  the  cat  and  bitch,  we  may  insert  far  into  the  uterine 
horn,  a  rubber  human  catheter,  and  through  this  inject  the  fluid  ; 
or  possibly  a  slightly  bent  metallic  catheter  might  be  used  with 
even  greater  advantage,  because  of  the  possibility  of  directing  it 
first  into  one  and  then  into  the  other  horn,  and  gently  flushing 
these  out  with  antiseptic  fluids. 

In  these  animals,  if  the  uterus  cannot  be  disinfected  by  irriga- 
tion, it  may  be  necessary  to  resort  to  hysterectomy,  as  described 
on  page  669. 


2.     CHRONIC  METRITIS.     PYOMETRA. 

Allied  to  acute  metritis,  and  frequentlj-  following  it  as  a  sequel, 
there  occurs  a  chronic  inflammation  of  the  uterus,  which  is 
characterized  b}'  suppuration  of  the  uterine  cavity,  with  more  or 
less  accumulation  of  pus,  constituting  pyometra,  or  in  case  the 
cervical  canal  of  the  uterus  becomes  completely  occluded  a  large 
volume  of  pus  may  be  confined  within  the  uterine  cavity,  to  con- 
stitute abscess  of  the  uterus. 

Chronic  metritis  or  pyometra  may  occur  in  any  domestic  ani- 
mal, but  has  been  observed  chiefly  in  the  mare,  cow  and  bitch.  It 
may  appear  at  almost  any  period  in  the  life  of  the  animal,  and  its 
relation  to  parturition  is  variable.  It  occurs  almost  always  in  fe- 
males which  have  previously  bred,  but  the  duration  of  time 
elapsing  between  the  last  birth  and  the  appearance  of  the  disease 
is  not  constant.  In  some  cases,  pyometra  or  chronic  metritis 
follows  parturition  after  an  interval  of  a  few  weeks,  or  there  may 
be  a  more  or  less  definite  acute  metritis,  wdiich  partially  recovers, 
to  be  continued  somewhat  indefiniteh'  as  a  chronic,  purulent  in- 
flammation. 

Anything  which  may  lead  to  an  infection  of  the  uterus,  and 
permit  it  to  continue  for  a  long  period  of  time,  suffices  to  estab- 
lish the  disease.  Anything,  therefore,  which  would  debilitate 
the  organ  or  the  general  system,  or  which  would  favor  or  lead  to 
the  introduction  of  micro-organisms  into  the  uterus,  would  act  as 
a  cause  of  the  malady.  Prominent  among  the  recognizable 
causes  of  this  malady,  are  retained  fetal  membranes  and  any  of 
those  causes  which  operate  to  bring  about  acute  metritis,  as  de- 
scribed in  the  preceding  article. 

In  many  cases  manipulations  during  dystokia  appear  to  be  the 
essential  source  of  an  infection,  which,  though  not  sufficiently 
virulent  to  bring  about  an  acute  metritis,  nevertheless  induces  a 
chronic  suppurative  disease  of  the  organ. 

a.  Chronic  Metritis  in  the  Mare.     Pyometra.   , 

Chronic  metritis  in  the  mare  has  not  received  that  attention, 

from  writers    upon  veterinary  obstetrics  or  gynaecology,  which 

its  importance  deserves.     The  affection  is  not  at  all  rare  in  the 

mare,   and  often   proves  very  obstinate   when    handled   b}'   the 

885 


886  Veterinary  Obstetrics 

methods  which  have  been  in  vogue.  This  affection  is  by  far 
most  frequently  seen  in  those  mares  which  have  at  some  pre- 
vious time  been  bred,  and  have  then  been  allowed  to  go  without 
further  attempts  at  breeding.  It  is  consequently  more  common, 
according  to  our  observations,  in  localities  where  few  horses  are 
rai.sed,  than  in  those  districts  where  most  mares  are  regularly 
used  for  breeding  purpo.ses. 

In  addition  to  the  general  causes  of  chronic  metrites,  indi- 
cated above,  it  is  not  rare  to  observe  chronic  metritis  in  the  mare, 
in  ca.ses  where,  because  of  apparent  sterility,  the  stallion  groom 
has  attempted  to  "  open  "  the  uterus  with  a  view  to  inducing  the 
mare  to  conceive.  The  groom  has  forced  his  dirty  hand  through 
the  cervix  of  the  uterus  in  a  rough  manner,  wounding  the  organ 
more  or  less  seriously  and  depositing  in  the  lacerations  or  abra- 
sions, abundant  infection  from  his  dirty  hand. 

The  symptoms  of  chronic  metritis  in  the  mare  consist  usually 
of  a  general  appearance  of  indifferent  or  poor  health,  with  some 
emaciation  and  want  of  power  of  endurance.  Accompanying 
these  systemic  disturbances,  there  usually  appears  from  time  to 
time  a  discharge  of  pus  from  the  vulva.  This  discharge  is  .some- 
times constant,  and  dribbles  away,  especially  when  the  mare  is 
moved  rapidly  upon  the  road  or  when  she  is  lying  down.  If  it  is 
at  all  constant,  the  tail  and  thighs  will  generally  be  found  soiled. 
In  many  cases  the  discharge  occurs  only  at  very  wide  intervals, 
and  apparently  proceeds  from  the  over-disten.sion  of  the  uterus, 
which  causes  the  cervix  uteri  to  dilate  and  brings  about  the  es- 
cape of  a  large  portion  of  the  contents.  In  these  cases  the  dis- 
ease behaves  somewhat  as  an  abscess.  The  uterine  cavity  be- 
comes filled  with  pus,  the  cervical  canal  opens  and  permits  the 
escape  of  the  pus,  then  closes,  and  the  abscess  cavity  again  be- 
comes distended.  Sometimes  the  evacuation  of  pus  is  preceded 
by  symptoms  of  colic,  and  expulsive  efforts. 

The  amount  of  pus  which  may  be  discharged  at  one  time  varies 
between  a  few  pints  and  four  or  five  gallons.  The  contents 
usually  present  the  ordinary  appearances  of  pus  from  an  abscess, 
with  the  admixture  of  more  or  less  mucus.  In  many  cases  it  is 
comparatively  free  from  odor,  while  in  others  it  is  quite  fetid. 
It  is  usually  yellowish  or  bluish-white,  or  may  be  of  a  dirty, 
grayish  color,  and   in  one   case  was  black,  somewhat  flocculent, 


Chronic  Metritis  i7i  the  Mare 


887 


and  presented  to  the  naked  e3e  the  appearance  of  a  disintegrated 
melanotic  tumor. 

Upon  vaginal  exploration,  the  vagina  is  usually  found  to  be 
normal,  though  possibl}^  the  mucosa  is  somewhat  irritated  because 
of  the  presence  of  the  pus  from  the  uterus.  When  the  os  uteri 
is  reached,  it  is  usuallj^  found  closed,  and  it  may  prove  exceed- 
ingly difficult  or  impossible  to  insert  a  finger.  If  the  cervical 
canal  can  be  passed,  the  uterine  cavity  is  found  filled  with  pus, 
and  the  uterine  walls  paretic  and  denuded  of  their  epithelial  cover- 
ing. Exploring  per  rectum,  the  operator  finds  the  uterus  very 
greatly  distended,  lying  inert,  and  containing  from  one  to  several 
gallons  of  liquid,  which  fluctuates  upon  palpation. 

There  are  few  affections  which  may  be  confounded  in  reference 
to  diagnosis  with  chronic  metritis.  Occasionally  we  meet  with  a 
similar  discharge  from  the  vulva  in  case  of  a  very  large  calculus 
in  the  bladder,  accompanied  by  purulent  cystitis.  Other  forms  of 
purulent  cystitis  maj'  cause  like  symptoms,  as  may  also  a  malig- 
nant tumor  of  the  bladder  when  breaking  down.  Chronic  vag- 
initis mav  also  be  mistaken  for  this  affection,  until  manual  ex- 


FlG.    141.       PV0MHTR.\    IN    MaRE. 

O,  O,  Ovaries.     UC,  Uterine  cornu.     U,  Uterus. 
CU,  Indurated  cervix  uteri.     V,  Vagina. 

ploration  is  made.  In  Case  3  we  record  below  an  instance  of  ter- 
atologic development  of  the  uterus,  which  induced  symptoms  of 
chronic  metritis. 

The  changes  observed  in  the  uterus  consist  chiefly  of  a  thick- 
ened and  sclerotic  condition   of   the   cervix  uteri,  with  extreme 


888  Veteri7iary  Obstetrics 

narrowing  of  the  os.  The  mucous  membrane  completely  loses 
its  ordinary  character  ;  ulcerating  patches  appear  ;  and,  as  shown 
in  Fig.  141,  the  cornua  become  displaced  from  their  normal  po- 
sition at  right  angles  to  the  uterine  body,  and  push  forward 
somewhat  in  the  direction  assumed  by  the  cornua  of  the  uterus 
of  the  cow.  The  normal  longitudinal  folds  in  the  nuicous  mem- 
brane are  entirely  obliterated,  and  in  their  place  there  appear 
numerous  transverse  ridges  in  the  muscular  walls. 

The  handling  of  chronic  metritis  in  the  mare  must  be  based 
upon  the  problem  of  local  disinfection,  the  principal  obstacles  to 
which  are  the  sclerotic  condition  of  the  cervix  uteri  and  the  pare- 
tic state  of  the  uterine  walls.  The  fundamental  duty  of  the 
practitioner  is  to  bring  about  a  thorough  dilation  of  the  os  uteri 
to  such  a  degree  as  to  permit  the  insertion  of  the  operator's  hand 
into  the  suppurating  cavity.  This  requires  much  patience  and 
hard  work  in  many  cases,  but  is  of  such  great  importance  that  it 
should  be  persevered  in  until  fully  accomplished.  In  some  cases 
it  requires  patient  endeavor,  extending  over  several  hours,  to 
dilate  the  os  sufficiently  to  insert  a  finger.  When  this  has  been 
attained,  the  uterus  can  be  irrigated  somewhat  ineffectiv^ely  by 
passing  a  tube  through  the  os,  injecting  a  large  volume  of  anti- 
septic fluid,  and  then  siphoning  it  out  b}^  means  of  the  tube 
through  which  it  entered.  But  the  further  dilation  of  the  os 
uteri  must  be  completed  before  recovery  can  be  assured.  This 
may  be  accomplished  with  the  finger  and  hand  of  the  operator, 
by  repeated  efforts  upon  succeeding  days. 

The  partially  dilated  os  may  also  be  tamponed  with  antiseptic 
gauze  or  other  material,  which,  remaining  in  place  for  twenty- 
four  hours,  tends  to  cause  a  dilation  or  softening  of  the  parts. 
A  large  and  powerful  uterine  dilator  may  be  of  great  service  in 
forcibly  dilating  the  os,  rendering  it  very  much  easier  for  the 
operator. 

Once  the  os  uteri  is  sufficiently  dilated  to  admit  freely  the 
operator's  hand,  he  is  in  a  position  to  proceed  with  the  final  pro- 
blem of  disinfection.  With  good  drainage,  the  question  of  a 
choice  of  disinfectants  is  not  supremely  important.  Any  reliable 
disinfectant  will  accomplish  the  end,  but  it  needs  be  intelligent- 
ly applied,  and  by  the  veterinarian  himself.  It  is  needless  to 
say  that  the  disinfecting  solution  should  be  sufficiently  volumin- 
ous to  fill  the  uterus  two  or  three  times  successively,  so  as  to  in- 


Chro7iic  Metritis  in  the  Mare  889 

sure  the  thorough  cleansing  of  the  cavity  at  each  operation.  The 
flushing  of  the  uterus  should  occur  regularly  as  often  as  once  a 
day,  and  should  be  persevered  with  until  success  is  obtained. 

Among  disinfectants,  i-iooo  permanganate  of  potash  solution 
is  highly  efficient.  We  have  had  good  results  with  a  solution 
consisting  of  carbolic  acid,  tannin,  glycerine  and  water.  We 
have  varied  the  strength  of  this  solution  according  to  circum- 
stances, as  related  in  the  cases  given  below.  It  is  important  to 
make  the  solution  as  strong  as  will  be  borne  without  irritating 
the  organ.  It  is  well  to  remember  that  most  disinfectants  are 
quickly  absorbed,  and  their  action  ceases.  In  this  respect  iodo- 
form offers  special  advantages.  After  cleansing  the  suppurating 
cavity  thoroughly  with  one  of  the  foregoing  disinfectants,  a 
gelatine  capsule  containing  5  or  10  grammes  or  more  of  powdered 
iodoform  may  be  carried  with  the  hand  into  the  cavity,  opened, 
and  the  powder  scattered  over  the  uterirre  floor.  The  specific 
gravity  of  the  iodoform  causes  it  to  drop  into  the  folds  and 
irregularities  of  the  mucosa,  and  prevents  its  being  thrown  out, 
while  its  feeble  solubility  causes  a  continued  action  for  a  day  or 
more.  At  the  same  time  it  acts  somewhat  as  a  local  anaesthetic, 
and  tends  to  prevent  straining. 

When  local  treatment  is  begun,  there  frequently  occurs  an 
increased  systemic  disturbance,  due  apparently  to  an  accelerated 
absorption  of  septic  material.  In  order  to  counteract  this  it  is 
well  to  administer  tonics  and  antiseptics,  such  as  nux  vomica  and 
iron,  potassium  iodide,  hydrastis  Canadensis,  or  other  agents. 
Still  more  important  perhaps,  especiallj^  if  the  pus  seems  more 
fetid  and  abundant,  the  irrigations  should  be  increased  to  two, 
three  or  more  times  daily  if  essential  to  cleanliness. 

When  the  disinfection  becomes  effective  there  is  decreased  sup- 
puration, any  odor  which  may  have  been  present  disappears, 
the  discharge  becomes  more  and  more  mixed  with  mucus,  the 
mucosa  of  the  uterus  becomes  normal  in  consistencj^  the  uterine 
walls  become  active  and  approach  each  other  so  that  they  lie  in 
contact. 

The  mare  should  be  kept  directly  under  the  supervision  of  the 
veterinarian  from  the  beginning  of  the  treatment  to  its  success- 
ful termination,  and  the  handling  should  on  no  account  be  en- 
trusted to  an  ordinary  layman.  The  treatment  should  not  be 
stopped  or  relaxed  until  the  recovery  is  complete.     By  following 


890  Veterinary  Obstetrics 

these  lines  of  handling  we  have  not  met  with  an  unsuccessful 
case,  while  we  do  not  recall  an  instance  where  the  treatment  has 
proven  successful  when  the  application  of  the  remedies  has  been 
entrusted  to  a  layman. 

Upon  the  question  of  breeding  after  recovery  we  have  no 
definite  data,  but  there  is  the  danger  that  the  oviducts  may 
occasionally  become  occluded  during  the  course  of  the  disease, 
and  cause  sterility. 

The  following  cases  are  illustrative  : 

Case  I. — A  mare,  aged  15,  entered  our  clinic  March  11,  1S99,  because  of 
a  vaginal  discharge.  An  examination  revealed  a  copious  discharge  of  dirty, 
vi'hitish  pus  from  the  uterus.  The  os  uteri  was  constricted.  The  uterine 
cavity  was  fir.st  injected  with  warm  water,  and  later  with  1-5000  corrosive 
sublimate  solution.  On  March  12,  a  horse  catheter  was  introduced  through 
the  con.stricted  os,  and  i  gallon  of  pus  siphoned  out,  after  which  the  cavity 
was  injected  with  1-5000  corrosive  sublimate  solution. 

This  line  of  treatment  \jas  continued  until  the  i6th,  when  the  os  and  uter- 
ine cavity  were  tightly  packed  with  gauze  saturated  with  creolin  solution. 
On  March  23  the  os  had  become  dilated,  and  the  uterus  had  regained  its 
power,  so  that  the  pack  of  gauze  was  expelled.  There  was  no  longer  an 
appreciable  amount  of  pus  in  the  uterus.  On  March  25  the  packing  of  the 
uterus  was  discontinued,  and  creolin  solution  was  substituted  for  the  corro- 
sive sublimate  for  irrigating.  The  suppuration  had  ceased,  and  the  mare 
was  discharged.     The  treatment  had  occupied  a  period  of  two  weeks. 

Case  2. — The  patient  was  a  mare  aged  9  yrs.,  weighing  about  1,100  lbs. 
She  was  entered  on  Januar}'  9,  1900,  with  the  history  of  a  vaginal  discharge 
.since  June,  1^99,  or  a  period  of  seven  months.  She  had  been  served  in 
June,  1899,  without  result.  Exploration  per  rectum  revealed  the  uterus 
greatly  di.stended  with  fluid.  A  rubber  hose  was  passed  into  the  uterus,  and 
5  gallons  of  pus  were  siphoned  out  A  weak  solution  of  creolin  was  then 
injected  into  the  uterus  by  gravity,  and  allowed  to  escape.  The  uterine 
cavity  was  then  packed  with  three  yards  of  cheese-cloth  saturated  with  2 ', 
creolin  solution. 

On  January  10  the  same  treatment  was  applied,  and  5  yards  of  cheese- cloth 
were  used  in  packing.  The  same  course  was  pursued  on  January  11.  On 
January  12  the  uterus  was  washed  with  creoline  solution,  and  packed  with 
gauze  saturated  with  carbolic  acid  solution,  which  was  left  in  place  until 
January  14,  when  it  was  re-dressed.  On  January  15  the  patient  seemed 
worse.  In  order  to  bring  about  a  more  complete  dilation  of  the  constricted 
OS,  a  new  plan  of  packing  was  adopted.  A  bag  was  made  of  sufficiently 
strong  cloth,  with  a  diameter  of  about  4  or  5  inches  and  a  length  of  3  feet. 
It  was  saturated  with  creolin  solution,  sprinkled  with  iodoform,  and  then 
oiled,  and  the  closed  end  passed  into  the  uterus.  Through  the  open  end 
there  were  then  passed  3  yards  of  cheese  cloth,  partly  into  the  uterus  but 
largely  in  the  tanal  of  the  cervix. 


Chronic  Metritis  in  the  Mare  891 

There  was  given  internally  for  the  five  following  daj's  i  dram  of  pow- 
dered nux  vomica  and  one-half  dram  sulphate  of  copper  twice  daily.  A 
manual  examination  of  the  uterine  cavity  showed  that  the  cornua,  in  their 
paretic  state,  tended  to  become  reflexed  upon  themselves  in  a  way  to  pre- 
vent good  drainage.  This  difficulty  slowh-  disappeared  as  the  case  pro- 
gressed. On  January  17  the  creoline  injection  was  displaced  by  1-2500 
corrosive  sublimate  solution,  and,  in  addition,  iodoform  powder  was  intro- 
duced into  the  uterus  on  January  20,  22  and  23.  She  now  improved  very 
rapidly.  The  internal  treatment  was  continued.  The  mare  was  discharged 
on  the  23rd,  convalescent,  after  fourteen  days  of  treatment. 

Case  3. — A  mare,  aged  4,  weighing  about  1,050  lbs.,  was  entered  on  Janu- 
ary 7,  1901,  with  the  history  that  she  had  suffered  from  a  vaginal  discharge 
since  one  year  old.  The  discharge  was  of  a  light  color,  and  was  dropping 
away  continuously,  keeping  the  tail  and  thighs  badly  soiled.  She  had  not 
been  bred,  and  had  never  shown  signs  of  estrum.  I'pon  making  a  manual 
exploration,  it  was  found  that  the  os  uteri  was  open  and  the  hand  could  be 
passed  through  it  readily.  The  right  cornu  appeared  normal,  while  the 
uterine  body,  with  the  left  cornu  formed  a  remarkably  large,  elongated 
cavity.  The  uterus  and  cornu  had  the  peculiar  property  of  ballooning,  like 
the  vagina,  under  the  movement  of  the  hand. 

The  case  is  inserted  here  because  of  its  unique  character.  It  oflFered  the 
general  external  appearances  of  chronic  metritis,  except  that  the  discharge 
was  mucoid  in  character  instead  of  purulent.  The  difficulty  was  evidently 
teratologic  in  character,  and  the  uterus  had  developed  like  the  vagina,  and 
should  physiologically  have  been  considered  a  part  of  that  organ. 

Case  4. — An  imported  French  draft  mare,  aged  23,  and  weighing 
about  1,350  lbs.,  was  entered  in  the  clinic  on  February  13,  1902,  for  chronic 
metritis.  She  had  a  copious  discharge  of  a  thick,  fetid  pus  from  the  vul- 
va. The  tail  had  a  number  of  small  melanotic  tumors.  The  uterus  was 
washed  with  a  weak  solution  of  carbolic  acid.  On  February  14  the  dis- 
charge seemed  somewhat  decreased,  and  potassium  permanganate  solution 
was  used  for  irrigating.  The  same  was  repeated  on  the  15th.  On  the  17th 
the  uterus  was  packed  with  cheese-cloth  saturated  with  iodoform  and 
vaseline.  On  the  i8th  the  pack  was  omitted,  and  the  uterus  was  washed 
with  a  solution  of  carbolic  acid  and  bi-carbonate  of  soda,  which  was  con- 
tinued on  the  19th  and  20th.  On  the  latter  date  there  was  but  a  small 
amount  of  discharge. 

On  the  2 1st  the  discharge  seemed  worse.  The  uterus  was  washed  as 
before.  Following  the  washing,  a  suppository  of  iodoform,  tannin,  vaseline 
and  beef  tallow  was  introduced  into  the  uterus.  On  the  22nd  the  uterus 
was  washed  with  carbolic  solution,  and  after  it  had  been  expelled  there  was 
inserted  into  the  uterine  cavity,  and  allowed  to  remain,  a  solution  con- 
sisting of  tannin  i  oz. ,  carbolic  acid  i  dram,  glycerine  4  oz.,  tepid  water 
I  pint.  This  treatment  was  continued  daily  until  March  3,  when  the  patient 
was  discharged  practically  convalescent,  with  directions  for  the  owner  to 
continue  the  disinfection  of  the  uterus  for  seven  or  eight  days. 

Case  5. — A  farm  mare,  aged  1 1,  was  entered  in  the  clinic  on  April  25,  1904. 
vShe  had  been  owned  by  the  party  who  presented  her  for  three  years.     Elev- 


892  l^eterinary  Obstetrics 

en  months  prior  to  entrance  she  had  been  taken  to  a  stallion  for  breeding, 
and  when  the  stallion  groom  examined  her  he  thought  that  the  os  uteri 
was  much  constricted.  After  using  considerable  force  he  succeeded  in 
passing  one  finger  through  the  os.  Immediately  afterwards  she  was  served, 
but  did  not  conceive.  Since  that  time  she  had  regularly  shown  signs  of 
estrum.  vSix  months  prior  to  entrance  in  our  clinic,  the  owner  observed 
intermittent  discharges  from  the  vulva,  of  a  thick,  white,  nmco-purulent 
character.  At  times  while  at  work,  she  would  discharge  a  large  amount  of 
pus,  and  then  for  several  days  the  discharge  would  virtually  cease. 
Examination  revealed  the  os  uteri  rigidly  contracted.  After  repeated  and 
laborious  attempts  we  succeeded  in  passing  two  fingers  into  the  uterus. 
We  introduced  a  piece  of  rubber  hose  into  the  uterus,  and  withdrew  seven 
quarts  of  a  thick,  grayish-white  viscid  pus.  We  then  washed  the  cavity  of 
the  uterus  repeatedly  with  i-iooo  corrosive  sublimate  solution,  after  which 
we  introduced  some  two  quarts  of  the  solution  into  the  cavity,  and  allowed 
it  to  remain.     We  then  packed  the  os  uteri  firmly  with  gauze. 

Internally  we  prescribed  copper  sulphate  1 — 1>4  oz.,  nux  vomica 
3  oz.,  potas-iium  iodide  5  oz.,  mixed  and  divided  into  twenty-four  powders, 
of  which  two  were  directed  to  be  given  daily  in  the  food. 

During  the  forcible  dilation  of  the  os,  the  mare  strained  violently  and 
offered  considerable  resistance.  On  April  26  the  mare  was  straining  a  great 
deal,  though  not  very  violently.  After  removing  the  pack,  it  was  found  that 
the  OS  had  dilated  but  little.  The  rubber  hose  was  again  introduced  into  the 
uterus,  and  the  cavity  thoroughly  washed  out  with  a  solution  of  lysol.  After 
repeated  injections  until  the  siphoned  fluid  came  away  clear,  we  introduced 
into  the  uterus  a  solution  consisting  of  tannin  i  oz.,  carbolic  acid  i  dram, 
glycerine  4  oz.,  water  i  pint.  We  then  packed  the  os  as  tightly  as  possible, 
after  which  she  strained  very  violently.  She  was  given  one  ounce  each  of 
chloral  and  powdered  ginger,  which  gave  relief. 

On  April  27  there  seemed  to  be  little  progress  in  dilating  the  os  by  means 
of  the  pack.  After  thorough  disinfection  of  the  parts,  the  os  was  forcibly 
dilated  until  the  hand  could  be  passed  into  the  uterus.  The  uterus  and 
horns  were  found  greatly  dilated,  with  thickened,  paralysed  walls. 
After  thoroughly  irrigating  the  cavity  with  lysol  solution,  we- deposited 
about  I  dram  of  powdered  iodoform  in  each  cornu,  and  injected,  and  al- 
lowed to  remain  in  the  uterus,  the  solution  used  upon  the  preceding  day. 
We  then  inserted  into  the  os  a  gauze  bag,  which  had  been  smeared  with 
iodoform  and  lard,  and  followed  this  by  packing  the  bag  as  full  as  possible 
of  surgeon's  cotton,  saturated  with  corrosive  sublimate  solution. 

On  the  28th  we  removed  the  pack,  and  found  no  accumulation  of  pus. 
The  cavity  was  washed  with  lysol,  after  which  the  solution  of  carbolic  acid, 
tannin  and  glycerine  of  the  preceding  days  was  repeated.  On  April  29  ex- 
amination showed  that  the  uterine  walls  were  resuming  their  normal  condi- 
tion and  contractile  power.  The  treatment  of  the  previous  day  was  repeated. 
The  same  treatment  was  applied  on  the  30th,  and  the  case  was  left  without 
interruption  on  May  i.  Examination  on  May  2  showed  a  small  amount  of 
mucus  in   the  uterus.     The  treatment   of  the  previous  days  was  repeated. 


Chronic  Metritis  in  the  Mare  893 

Recovery  was  now  rapid,  and  she  was  discharged  fully  convalescent  on 
May  7,  or  thirteen  days  after  the  beginning  of  the  treatment. 

Case  6. — A  mare  aged  14,  weighing  about  1,050  lbs.,  was  entered  in  the 
clinic  on  October  6,  1904,  for  poll-evil.  During  the  operation  for  poll-evil, 
under  chloroform,  there  was  a  constant  discharge  of  a  very  fetid  black  pus 
from  the  vulva.  A  rubber  hose  was  inserted  into  the  uterus,  and  4  gallons 
of  pus  siphoned  away.  Upon  the  following  day  one  and  a  half  gallons  of 
pus  were  removed,  and  the  uterus  was  washed  with  a  solution  of  potassium 
permanganate  1-500.  Three  of  these  injections  were  employed  consecu- 
tively, each  consi.sting  of  2'/^  gallons  of  the  fluid.  On  the  third  da)-  the 
amount  of  pus  collected  in  the  uterus  had  decreased  to  one  quart.  The 
treatment  of  the  previous  days  was  repeated. 

The  accumulation  of  pus  in  the  uterus  gradually  decreased  from  day  to 
day,  and  became  lighter  in  color.  On  October  12  the  pus  had  assumed  the 
ordinary  muco-purulent  character  in  colour  and  consistence,  and  was  free 
from  odor. 

On  the  first  day  there  appeared  to  be  some  blood  clots  in  the  discharge, 
and  the  highly  fetid  pus  had  the  appearance  of  broken-down  melanotic  tis- 
sue. Microscopical  examination  of  the  pus  revealed  streptococci,  and  a 
peculiar  fungus  which  was  apparently  responsible  for  the  color. 

From  the  beginning  of  our  treatment  the  mare  had  received  daily  in  her 
feed  Yz  oz.  of  iodide  of  potash  and  %  oz.  powdered  nux  vomica.  On  Octo- 
ber 18  the  administration  of  potassium  iodide  and  nux  vomica  was  decreased 
one-half ;  the  discharge  was  constantly  growing  lighter  in  color ;  and  the 
pus  was  being  replaced  by  mucus. 

During  the  entire  course  of  treatment  the  os  had  been  very  much  con- 
stricted, and  each  day  forcible  dilation  was  attempted,  but  it  was  not  until 
the  20th  that  it  was  practicable  to  insert  the  entire  hand  into  the  uterus. 
On  the  22nd,  the  potassium  permanganate  injection  was  replaced  by  the  car- 
bolic acid,  tannin  and  glycerine  solution  described  in  the  previous  cases. 
On  October  24  the  same  treatment  was  repeated,  with  the  addition  of  one 
ounce  of  powdered  iodoform  deposited  in  the  uterus  before  the  injection  of 
the  disinfecting  solution.  On  October  26  the  os  was  well  dilated,  there  was 
a  small  amount  of  mucus  present,  the  uterine  walls  were  contracting,  and 
and  the  patient  was  convalescent.  vShe  was  discharged  on  October  27,  after 
twenty-one  days'  treatment. 

Cask  7.— A  mare,  aged  7,  weighing  about  1,000  His.  was  entered  in  the 
clinic  on  October  13,  1904,  for  chronic  metritis.  The  owner  related  that  she 
had  had  a  very  pendulous  abdomen  for  some  time  and  had  shown  an  inter- 
mittent vaginal  discharge.  She  had  expelled  a  considerable  quantity  of  pus 
on  the  da}-  of  entrance.  A  rubber  tube  was  inserted  into  the  uterus,  and  5 
gallons  of  thick,  whitish  pus  withdrawn.  The  cervix  uteri  was  hard  and 
unyielding,  and  the  os  much  constricted.  The  mucosa  of  the  uterus  felt 
nmch  thickened.  Only  two  fingers  could  be  passed  through  the  os  into  the 
uterus.  The  uterus  was  washed  daily,  up  to  October  20,  with  a  solution  of 
permanganate  of  potash.  On  October  20  the  permanganate  of  potash  was 
discontinued,  and  in  its  stead  we  injected  into  the  cavity  a  solution  consist- 


894  Veterinary  Obstetrics 

ing  of  taunin  one  ounce,  carbolic  acid  one  ounce,  glycerine  three  ounces, 
and  water  one  gallon.    This  line  of  treatment  was  continued  until  October  25. 

Throughout  the  course  of  the  treatment,  attempts  had  been  made  to  dilate 
the  OS  uteri,  but  had  not  succeeded,  and  consequently  on  October  25  we  in- 
serted a  uterine  dilator,  and  forcibly  dilated  the  os  uteri  until  the  hand 
could  almost  be  passed  into  it.  The  os  was  packed  with  gauze  saturated 
with  2  per  cent,  lysol.  On  the  following  day  there  was  a  considerable  ac- 
cumulation of  fetid  pus,  and  the  os  uteri  was  much  swollen.  The  uterus  was 
washed  with  0.5  per  cent,  potassium  permanganate  solution,  and  the  os  was 
packed  with  gauze  saturated  with  lysol*  solution.  On  October  27  we  suc- 
ceeded in  inserting  the  hand  into  the  uterus.  The  treatment  of  the 
previous  day  was  repeated,  and  continued  until  November  3,  when  the 
cavity  was  injected  with  corrosive  sublimate  solution,  after  which  we 
deposited  in  the  uterus  half  an  ounce  of  iodoform  and  two  ounces  of  olive 
oil.  This  line  of  treatment  was  now  continued,  and  the  case  improved  rap- 
idly until  November  16,  when  the  patient  was  discharged  convalescent. 

Cask  S.— A  farm  mare,  aged  21,  was  entered  in  the  clinic  on  May  3,  1905, 
for  chronic  metritis,  The  owner  related  that  a  whitish  vaginal  discharge 
had  been  present  to  some  extent  for  three  years.  She  had  given  birth  to  a 
foal  in  the  spring  of  1904,  since  which  time  the  discharge  had  been  much 
increased.  The  os  uteri  was  dilated  so  that  the  hand  was  readily  passed  into 
the  cavity.  The  uterine  walls  were  flaccid  and  thickened.  The  iiterus  con- 
tained a  collection  of  fetid  pus.  The  uterus  was  washed  with  a  1-2,000  cor- 
rosive sublimate  solution. 

Owing  to  the  paretic  condition  of  the  uterine  walls,  there  was  difficulty  in 
expelling  the  fluid.  vShe  was  given  internally  nux  vomica  and  sulphate 
of  copper.  The  case  was  discharged  on  the  da.\  of  entrance,  and  the  owner 
was  directed  to  wash  the  uterus  daily  with  1-2,000  corrosive  sublimate  solu- 
tion. It  was  later  reported  that  in  the  hands  of  the  owner  the  treatment 
proved  unsatisfactory  and  the  animal  was  destroyed. 

b.  Chronic  Metritis  in  the  Cow. 

Chronic  metritis  in  the  cow  occurs  chiefly  in  those  animals 
which  are  clo.sely  housed,  used  for  dairying  purposes,  and  regu- 
larly bred. 

The  causes  appear  to  be  chiefly  retained  fetal  membranes  or 
improper  manipulations  during  dystokia.  It  appears  to  be 
e.speciall}^  common  in  the  granular  venereal  disease,  or  granular 
vaginitis.  Whether  in  these  ca.ses  it  results  indirectly  from  re- 
tained placenta  as  a  consequence  of  the  disease,  or  directly  from 
the  extension  of  the  disease  into  the  uterine  cavity,  is  not  clear. 

The  symptoms  in  the  cow  consist  mainly  of  a  chronic  purulent 
discharge,  of  a  dirty  gray  color,  accompanied  sometimes  by  in- 
different health,  with  loss  of  condition  and  decrease  of  milk.  In 
many  cases,  in  addition  to  these  general  signs,  there  is,    in  the 


Pyometra  in  the  Bitch  and  Cat.  895 

cow,  a  tendency  to  prolapse  of  the  vagina.  Usually  the  dis- 
charge occurs  while  the  cow  is  in  the  recumbent  position,  and 
the  dirt}'  reddish-gray  accumulation  is  found  lying  behind  the 
patient  in  the  gutter.  In  cases  where  prolapse  of  the  vagina 
occurs,  the  discharge  from  the  uterus  may  largely  pass  un- 
noticed. In  many  cases  of  chronic  metritis  in  the  cow,  the  dis- 
charge from  the  uterus  is  intermittent,  may  be  comparatively 
insignificant  in  volume,  and  therefore  not  readily  observed. 

When  such  a  discharge  appears  at  the  vulva,  or  the  animal 
seems  to  be  in  indifferent  health,  or  is  sterile,  it  is  well  for  the 
veterinarian  to  make  a  manual  exploration  of  the  uterus  and  de- 
termine its  condition.  If  chronic  metritis  exists,  the  uterus  will 
be  found  enlarged,  according  to  the  amount  of  pus  retained 
within  its  cavity.  The  amount  of  liquid  within  the  uterus 
may  vary  between  one  pint  and  4  or  5  gallons.  The  os  uteri  is 
firmly  closed  ;  otherwise  the  imprisonment  of  the  pus  would  not 
be  so  marked.  Chronic  metritis  in  the  cow  constitutes  an  im- 
portant cause  of  sterility. 

Handling.  The  handling  of  chronic  metritis  or  pyometra  in 
the  cow  must  be  based  upon  the  same  general  principles  as  al- 
ready related  in  detail  for  the  mare.  In  the  disinfection  of  the 
organ  one  may  follow  the  method  already  suggested  for  the 
mare,  dilating  the  os  uteri  and  injecting  disinfectants  into  the 
uterine  cavity.  The  problem  of  dilating  the  cervical  canal  in 
the  cow  is  far  more  difficult  than  in  the  mare,  becau.se  of  ana- 
tomical conditions.  The  treatment  consequently  requires  more 
time  and  effort  than  in  the  mare. 

A  second  plan  for  dealing  with  chronic  metritis  or  pyometra 
in  the  cow  has  been  proposed  by  Hess,  and  already  described 
while  discussing  the  subject  of  sterility  on  page  224.  According 
to  Hess,  his  plan  of  handling  pyometra  by  pressing  out  the  per- 
sistent yellow  body  of  the  ovary,  and  then  applying  ma.ssage  to 
the  uterus  from  before  backward,  has  been  followed  by  gratify- 
ing results.      This  plan  has  proven  effective  in  our  hands. 

c.  Pyometra  in  the  Bitch  and  Cat. 

In  the  bitch  and  cat,  pyometra  seems  most  common  in  those 
animals  which  have  been  bred  and  later  excluded  from  breeding, 
but  may  occur  in  animals  which  have  not  been  bred  at  all. 

The  symptoms  are  very  similar  to  those  already  noted  in  the 


896  Veterinary  Obstetrics 

mare  and  cow,  and  include  a  general  weakness  and  emaciation  of 
the  patient,  combined  with  a  grayish-red  discharge  from  the  vul- 
va, which  stains  the  bedding.  When  the  uterus  becomes  much 
distended,  the  size  of  the  abdomen  may  be  augmented,  and  the 
enlarged,  fluctuating  uterus  may  be  recognized  by  abdominal 
palpation. 

The  handling  of  the  disease  in  these  animals  is  to  be  based  upon 
the  same  general  principles  as  in  the  preceding  cases,  modified 
by  differences  in  the  size  of  the  patient  and  the  form  of  the 
uterus. 

Owing  to  the  smallness  of  the  uterus,  and  its  form,  it  is  well- 
nigh  impossible  to  effectively  irrigate  and  disinfect  its  cavity.  A 
catheter  or  other  tube  may  be  pushed  along  through  the  vagina 
into  one  of  the  horns,  but  it  can  scarcely  advance  to  the  apex  or 
be  introduced  at  will  into  the  right  or  left  cornu  ;  nor  can  the  vet- 
erinarian determine,  after  it  has  entered  one  of  the  cornua,  which 
one  it  occupies.  The  irrigation  with  antiseptics  is  consequently 
indefinite  and  unsatisfactory. 

Hobday  (Vet.  Jour.,  Jan.,  1907,  page  30)  relates  that  he  has 
had  favorable  results  in  rare  instances  by  the  administration  of 
the  extract  of  hydrastic  Canadensis,  while  a  solution  of  the  same 
was  used  as  an  injection  into  the  vagina. 

Hobday  recommends,  instead  of  antiseptic  irrigations  or  inter- 
nal medication,  the  operation  of  hysterectomy,  because  as  a  gen- 
eral rule  the  more  conservative  measures  ultimately  fail  to  bring 
about  recovery,  while  hysterectomy  in  his  experience  has  been 
safe  and  efficient.  The  technic  of  this  operation  has  been  de- 
scribed on  page  669. 

It  is  essential  to  carry  out  the  operation  under  the  .strictest 
aseptic  precautions,  and  to  this  end  it  is  well  that  the  operation 
be  performed  under  general  anaesthesia. 

3.  Uterine  Abscess. 

When  chronic  purulent  metritis  is  complicated  with  atresia  of 
the  OS  uteri,  there  ensues  a  condition  which  may  be  best  de- 
scribed as  uterine  abscess.  The  line  of  demarcation  between 
chronic  metritis  or  pyometra,  described  in  the  preceding  article, 
and  uterine  abscess  is  not  clear.  In  the  former  the  evacuation 
of  the  uterine  contents  is  sometimes  constant  and  sometimes 
intermittent.       The    intermittent   character    may    be   due    to   a 


Uterine  Abscess  897 

temporary  atresia  of  the  os  or  the  cervical  canal,  and  the 
final  discharge  of  the  accumulated  fluid  may  be  the  result  of  a 
breaking  down  of  the  adhesions  in  the  canal,  in  a  way  which 
might  be  compared  to  the  rupture  of  an  abscess.  In  some  cases, 
however,  the  atresia  or  closure  of  the  os  is  more  persistent,  and 
brings  about  a  state  which  cannot  be  better  designated  than  as 
abscess. 

The  causes  of  abscess  of  the  uterus  are  similar  to  those  of 
chronic  metritis,  and  are  very  largely  referable  to  infection  fol- 
lowing manipulations  during  dystokia  or  to  retention  of  the  fetal 
membranes. 

The  symptoms  of  uterine  abscess  differ  from  those  which  are 
typical  of  chronic  metritis.  The  disease  is  observed  chiefly  in  the 
mare.  The  principal  symptoms  observed  are  those  of  general 
debility  accompanied  b}-  some  emaciation  and  general  appear- 
ances of  ill-health,  with  evidences  of  abdominal  pain,  which  may 
be  described  as  colic.  Later,  expulsive  efforts  appear.  The 
uterine  walls  serve  as  abscess  walls,  and  the  tension  within  the 
cavity  constantly  increases,  until  finally  the  walls  rupture  in  the 
direction  of  least  resistance,  and  the  contents  escape.  So  far  as 
we  have  observed,  the  abscess  ruptures  into  the  vagina,  appar- 
ently through  the  occluded  os  uteri. 

Under  these  conditions  a  manual  exploration  per  rectum  re- 
veals an  enormously  enlarged  uterus,  very  tense  and  fluctuating. 
The  uterus  may  contain  as  much  as  4  or  5  gallons  of  pus.  The 
organ  loses  its  usual  form,  and  becomes  more  or  less  spherical. 

Manual  exploration  per  vaginam  reveals  a  normal  vulva  and 
vagina  ;  but  the  os  uteri  is  absent,  and  that  portion  of  the  uterus 
which  normally  projects  into  the  cavity  of  the  vagina  has  be- 
come wholly  effaced.  The  anterior  wall  of  the  vagina  appears  as 
a  tense  partition,  without  any  opening  toward  the  uterus. 
Through  this  wall  the  distended  organ  may  be  readily  felt,  or 
rather  we  might  say  that  the  anterior  vaginal  wall,  with  which 
the  hand  comes  in  immediate  contact,  constitutes  the  posterior 
wall  of  the  abscess  cavity. 

In  one  mare  we  had  considerable  difficulty  in  overcoming  dys- 
tokia. After  the  fetus  was  removed  by  means  of  embryotomy, 
the  mare  did  not  recover  with  that  promptness  and  completeness 
which  should  be  expected,  and  finally  began  to  decline.  Later 
57 


898  Veterinary  Obstetrics 

she  was  presented  for  examination  because  of  frequent  colicky 
pains  and  expulsive  efforts.  Upon  manual  exploration  per 
rectum,  the  uterus  appeared  as  an  immense  spherical  sac  contain- 
ing 5  or  6  gallons  of  liquid.  Upon  introducing  the  hand  into  the 
vagina,  the  os  uteri  could  not  be  definitely  recognized,  and  there 
was  no  opening  extending  forward  into  the  uterine  cavity. 

The  owner  hesitated  about  an  operation,  and  after  a  few  days, 
upon  going  to  the  stable  in  the  morning,  he  found  lying  in  the 
stall  behind  the  mare  some  5  or  6  gallons  of  thick  and  extremelj' 
fetid  pus. 

Handling.  The  treatment  of  uterine  ab.scess  shoud  be  essen- 
tially the  same  as  that  for  other  ab.scesses.  The  abscess  cavity 
should  be  freely  opened,  and  its  contents  evacuated,  followed  by 
thorough  disinfection.  The  point  for  opening  the  abscess  is 
through  the  occluded  os  uteri.  The  opening  may  be  made  with 
a  scalpel,  or  a  finger  may  be  thrust  through  the  wall,  if  not  too 
dense.  The  opening  should  be  sufficiently  dilated  that  the  hand 
may  be  passed  through  into  the  abscess  cavity.  The  later  treat- 
ment is  the  same  as  for  chronic  metritis. 

The  prognosis  in  uterine  abscess  should  be  guarded.  The  life 
of  the  patient  may  usually  be  saved.  The  abscess  tends  to  cause 
occlusion  of  the  oviducts  and  consequent  sterility. 

4.  Vaginitis  and  Vulvitis. 

Inflammation  of  the  vagina  and  vulva  almost  inevitably  ac- 
company acute  metritis,  because  the  passage  of  infected  and  irri- 
tant discharges  from  the  uterine  cavity  must  contaminate  the  mu- 
cous membrane  of  these  organs  in  escaping  externally.  In  such 
cases  the  vaginitis  and  vulvitis  normally  di.sappear  when  the  me- 
tritis recovers.  Aside  from  this  we  sometimes  meet  with  inflam- 
mation of  the  vagina  and  vulva  without  the  uterus  becoming  in- 
volved. 

Causes.  Anything  which  may  cause  contusions,  lacerations  or 
abrasions  of  the  vaginal  and  vulvar  mucosa  tends  to  cause  the  dis- 
ease, if  added  to  this  there  is  favorable  opportunity  for  infection. 
In  dystokia,  the  manipulations  of  a  careless  obstetrist  may  do 
much  to  lacerate  and  abrade  the  vagina  and  bring  about  infec- 
tion of  the  wounds.  Laymen  and  empirics,  as  well  as  .some  vet- 
erinarians, frequently  use  old,  dirty  cords  or  ropes,  made  of  very 
coarse,    harsh   material,    for  carrying  out   obstetric  operations. 


Vaginitis  and   Vulvitis  899 

These  lacerate  and  abrade  the  genital  passages  in  a  highly  repul- 
sive manner,  and  simultaneously  deposit  the  infection  in  the 
maimed  tissues.  Add  to  these,  dirty  hands  of  careless  operators 
and  the  virulent  infection  from  a  putrid  fetus  or  fetal  membranes, 
and  a  highly  dangerous  infection  of  the  vagina  or  vulva  is  almost 
inevitable. 

Necessarily  no  differentiation  can  usually  be  made  between 
inflammation  of  the  vagina  and  of  the  vulva,  since  these  two 
canals  are  continuous  at  the  time  of  parturition,  and  the  vagina 
cannot  well  be  involved  without  the  vulva  sharing  in  the  disease 
to  a  greater  or  less  extent,  and  vice  versa. 

Inflammation  of  the  vagina  or  vulva  may  lead  to  suppuration, 
ulceration  or  gangrene.  Necrosis  of  the  lips  of  the  vulva,  or  of 
the  walls  of  the  vagina,  may  lead  to  a  rapidly  fatal  termination  ; 
or,  should  the  patient  survive,  the  vulvar  lips  may  slough  away, 
and  more  or  less  atresia  of  the  vulva  or  vagina  result.  While 
dealing  with  dystokia  in  the  anterior  presentation,  due  to  the 
extension  of  the  posterior  limbs  beneath  the  fetal  body,  we  re- 
lated, on  page  778,  three  cases  in  which  serious  vulvitis,  vaginitis 
or  cystitis  followed,  one  case  ending  fatally. 

The  lips  of  the  vulva,  and  the  mucous  membrane  of  the  vulva 
and  vagina,  become  inflamed  and  swollen.  If  the  lips  of  the 
vulva  are  parted,  the  mucosa  is  observed  to  be  of  a  deep  red  or 
dark  blue,  or  a  necrotic  greenish-black.  Usually  there  are  also 
visible  lacerations  or  abrasions  of  the  mucous  membrane,  with 
more  or  less  suppuration.  The  swelling  and  pain  in  the  parts 
may  cause  difficulty  in  defecation  or  urination. 

The  prognosis  of  vaginitis  and  vulvitis  must  be  based  upon  the 
extent  and  virulence  of  the  infection.  Where  the  necrosis  of  the 
tissues  is  not  extensive,  the  prognosis  is  usually  good;  but  when 
there  is  extensive  gangrene,  accompanied  by  general  septicaemia, 
a  fatal  i.ssue  may  be  expected.  In  cases  of  more  or  less  exten- 
sive ulceration  or  gangrene,  without  marked  septicaemia,  there 
may  be  highly  important  adhesions  or  constrictions,  which  may 
serve  to  prevent  thereafter  the  breeding  of  the  animal. 

The  treatment  of  vaginitis  consists  essentially  of  disinfection, 
which  needs  be  vigorous  and  thorough.  The  attending  veteri- 
narian should  guard  with  all  possible  care  against  .septicaemia  in 
cases  of  gangrene,   by  the  administration  internally  of  quinine, 


900  Veterinary  Obstetrics 

potassium  iodide  or  other  similar  remedies  in  large  doses,  in  addi- 
tion to  vigorous  local  disinfection. 

In  all  cases  of  dystokia  where  the  obstetrist  has  reason  to  fear 
vulvo-vaginitis,  he  should  apply  strict  'prophylactic  measures,  in 
the  form  of  careful  and  repeated  irrigations  with  warm  antisep- 
tics, and  the  washing  of  the  tail,  vulva,  anus  and  surrounding 
parts  frequently  with  reliable  antiseptics  like  2.57^  carbolic  acid 
solution. 

5.  Cystitis. 

Septic  inflammation  of  the  bladder,  as  a  result  of  puerperal  in- 
fection, is  not  a  very  common  malady  in  domestic  animals.  We 
have  observed  one  case  in  the  mare,  which  we  have  already  briefly 
related  at  the  bottom  of  page  778. 

After  overcoming  the  dystokia,  the  vagina  and  vulva  were 
cleansed  as  well  as  practicable,  but  the  case  was  neglected  and 
not  seen  by  us  again  for  some  weeks,  when  we  found  severe  vag- 
initis, vulvitis  and  cystitis.  The  cystitis  was  the  most  formid- 
able of  the  lesions.  The  meatus  was  open,  and  the  index  finger 
could  readily  be  passed  into  the  cavity  of  the  bladder.  The  walls 
of  the  bladder  were  thickened,  and  the  mucosa  was  thrown  into 
extensive  folds,  which  were  covered  over  by  crusts  of  urinary 
salts,  mixed  with  pus.  The  purulent  urine  had  a  very  fetid  odor. 
The  cavity  of  the  bladder  was  small,  and  the  thickened  walls 
paretic  and  inextensible,  so  that  the  urine  flowed  from  the  bladder 
involuntarily,  producing  an  intense  irritation  of  the  vulva. 
Dribbling  down  constantly  over  the  thighs,  the  urine  kept  these 
parts  repulsively  soiled  and  excoriated,  and  the  tail  constantly 
wet  and  filthy. 

The  treatment  of  purulent  cystitis  consists  essentially  of 
the  disinfection  of  the  vagina,  vulva  and  bladder.  Somewhat 
mild  and  efficient  antiseptic  fluids,  such  asao.57  solution  of 
carbolic  acid,  or,  perhaps  better,  o.i'/c  permanganate  of  potash, 
should  be  injected  into  the  cavity  of  the  bladder.  On  account 
of  the  precipitation  of  the  urinary  .salts  on  the  walls  of  the  blad- 
der, it  might  be  well  to  slightly  acidulate  the  fluids  injected  into 
the  viscus,  in  order  that  the  urinary  salts  may  be  dissolved,  and 
hence  the  irritation  caused  by  their  presence  overcome.  The 
disinfection  of  the  vagina,  vulva  and  bladder  should  be  frequently 
repeated,  at  least  once  a  day,  and  persisted  in  until  complete 
recovery  is  assured. 


Peri-vagiyial  Abscesses  901 

6.  Peri-vaginal  Abscesses. 

In  difficult  labor,  much  of  the  violence  to  the  genital  tract  is 
concentrated  upon  the  vagina  and  the  pelvic  portion  of  the  uter- 
us. These  parts  may  be  caught  between  unyielding  portions 
of  the  fetus  and  the  bony  walls  of  the  pelvis,  and  become 
more  or  less  seriously  contused,  abraded  or  lacerated.  In  addi- 
tion to  these  injuries,  the  obstetrist  may  irritate  the  parts 
in  some  measure  with  his  hands  and  arms,  and  with  instru- 
ments and  apparatus,  especially  with  coarse  cords  or  straps  for 
the  exertion  of  traction.  Under  these  conditions  the  walls  of 
the  vagina  are  liable  to  become  seriously  infected.  The  septic 
material,  finding  its  way  deeply  into  the  tissues,  eventually  in- 
duces the  formation  of  abscesses  in  the  walls  of  the  vagina  itself 
or  outside  in  the  pelvic  connective  tissue.  More  anteriorly,  the 
infection  of  the  vaginal  walls  may  cause  adhesions  between  the 
vaginal  or  uterine  peritoneum  and  the  walls  of  the  pelvis,  and 
lead  to  the  formation  of  abscesses  between  these  two  layers  of 
adherent  peritoneum  or  in  the  adjacent  connective  tissues. 

The  abscesses  occur  with  greatest  frequency,  according  to  our 
observations,  along  the  floor  of  the  vagina  in  the  region  of  the 
bladder,  and,  when  very  extensive,  press  upon  that  organ  and 
interfere  with  urination.  They  may  so  involve  the  walls  of 
the  bladder  as  to  cause  a  rupture  of  that  organ,  either  into  the 
vagina  or  the  peritoneal  cavity.  The  ab.scesses  ma}-  rupture 
into  the  vagina,  rectum,  or  peritoneal  cavity. 

The  symptoms  of  peri-vaginal  abscesses  consist  at  first  chiefly 
of  a  stiffness  in  the  posterior  portions  of  the  body,  with  a  disin- 
clination to  move,  accompanied  by  general  febrile  disturbances, 
including  elevation  of  temperature,  loss  of  appetite  and  general 
dullness.  The  vulva  is  usually  swollen,  and  upon  separating 
the  lips,  the  mucous  membrane  is  usually  found  to  be  swollen 
and  dark  colored.  Defecation  is  painful,  if  not  difficult,  be- 
cause of  the  extreme  sensitiveness  of  the  parts,  accompanied 
by  more  or  less  extensive  swelling.  If  the  abscesses  are  forming 
between  the  pubis  and  the  vaginal  floor,  the  act  of  urination  is 
almost  inevitably  accompanied  by  pain  and  difficulty. 

Upon  manual  exploration  of  the  vagina,  the  parts  are  found  to 
be  very  hot  and  sensitive,  while  at  some  point,  most  probably 
along  the  vaginal  floor,  extensive,  hard  swellings  may  be   felt, 


902  Veterhiary  Obstetrics 

which,  later  in  the  progress  of  the  disease,  fluctuate.  In  a  mare 
we  observed  ahnost  the  entire  floor  of  the  vagina  involved  in  a 
series  of  large  abscesses,  which  extended  forward  as  far  as  the 
pubic  brim.  The  fluctuation  could  be  readily  felt.  The  parts 
were  exceedingly'  tender,  and  the  animal  moved  with  very  great 
difficulty. 

The  prognosis  of  peri-vaginal  abscesses  must  be  based  largely 
upon  their  location  and  the  possibility  or  probability  of  their  rup- 
turing or  being  opened  into  the  vagina  or  rectum. 

The  handling  of  peri-vaginal  abscesses  should  be  in  accordance 
with  general  surgical  principles,  and  should  consist  funda- 
mentally of  opening  the  abscesses  into  the  vagina  or  rectum  at  the 
earliest  possible  moment.  In  the  instance  which  we  have  already 
cited,  we  hesitated  too  long  to  open  the  abscess,  lest  we  might 
thereby  open  the  peritoneal  cavity,  and  hoped  for  a  spontaneous 
rupture  into  the  vagina,  but  our  delay  permitted  the  abscess 
to  rupture  into  the  peritoneal  cavity  instead.  It  is  hazardous 
to  delay  opening  the  abscesses.  If  they  cannot  be  safely  opened 
into  the  vagina  or  rectum,  then  fatal  rupture  into  the  peritoneal 
cavit}'  is  practically  certain.  Thorough  irrigation  of  the  vagina 
and  abscess  cavity  should  be  applied  daily  or  more  frequently, 
according  to  circumstances.  Internal  antiseptics,  such  as  quinine 
and  potassium  iodide,  in   full  doses,  are  indicated. 

7.  Py.^mic  Infection. 

Aside  from  the  strictly  local  infections  of  the  genital  tract, 
lesions  of  these  organs  afford  a  portal  for  the  entrance  of  infec- 
tions of  various  kinds  into  the  system.  The  infecting  organisms 
may  gain  the  lymph  or  blood  circulation,  and  be  carried  to  distant ' 
parts  of  the  body,  where  they  may  become  lodged  to  multiply 
and  produce  localized  inflammation,  with  the  formation  of  ab- 
scesses or  other  changes,  to  constitute  pysemia.  Pyaemic  in- 
flammations may  involve  any  tissue  or  organ  in  the  body,  and 
consequently  may  produce  a  great  variety  of  symptoms.  In  ob- 
stetric practice  we  observe  chiefly,  as  pysemic  diseases  belonging 
to  the  puerperal  state,  poly-arthritis  or  pyaemic  arthritis,  and 
metastatic  inflammation  of  tendon  sheaths. 

a.  Poly-arthritis  may  be  defined  as  an  arthritis  following  par- 
turition, and  generally  involving  several  joints,  especially  the 
tarsal,  carpal,  and  femoro-tibial  articulations.     No  articulation  is 


Pycsniic  Infection  903 

immune.  According  to  cle  Bruin  the  disease  may  have  its  origin 
in  the  articular  serous  membrane  or  in  the  bone  marrow,  and 
may  be  either  serous  or  purulent  in  character.  It  is  observed 
chiefly  in  the  cow. 

It  is  believed  that  the  infection  reaches  the  articulations  pri- 
marily by  being  taken  up  by  the  veins  from  the  uterus,  probably 
in  the  form  of  small  thrombi,  which,  passing  to  the  heart  and 
thence  to  the  lungs,  succeed  in  passing  through  the  latter  organs 
and  gaining  the  systemic  circulation,  through  which  they  event- 
ually reach  the  synovial  membranes  or  marrow  of  the  bone, 
where  the  micro-organisms  lodge  and  multiply  to  induce  arthritis. 

As  a  rule  poly-arthritis  follows  some  recognizable  puerperal 
infection  of  the  uterus,  such  as  retained  placenta,  or  other  dis- 
ease, followed  by  more  or  less  evident  metritis  or  vaginitis.  In 
some  instances  the  disease  follows  an  apparently  normal  puerpe- 
ral period,  presumably  because  some  very  small  wound  of  the 
mucosa  of  the  genital  tract,  or  other  injury,  has  led  to  an  infec- 
tion which  has  escaped  notice  until  the  arthritis  appears. 

The  .symptoms  of  poly-arthritis  usually  appear  at  about  6  to  8 
days  after  parturition,  though  they  may  be  delayed  for  some 
weeks.  They  consist  chiefly  of  stiffness  in  the  gait,  accompanied 
by  more  or  less  distinct  lameness  and  difficulty  in  getting  up. 
Pain  is  very  evident,  and  the  animal  assumes  the  recumbent  posi- 
tion for  a  large  part  of  the  time.  There  is  well  marked  fever, 
with  the  accompanying  symptoms  of  loss  of  appetite,  cessation 
of  rumination  and  a  decreased  secretion  of  milk.  An  examina- 
tion of  the  uterus  may  reveal  the  presence  of  retained  placenta, 
or  of  a  dark-colored  fluid,  which  may  or  may  not  be  fetid. 

The  pain  in  the  affected  limb  is  .so  great  that  the  animal  de- 
clines to  bear  weight  upon  it  so  far  as  avoidable.  The  capsule 
of  the  joint  is  distended  and  tender.  The  epiphyses  of  the  bones 
are  sometimes  swollen  and  painful.  If  more  than  one  joint  is 
simultaneously  involved,  the  movements  of  the  animal  become 
exceedingly  difficult  and  painful.  The  symptoms  may  be  com- 
plicated by  metastatic  inflammation,  or  ab.sce.s,ses  of  some  of  the 
internal  organs,  which  may  cause  edema  of  some  of  the  depen- 
dent parts  of  the  body. 

The  prognosis  is  variable.  If  the  arthritis  is  serous  in  char- 
acter, perhaps  we  might  say  if  it  is  due  to  the  irritation  of  the 
bacterial  products  in  the  part  rather  than   to   the   presence  of 


904  ■  Veterinary  Obstetrics 

the  bacteria  themselves,  the  disease  may  run  a  favorable  course, 
with  complete  recovery  in  a  comparatively  short  time.  When 
the  bone  marrow  is  involved,  the  disease  becomes  more  serious, and 
a  fatal  termination  is  probable,  as  is  also  the  case  when  the  dis- 
ease assumes  a  purulent  character  and  abscesses  form  in  or  about 
the  articular  capsule. 

Upon  post-mortem  examination  the  synovial  membranes  of 
the  joints  are  found  reddened  and  thickened,  and  the  superficial 
epithelium  destroyed.  The  synovia  is  of  a  dark  yellow  color,  or 
purulent  in  character,  while  the  tissues  outside  the  capsule  are 
infiltrated.  Scattered  here  and  there  are  small  purulent  cen- 
ters. The  articular  cartilage  may  be  eroded  and  destroyed,  and 
the  epiphy.ses  of  the  bones  may  have  undergone  purulent  de- 
struction. 

Handling.  Our  first  care  in  the  handling  of  the  disease  should 
be  the  thorough  and  repeated  disinfection  of  the  genital  tract,  in 
order  to  prevent  further  absorption  of  septic  material  from  the 
original  source.  If  the  fetal  membranes,  or  fragments  of  them, 
still  remain  in  the  uterus,  they  should  be  removed.  If  some  of 
the  cotyledons  are  necrotic,  and  destined  to  slough  away,  the  pro- 
cess should  be  hastened  by  their  removal,  and  the  organ  thorough- 
ly irrigated  with  antiseptic  .solutions. 

Reliable  antiseptics  should  be  applied  to  the  affected  articula- 
tions by  means  of  a  large  pack  of  cotton,  jute  or  oakum,  kept 
constantly  saturated  with  the  di.sinfectant.  In  .some  instances 
where  the  bone  is  extensively  involved,  it  has  been  recommended 
to  apply  the  thermo-cautery  in  small  punctures.  When  ab- 
scesses form  about  the  joint,  they  should  be  treated  according  to 
surgical  principles,  though  as  a  general  rule  they  cannot  be  suc- 
cessfully handled. 

Internally  the  animal  may  receive  antiseptics,  among  which 
de  Bruin  especially  recommends  camphor  and  turpentine. 

b.  Metastatic  Tendovaginitis.  Under  this  title  de  Bruin 
describes  an  inflammation  of  the  tendon  sheaths  of  cows  during 
the  puerperal  state,  occurring  chiefly  in  the  great  flexor  tendons. 

The  symptoms  consist  of  a  stiffness  in  the  gait,  with  evidences 
of  pain,  accompanied  by  loss  of  appetite  and  of  milk  secretion, 
and  a  tendency  for  the  animal  to  remain  in  the  recumbent  posi- 
tion. Examining  the  animal  locally,  the  veterinarian  finds  the 
tendon  sheaths  hot,  swollen  and  tender.    The  disease  mav  co-exist 


Py(emic  Infection  '  905 

with  poly-arthritis.  The  prognosis  is  fairly  good  if  only  one  of 
the  limbs  is  diseased  ;  but  if  all  are  involved,  extreme  emacia- 
tion is  probable,  along  with  extensive  decubitis  gangrene.  These 
tend  to  greatly  complicate  the  disease,  and  render  the  prognosis 
very  grave.  Even  here,  however,  prompt  and  vigorous  meas- 
ures may  save  the  life  of  the  animal. 

Handling.  The  general  line  of  treatment  is  identical  with 
that  of  poly-arthritis.  The  uterus  should  be  cleansed  and  disin- 
fected. The  affected  tendon  sheaths  should  be  enclosed  in  anti- 
septic packs,  w^hich  are  to  be  kept  constantly  moistened.  If  the 
tendon  sheaths  undergo  suppuration,  they  should  be  freely  opened 
from  end  to  end  upon  the  median  line,  and  the  cavity  packed 
with  gauze  saturated  with  tincture  of  iodine,  in  order  to  bring 
about  at  once  a  thorough  disinfection  of  the  parts.  Over  this 
there  should  be  placed  an  ample  pack  of  surgeon's  cotton  or  oak- 
um, saturated  with  a  reliable  antiseptic. 

8.  Puerperal  Septicaemia. 

Puerperal  septicaemia  signifies  the  entrance  into  the  general 
system  of  .septic  products,  accompanied  or  not  by  the  bacteria  by 
which  these  products  have  been  formed.  Technically  a  distinc- 
tion is  made  between  septicaemia — by  which  pathologists  under- 
stand the  entrance  of  micro-organisms  along  with  their  products 
into  the  blood,  and  the  continued  multiplication  of  the  bacteria 
in  the  body  fluids — and  saprgemia  or  toxaemia — by  which  is 
understood  the  entrance  into  the  blood  of  the  bacterial  poisons 
only. 

Clinically  the  differentiation  between  .septicaemia,  bacteri- 
aemia  and  .sapraemia  is  not  easily  defined.  Yet  they  present  an 
es.sential  difference  in  prognosis.  The  condition  accompanies  to 
a  greater  or  less  extent  most  forms  of  .septic  infection  of  the  gen- 
ital tract  during  the  puerperal  state,  but  the  intensity  of  the 
septicaemia  is  not  necessarily  parallel  to  that  of  the  local  disease. 
We  meet  clinically  with  very  exten.sive  septic  inflammation  of 
the  uterus,  resulting  from  a  retained  fetus  undergoing  putrid  de- 
composition over  a  period  of  days,  weeks  or  months,  or  from  re- 
tained placenta  undergoing  rapid  decomposition,  during  which 
the  cotyledons  may  become  necrotic  and  slough  off,  while  the  de- 
gree of  septicaemia  or  sapraemia  may  be  very  insignificant.  On 
the  other  hand,    there   may   occur  virulent   .septicaemia  in  the 


9o6  Veterifiary  Obstetrics 

presence  of  comparatively  slight  discoverable  disease  of  the  gen- 
ital tract. 

The  disease  may  follow  dystokia  or  normal  birth,  and  the  port 
of  entry  for  the  bacteria  may  consist  of  wounds  or  abrasions  or  of 
the  denuded  mucosa,  resulting  from  the  separation  of  the  pla- 
centa. The  organisms  may  be  introduced  by  the  obstetrist  or 
other  persons  upon  the  hands  or  arms  ;  by  means  of  instruments 
or  apparatus,  or  in  various  other  ways. 

Symptoms.  The  symptoms  of  septiccemia  are  acute.  The 
disease  is  usually  ushered  in  suddenly  in  from  one  to  four  or  five 
days  after  parturition  or  after  the  death  of  the  fetus,  with  open 
OS  uteri  and  decomposition  of  the  uterine  contents.  The  symptoms 
consist  chiefly  of  the  general  signs  of  fever,  including  elevation 
of  temperature,  cessation  of  feeding  and  of  rumination,  decrease 
in  milk  secretion,  quickened  pulse  and  respiration,  with  injection 
of  the  visible  mucous  membranes. 

Locally  there  is  swelling  of  the  vulva,  and  when  the  dis- 
ease is  very  intense  the  vulvar  lips  may  become  greatly 
tumefied,  cold  to  the  touch  and  blue-black  in  color.  The 
vulvar  mucosa  is  swollen  and  dark  colored,  and  may  show  wounds 
or  ulcers.  The  contents  of  the  uterus  may  consist  of  shreds  of 
placenta,  with  accumulations  of  pus  of  variable  color,  which  is 
usually  very  fetid. 

The  patient  generally  shows  extreme  weakness  and  listless- 
ness..  Most  animals  tend  to  lie  down  much  of  the  time.  The 
eyes  soon  become  lustreless  ;  in  the  cow  they  may  appear  swol- 
len.    Ruminants  may  grit  the  teeth,  and  moan. 

The  bowels  are  irregular,  at  one  time  showing  constipation, 
at  another  a  fetid  diarrhea.  If  purgatives  are  given,  especially 
saline,  oleaginous  or  aloetic,  superpurgation  is  highly  probable. 

Acute  puerperal  septicaemia  is  usually  fatal,  generally  ending 
in  death  within  a  few  days.  It  sometimes  runs  a  very  stormy 
course.  We  have  observed  cases  in  the  cow  which  have  ended 
fatally  in  less  than  24  hours  after  the  advent  of  signs  of  disease. 

Pathology.  The  changes  in  the  genital  tract  are  not  always 
in  harmony  with  the  profound  effect  upon  the  general  system. 
A  diligent  search  may  fail  to  reveal  very  pronounced  changes  in 
the  uterus  or  vagina.  The  blood  is  thin  and  does  not  coagulate, 
and  the  muscles  are  pale  and  have  the  appearance  of  having  been 
cooked.  There  may  be  more  or  less  evident  metritis,  with  all 
the  changes  belonging  to  that  affection. 


Pycemic  Infection  907 

The  peritoneum  shows  here  and  there  ecchymoses.  Ente- 
ritis may  be  present.  The  liver,  spleen  and  kidneys  show  well- 
marked  degeneration,  and  are  somewhat  enlarged  and  friable. 

Handling.  All  attempts  at  therapeutics  usually  fail.  De 
Bruin  recommends  camphor,  turpentine  and  alcohol,  but  without 
having  any  faith  in  their  bringing  about  a  cure.  He  very  prop- 
erly places  the  chief  emphasis  upon  the  question  of  prophylaxis. 
Especially  is  it  important  that  the  veterinary  obstetrist  should 
take  due  precautions  against  acting  as  a  bearer  of  the  infection 
through  his  person,  instruments  or  apparatus. 

Any  animal  suffering  from  septic  infection  of  the  genital  tract, 
or,  for  that  matter,  of  any  other  organs  or  tissues,  should  be  care- 
fully excluded  from  the  stable  and  vicinity  of  parturient  animals, 
and  there  should  be  no  intermediary  communication  between 
them  by  which  the  transportation  of  infecting  material  from  one 
to  the  other  is  rendered  possible. 

Whenever  a  veterinarian  is  called  to  attend  a  parturient  ani- 
mal suffering  from  fever  or  other  systemic  disturbance,  the 
genital  tract,  and  especially  the  uterus,  should  first  of  all  be 
thoroughly  examined  in  order  to  determine  whether  it  be  the 
avenue  of  a  serious  infection. 

Should  the  examination  reveal  septic  utero-vaginal  disease,  no 
time  should  be  lost  in  thoroughly  cleansing  and  disinfecting  the 
genital  tract. 

Time  and  again  the  careless  veterinarian  treats  an  animal, 
especially  a  cow,  for  indigestion,  constipation,  diarrhea  or  some 
other  symptom  of  disease,  without  taking  the  trouble  to  examine 
the  uterus  and  learn  therefrom  that  the  constipation,  diarrhea  or 
or  other  symptom  which  he  is  handling  is  dependent  upon  a 
serious  puerperal  infection,  which  demands  prompt  and  vigorous 
treatment.  The  handling  of  these  conditions  falls  essentially 
under  "  Retained  Placenta."  page  791,  and  "Acute  Metritis," 
page  872. 

9.  Puerperal  Laminitls.     Patiriext  Lamixitis. 

While  describing  endometritis  in  the  mare  we  had  occasion  to 
refer  to  parturient,  or  puerperal  laminitis.  So  far  as  we  have  been 
able  to  determine,  parturient  laminitis  occurs  in  the  mare  only, 
though  there  is  no  reason  why  it  may  not  occur  in  ruminants, 
where    laminitis   from   other   causes   is    not  unknown.       Flem- 


9o8  l^eterinarr  Obstetrics 

ing  cites  RolofT  as  having  observed  a  peculiar  inflammation  of  the 
feet  of  cows  just  after  parturition,  though  the  description  which 
he  gives  does  not  fully  identify  it  with  laminitis. 

Parturient  laminitis  in  the  mare  is  a  well-nigh  constant  accom- 
paniment of  endometritis.  It  is  so  common  that  it  may  be  re- 
garded as  an  essential  part  of  that  malady.  It  is  probably 
overlooked  sometimes  because  there  are  present,  in  endometritis 
of  the  mare,  two  painful  areas — the  abdominal  pain  due  to  metri- 
tis, and  the  pain  in  the  feet  from  the  laminitis,  each  of  which 
induces  a  stiifness  in  the  gait  which  is  very  much  like  the  other. 

The  nature  of  parturient  laminitis,  .so  far  as  we  have  been  able 
to  observe  clinically,  does  not  differ  in  any  essential  respect  from 
the  laminitis  due  to  irritation  of  the  intestinal  tract  from  indiges- 
tion. It  appears  to  be  a  purely  metastatic  inflammation,  depend- 
ent directly  upon  the  irritation  in  the  uterus  as  a  result  of  en- 
dometritis, and  the  absorption  from  the  uterine  mucosa  of  the 
products  of  bacterial  decomposition. 

The  symptoms  of  puerperal  laminitis  are  identical  with  the 
symptoms  of  the  laminitis  following  indigestion.  It  usually 
occurs  in  those  cases  of  endometritis  in  the  mare  which  have 
their  origin  in  a  retention  of  the  placenta  in  the  non-gravid  horn 
of  the  uterus.  As  a  rule  it  follows  an  apparently  normal  birth, 
in  which  the  placenta  has  been  expelled  promptly,  and  so  far 
as  the  owner  observes,  completely,  but  that  portion  of  it  which 
has  occupied  the  non-gravid  cornu  has  been  broken  off  and  re- 
tained. In  the  cour.se  of  48  to  72  hours  after  parturition,  there 
appear  the  general  symptoms  of  endometritis,  as  already  de- 
scribed on  page  874.  Upon  examination,  the  fragment  of 
placenta  may  still  be  found  in  the  non-gravid  cornu. 

At  the  same  time  that  the  symptoms  of  endometritis  are  first 
observed,  well-marked  laminitis  also  usually  appears.  The 
disease  may  involve  the  two  anterior  feet,  or  all  four  feet. 
As  in  ordinary  cases  of  laminitis,  the  animal  moves  with  great 
difficulty,  and  places  its  weight  upon  its  heels  so  as  to  relieve  the 
sen.sitive  laminae  upon  the  anterior  walls  of  the  feet  from  pres- 
sure as  far  aspos.sible.  If  the  disease  is  very  severe,  the  animal 
tends  to  persistent  recumbency,  or  stands  riveted  to  the  spot  and 
can  hardly  be  induced  to  move. 

Examination  of  the  hoofs  reveals  a  distinct  elevation  in  their 
temperature,  varying  of  course  according  to  the  intensity  of  the 
attack.     Throbbing  of  the  arteries  of  the  feet  is  very  evident. 


Puerperal  Tetanus  909 

The  prognosis  of  the  disease  is  generally  highly  favorable,  and 
is  parallel  to  the  prognosis  of  the  endometritis.  In  fact  the 
two  diseases  are  inseparably  bound  up  together,  so  that  their 
prognosis  and  handling  are  essentially  identical.  Like  laminitis 
from  other  causes,  so  puerperal  laminitis  is  largely  a  disease  of 
the  draft  animal.  The  prognosis  will  depend  to  a  degree  upon 
the  size  of  the  patient.  The  gravity  of  the  disease  increases 
with  the  weight  of  the  animal. 

The  handling  of  the  endometritis  we  have  already  discussed 
on  page  874,  and  it  is  only  essential  at  this  time  to  consider  the 
local  treatment  of  the  laminitis.  There  are  two  plans  for  hand- 
ling the  inflammation  of  the  feet,  each  of  which  has  its  devotees 
— hot  and  cold  applications. 

We  distinctly  prefer  the  application  of  cold,  either  in  the  form 
of  water  or  of  ice,  and  that  the  application  be  continuous  and 
ample.  If  the  animal  is  recumbent  or  can  be  induced  to  remain 
recumbent,  so  much  the  better,  because  it  relieves  the  feet  from 
the  weight  of  the  patient.  In  the  recumbent  animal,  cold  water 
is  not  readily  applied,  and  consequently  one  may  most  con- 
veniently apply  ice  poultices,  renewing  them  frequently  in  order 
to  maintain  constant  refrigeration.  If  the  animal  can  readily 
stand,  and  will  do  so,  it  should  be  placed  in  a  bath  of  cold  water, 
the  temperature  of  which  may  be  reduced  to  a  low  point  by  the 
frequent  addition  of  ice.  The  cold  water  bath  should  extend  up 
to  or  above  the  fetlocks,  and  the  floor  of  the  bath  should  be  of 
some  yielding  substance,  so  that  the  entire  plantar  surfaces  of 
the  feet  may  contribute  to  the  support  of  the  weight.  The  shoes 
should  be  removed  in  order  to  prevent  the  sinking  of  the  os 
pedis,  or  the  dropping  of  the  sole  may  be  still  better  prevented 
by  the  application  of  special  padded  shoes,  and  the  weight  dis- 
tributed equally  over  the  entire  plantar  surface  of  the  hoof. 

The  internal  treatment  and  the  handling  of  the  uterus,  which 
have  already  been  discussed  on  page  875,  are  quite  as  important 
as  the  local  applications  to  the  feet. 

ID.  Puerperal  Tetanus. 

In  di.scussing  the  question  of  retained  placenta  in  the  sheep  on 
page  811,  and  of  prolapse  of  the  uterus  on  page  827,  we  have 
alluded  to  the  rare  occurrence  of  tetanus  as  a  complication.  We 
observed  one  case  of  tetanus  following  retained  placenta  in  a  cow. 


9IO  Veterinary  Obstetrics 

Tetanus  infection  may  find  entrance  into  the  genital  tract  under 
still  other  conditions  during  the  puerperal  state,  and  induce 
typical  tetanus.  The  obstetrist  or  others  may  readily  introduce 
the  bacilli  into  the  genital  tract,  during  a  case  of  dystokia  or 
the  removal  of  placenta.  Having  gained  the  susceptible  genital 
tract,  the  organisms  may  there  multiply  and  induce  the  disease. 
The  period  of  incubation,  symptoms,  pathology  and  treatment 
are  identical  with  those  of  cases  of  tetanus  in  which  the  micro- 
organisms have  entered  by  other  avenues.  The  number  of  cases 
of  puerperal  tetanus  is  small,  so  that  the  comparative  prognosis  is 
uncertain.  In  the  case  of  prolapse  of  the  uterus  mentioned  on 
page  827,  the  mare  recovered  successively  from  uterine  prolapse 
and  from  tetanus. 


PUERPERAL  ECLAMPTIC  DISEASES. 

In  domestic  animals  there  occurs  with  considerable  frequency  a 
group  of  diseases  characterized  chiefly  by  a  profound  disturbance 
of  the  central  nervous  system,  which  express  themselves  either  in 
tonic  and  clonic  spasms  or  in  coma.  These  diseases  appear 
usually  soon  after  parturition,  but  may  occur  during  the  act  or 
shortly  prior  to  that  event.  They  all  run  a  very  rapid  and 
stormy  course,  with  a  high  mortality,  except  their  course  is  in- 
terrupted by  prompt  and  judicious  treatment. 

The  pathology  of  this  group  of  diseases  is  unknown.  Various 
theories  have  been  propounded  to  account  for  the  occurrence  of 
these  affections,  but  none  of  them  have  met  with  general  accep- 
tance, and  the  correctness  of  none  of  them  has  been  shown.  Post- 
mortem examinations  have  revealed  various  lesions  or  alleged 
lesions,  which  may  be  regarded  as  results  of,  rather  than  the 
cause  of,  the  malady.  They  fail  to  reveal  the  true  character  of 
the  disease.  For  example,  there  is  frequently  found  in  parturi- 
ent paresis  of  the  cow  a  well-marked  pneumonia,  which  we 
know  is  not  a  part  of  the  di.sease.  but  an  inter-current  com- 
plication due  to  the  inhalation  of  food  particles  or  medicines. 
Hemorrhages  upon  the  brain  have  been  found  ;  but  this  is  not 
strange  if  an  animal  has  thrown  itself  about  violently  for  a 
number  of  hours,  striking  its  horns  with  great  force  against 
the  wall,  floor  or  ground,  and  thus  causing  more  or  less  injury 
by  concussion  of  the  brain.  In  a  similar  way  we  might  account 
for  other  lesions  which  have  been  discovered  upon  post-mortem 
examination.  In  many  instances  the  post-mortem  revelations 
are  nil,  and  it  would  appear  from  such  knowledge  as  has  been 
gained  up  to  the  present  time  that  in  reality  no  lesion  has  been 
discovered  which  constitutes  an  essential  part  of  the  malady,  and 
consequently  that  its  true  pathology  is  unknown. 

The  causes  of  this  group  of  maladies  in  domestic  animals  are 
unknown.  It  is  difficult  to  arrive  at  a  general  conclusion,  be- 
cause various  reasons  are  assigned,  and  there  is  no  general  agree- 
ment as  to  what  maladies  should  be  included  in  the  group. 

In  woman  there  occurs  a  somewhat  common  and  highly  fatal 
disease  known  as  parturient  eclampsia,  which  some  authors  con- 
sider identical  with  the  parturient  paresis  of  the  cow,  while  others 
strongly  dispute  the  identity  or  analogy  of  the  two. 
911 


912  Veterinary  Obstetrics 

The  eclampsia  of  woman  occurs  most  frequently,  or  in  approxi- 
mately 50%  of  the  cases,  during  birth.  About  25%  occur  before 
parturition,  and  the  other  2^'/(  after  childbirth.  The  history  of 
the  date  of  attack  of  eclampsia  in  woman  and  of  parturient  paresis 
in  the  cow  are  somewhat  alike  in  so  far  as  the  occurrence  of  cases 
before,  during  and  after  birth  are  concerned,  but  the  percentages 
of  cases  during  these  various  epochs  are  not  at  all  alike.  Very 
few  attacks  of  parturient  paresis  occur  in  the  cow  during  preg- 
nancy or  labor,  and  almost  all  of  them  during  the  puerperal 
state. 

Eclampsia  in  woman  is  characterized  by  sudden  and  severe 
spasms,  which  endure  for  a  few  minutes,  to  be  followed  by  a 
pause  and  later  a  recurrence  of  the  spasms.  The  pause  is  some- 
times characterized  by  deep  coma.  The  disease  usually  appears 
very  suddenly,  without  warning,  though  in  some  cases  there  may 
be  premonitory  symptoms  of  unrest,  headache  and  nervous  twitch- 
ings.  •  Then  follows  dilation  of  the  pupil,  with  loss  of  conscious- 
ness accompanied  by  clonic  and  tonic  spasms.  The  jaws  are 
tightly  closed,  sometimes  severely  w^ounding  the  tongue.  The 
temperature  is  usually  high,  and  tends  to  become  more  elevated 
as  the  spasms  are  more  severe. 

Upon  post-mortem  examination,  the  changes  which  are  ob- 
served can  scarcely  be  considered  as  characteristic  of  the  disease, 
or  as  indicating  the  essential  pathology  of  it. 

The  symptoms  of  parturient  paresis  in  the  cow  admittedly 
differ  widely  in  a  general  way  from  those  seen  in  the  eclampsia 
of  woman.  This  leads  Harms  to  remark  that  a  comparison  of 
the  symptoms  of  eclampsia  in  woman  with  this  malady  would 
cause  anyone  who  had  ever  seen  a  case  of  milk  fever  in  the  cow 
to  at  once  conclude  that  they  were  two  wholly  distinct  maladies. 
Other  veterinary  obstetrists  believe  that  the  two  maladies  are 
essentially  identical,  -in  which  opinion  we  concur.  The  two 
maladies  appear  at  a  similar  date  as  related  to  parturition,  the 
true  pathology  of  neither  has  been  satisfactorily  determined,  and 
post-mortem  changes  which  can  properly  be  considered  as  the 
basic  lesions  of  the  disease  are  wanting. 

In  .some  domestic  animals,  especially  in  the  mare,  bitch  and  .sow, 
it  is  not  rare  to  observe  a  parturient  eclampsia  which,  in  history, 
symptoms,  course  and  termination,  is  quite  parallel  to  that  ob- 
served in  woman.     There  are   present  similar  tonic  and  clonic 


Ptierperal  Eclamptie  Diseases  913 

spasms,  the  well-marked  trismus,  the  pirouetting  of  the  eyes, 
the  elevation  of  temperature,  the  stormy  course  and  the  high 
mortality. 

Though  we  usually  observe  profound  coma  instead  of  spasms 
in  the  parturient  paresis  of  the  cow,  this  does  not  prove  the  non- 
identity  of  it  with  the  eclampsia  of  woman.  Tonic  and  clonic 
spasms  are  common  in  woman,  and  in  some  of  the  domestic  ani- 
mals, from  a  variety  of  causes.  Coma  in  some  animals,  like  the 
horse,  is  exceedingly  rare.  In  the  cow  coma  is  a  common  symp- 
tom of  disease,  and  occurs  in  many  maladies.  We  see  it  in  indi- 
gestion, especially  from  over-feeding,  in  which,  in  the  horse,  in 
man  or  in  carnivora,  we  might  see  spasms.  We  observe  coma 
in  the  cow  as  a  result  of  infections  from  the  uterus  or  udder,  and 
along  with  these  we  may  meet  with  a  sub-normal  temperature, 
just  as  we  do  in  parturient  parasis.  Coma  also  appears  at  inter- 
vals in  the  eclampsia  of  woman,  and  tonic  and  clonic  spasms  ap- 
pear in  the  parturient  paresis  of  the  cow.  The  difference  in 
symptoms  is  not  basic,  but  rather  a  question  of  preponderance  of 
spasms  as  related  to  coma,  or  vice  versa,  in  the  different  patients. 

In  one  instance  we  observed  a  cow  in  which  the  general  symp- 
toms of  eclampsia  were  present  a  few  hours  after  easy  parturi- 
tion. The  pupils  were  dilated,  the  eyes  were  rolled,  there  was 
grinding  of  the  teeth  with  frothing  at  the  mouth,  there  were 
clonic  spasms,  especially  of  the  head  and  neck,  and  a  general 
disturbance  of  consciousness,  so  that  the  animal  looked  and  acted 
as  if  temporarily  insane.  The  condition  lasted  for  about  two 
hours,  when  the  symptoms  passed  into  those  of  ordinary  parturient 
paresis,  with  the  profound  coma  and  sub-normal  temperature. 

In  other  instances  of  parturient  paresis  we  have  observed  some- 
what similar,  though  less  marked  eclamptic  symptoms  in  the 
earlier  stages,  but  these  have  quickly  passed  into  the  character- 
istic symptoms  of  paresis. 

While  our  knowledge  of  eclampsia  in  woman  and  in  the  do- 
mestic animals  remains  so  imperfect  as  at  present,  with  our 
equal  want  of  knowledge  as  to  the  nature  of  the  parturient  pare- 
sis in  the  cow,  it  is  impossible  to  determine  precisely  what  rela- 
tion they  bear  to  each  other.  It  would  appear  from  the  fore- 
going that,  until  some  positive  knowledge  as  to  the  actual  causes 
of  these  diseases  is  obtained,  they  should  be  considered  as  con- 
stituting one  great  group  dependent  upon  the  same  general 
5« 


914  Veterinary  Obstetrics 

causes.  The  disease  is  expressed  somewhat  differently  by  the 
various  species  of  animals.  Here  and  there  a  case  occupies  a 
middle  ground  between  the  symptoms  recognized  as  character- 
istic of  two  different  members  of  the  group,  constituting  connec- 
ing  links  which  serve  to  bind  them  more  or  less  closely  together 
into  a  highly  interesting  class  of  diseases. 

a.  Parturient  Eclampsia  in  thk  Mare. 

Parturient  eclampsia  in  the  mare  is  a  disease  which  is  closely 
related  to  the  parturient  state,  and  is  expressed  chiefly  by  violent 
tonic  and  clonic  spasms,  which  run  a  very  rapid  course,  and 
quickly  terminate  in  recovery  or  death,  without  producing  any 
lesions  yet  discovered  which  may  be  properly  considered  as 
fundamental. 

So  far  as  we  know,  the  first  definite  description  of  this  disease 
was  a  paper  presented  by  the  author  before  the  Illinois  Veteri- 
nary Medical  Association,  which  later  appeared  in  the  American 
Veterinary  Review,  Vol.  14,  page  559.  Since  that  time  a  few 
cases  have  been  described  which  seem  to  be  identical,  and  in 
various  personal  communications,  practicing  veterinarians  have 
assured  us  of  the  occasional  occurrence  of  this  malady  in  their 
practice.  Under  the  designation  of  trismus,  Plaskett  describes 
cases  which  appear  identical  with  ours.  (American  Veterinary 
Review,  Vol.  23,  page  254.) 

There  is  a  bare  hint  of  eclampsia  in  the  mare  by  Fleming 
(Veterinary  Obstetrics,  p.  660),  who,  in  speaking  of  parturient 
apoplexy  of  the  cow,  says,  "  It  is  worthy  of  notice  that  the  first 
stage  of  parturient  fever,  viz.,  the  stage  marked  by  congestion 
of  the  brain,  is  observed  in  the  mare.  It  soon  terminates  in 
death,  as  is  also  sometimes  the  case  with  the  cow,  as  a  result  of 
apoplexy.  Such  cases,  though  not  sufficiently  substantiated  by 
the  result  of  autopsies,  have  been  described  by  Gerard  (Veteri- 
narian, 1874).  The  mares  in  question  died  during  parturition, 
or  soon  after."  Gerard's  cases  were  evidently  es.sentially  differ- 
ent from  those  here  described  as  eclampsia. 

My  first  case  occurred  in  an  adult  grade  draft  mare,  which  had 
at  her  side  a  healthy,  vigorous  foal,  some  ten  days  old.  The 
mare  had  foaled  naturally  and  easily  at  the  ordinary  time,  and 
the  very  apparent  vigor  of  the  foal  showed  clearly  that  she  had 
been  furnishing  an  abundant  supply  of  milk.     The  owner  re- 


Parturient  Eclampsia  in  the  Mare  915 

ported  that  a  few  hours  prior  to  my  arrival  the  mare  suddenly 
became  strangely  nervous,  assuming  a  wild  look,  with  staring 
eyes,  restlessness,  stiffness  of  gait,  twitching  of  the  muscles, 
occasionally  lying  down  and  getting  up.  The  symptoms  all  very 
rapidly  increased,  until  she  lay  prostrate  on  her  side,  unable 
to  rise.  In  this  position  I  found  her,  with  the  whole  muscular 
system  exceedingly  rigid,  breathing  labored,  convulsions  con- 
stant, pupils  greatly  dilated,  mucous  membrane  livid,  firm  tris- 
mus, and  the  muscles  of  her  limbs  so  rigid  that  they  could  not 
be  flexed  sufficiently  to  raise  her  upon  her  chest. 

The  second  case  was  a  high  grade  draft  mare,  used  exclusively^ 
for  breeding  purposes,  and  aged  six  years.  The  mare  was  quite 
large,  very  robust  and  had  foaled  ten  days  previously  without 
difficulty.  The  foal  at  her  side  was  very  vigorous  and  well  nour- 
ished. 

I  found  the  mare  lying  apparently  quiet  on  her  sternum,  show- 
ing no  evidence  of  suffering  and  looking  quite  bright  and  health3\ 
Upon  approaching  her,  however,  she  showed  marked  nervous- 
ness, and  at  once  tried  to  get  up,  but  appeared  to  have  lost  the 
power  of  co-ordination.  Her  efforts  brought  on  clonic  spasms  of 
a  severe  character.  Her  hind  legs  knuckled  at  the  pasterns, 
much  as  in  azoturia. 

During  my  stay  she  became  more  nervous  and  uneasy,  making 
repeated  unsuccessful  attempts  to  rise.  Respiration  was  rapid 
and  laborious,  and  there  were  constant  and  severe  cramps  of  the 
entire  body,  tremblings  and  profuse  perspiration,  all  of  which 
appeared  to  decrease  in  intensity  when  we  would  withdraw  and 
permit  her  to  become  more  tranquil.  The  passage  of  the  catheter 
increased  the  convulsions  quite  markedly.  There  was  appar- 
ently hyperaesthesia  of  the  vulva,  and  of  the  body  generally. 

I  diagnosed  azoturia,  and  prognosticated  a  favorable  termina- 
tion. Later  observations  have  shown  me  that  mares  with  young 
foals  do  not  contract  azoturia  ;  moreover,  the  fact  that  the  mare 
had  been  running  at  grass  constantly,  precluded  the  possibility  of 
that  di-sease.     She  died  a  few  hours  later. 

During  the  summer  of  1889  an  unusual  number  of  cases  oc- 
curred in  rapid  succession,  showing  everj'  degree  of  intensity. 
At  this  date  our  rapidly  developing  horse-breeding  interests 
had  about  reached  their  maximum  in  my  locality,  so  that  large 
numbers  of  mares  were  kept  .solely  for  breeding  purposes.    Favor- 


9i6  Veterinary  Obstetrics 

able  weather  during  the  season  furnished  exceedingly  luxuriant 
pasturage.  During  that  year  I  observed  seven  well  marked  cases, 
several  of  which  offered  favorable  opportunities  for  observation 
throughout  a  greater  part  of  the  course  of  the  disease. 

A  well-bred  road  mare,  in  high  condition,  with  a  vigorous, 
well-nourished  foal,  eight  to  ten  days  old,  at  her  side,  was 
brought  from  the  pasture  preparatory  to  being  bred.  Soon  after 
her  arrival  at  the  owner's  stable,  it  was  noticed  that  the  mare 
was  restless  and  nervous,  her  eyes  somewhat  staring,  and  occa- 
sional muscular  twitchings  were  present.  Most  noticeable  of  all 
was  a  peculiar,  very  well-marked  throbbing  of  the  chest,  which 
shook  the  entire  body.  It  seemed  like  an  exaggerated  heart- 
beat, and  was  quite  regular  in  rhythm  and  force,  but  was  not 
rhythmical  with  the  heart-beat.  The  disturbance  seemed  great- 
est along  the  line  of  attachment  of  the  diaphragm  to  the  ribs, 
and  the  phenomena  could  be  attributed  to  no  other  cause  than 
clonic  spasm  of  the  diaphragm.  There  was  some  trismus  present, 
but  not  sufficient  to  prevent  the  patient  from  eating  with  relish 
and  comparative  ease. 

With  quietude  and  moderate  doses  of  belladonna  and  cannabis 
Indica,  she  made  a  good  recovery  in  a  few  hours. 

In  another  case  I  was  called  to  attend  a  half-blood  draft  mare, 
aged  seven  years,  in  prime  condition  and  perfect  health  prior  to 
the  date  of  my  visit.  She  had  foaled  ten  days  before  without 
trouble,  and  the  foal  was  vigorous  and  well  nourished.  She  was 
then  brought  from  the  pasture  for  the  first  time,  and  placed  in 
the  stable.  Within  a  few  hours,  symptoms  of  disease  were 
manifested. 

I  found  the  animal  in  great  pain,  very  nervous,  and  easily  dis- 
turbed by  any  movements  or  noise.  She  lay  down  quite  fre- 
quently. While  lying,  she  became  more  tranquil,  and  all  the 
symptoms  abated.  While  down,  the  animal  lay  on  her  sternum, 
and  did  not  attempt  to  roll  ;  in  rising  she  did  so  with  apparent 
ease.  While  standing  there  were  constant  clonic  twitchings  of 
the  muscles  of  the  entire  body,  spasmodic  movements  of  the 
limbs,  frequent  changes  in  posture,  trembling,  profuse  sweating, 
with  the  nostrils  widely  distended,  and  the  movements  stiff  as  in 
tetanus.  There  was  no  protrusion  of  the  membrana  nictatans 
over  the  eyeballs,  but  the  eyes  were  staring,  the  pupils  dilated, 
and  the  conjunctivae  dark  livid  in  color.     There  was  severe  tris- 


Parturient  Eclampsia  in  the  Mare  917 

nius,  aud  the  jaws  were  wholly  immovable.  As  in  the  pre- 
ceding case,  there  was  violent  spasm  of  the  diaphragm.  She 
was  bled  freel}-  from  the  jugular,  and  given  large  and  repeated 
doses  of  belladonna  and  cannabis  Indica.  For  nearly  thirty-six 
hours  the  S}-mptoms  remained  about  the  same,  when  the}-  began 
to  abate  rapidly,  and  in  48  hours  after  the  beginning  of  the 
attack  the  mare  was  in  her  usual  health. 

On  the  same  day,  on  a  neighboring  farm,  I  attended  another 
grade  draft  mare  with  a  similar  history  of  recent  easy  parturi- 
tion, healthy  foal  at  her  side,  etc.  Prior  to  my  arrival,  she  had 
shown  a  similar  train  of  symptoms  to  those  noted  above  :  but 
the  owner  delayed  calling  me,  so  that  upon  my  arrival  I  found 
the  animal  prostrate  on  her  side,  the  whole  muscular  system 
thoroughly  tetanized,  the  eyes  set  and  insensible  to  light,  firm 
trismus,  well-marked  opisthotomos,  repeated  severe  convulsions 
of  the  entire  body,  readily  increased  by  any  sudden  noise. 

Barring  the  want  of  protrusion  of  the  membrana  nictatans  and 
the  greater  nervousness,  the  case  closely  simulated  recumbent 
tetanus.     The  animal  succumbed  after  about  twenty-four  hours. 

In  another  case  I  was  called  to  attend  a  full-blood  draft  foal, 
five  or  six  days  old,  which  was  suffering  from  lameness.  In 
order  that  the  foal  might  be  well  attended,  the  mare  was  brought 
from  the  pasture  and  placed  in  the  stable.  The  next  morning  I 
was  hurriedly  called  to  attend  the  mare,  which  I  had  seen  the 
previous  day  in  apparently  perfect  health  and  unusually  robust 
and  vigorous.  Upon  my  arrival  at  the  farm  I  found  her  greatly 
agitated,  the  whole  body  tetanized,  with  constant  clonic  twitch- 
ings,  spasmodic  movements  of  the  limbs,  hurried,  labored  respi- 
rations, nostrils  widely  dilated,  visible  mucous  membranes  of  a 
dark  livid  hue,  firm  trismus  and  profuse  sweating.  When  on 
her  feet  she  could  not  stand  still,  but  continually  moved  about 
involuntarily,  and  so  very  uncertainly  that  she  could  scarcely 
be  approached  with  safety.  The  perspiration  was  so  profuse 
that  it  streamed  from  the  dependent  parts  of  her  body,  the  nose 
was  poked  out,  the  head  elevated,  the  back  arched,  the  tail 
erected,  giving  the  entire  body  the  posture  assumed  in  severe 
tetanus  ;  but  the  well-marked  protrusion  of  the  membrana  nicta- 
tans seen  in  the  latter  disease  was  wanting.  The  animal  would 
lie  down  frequently,  usually  on  the  sternum,  in  which  position 
she  became  more  tranquil  and  apparently  obtained  some  relief. 


9i8  Veterinary  Obstetrics 

At  other  times  she  lay  prostrate  on  her  side,  in  severe  convul- 
sions, the  legs  all  rigid,  so  that  the  upper  feet  did  not  touch  the 
ground,  but  projected  in  a  straight  line  from  the  body.  The 
spasm  of  the  diaphragm  was  so  violent  that  even  when  the  mare 
was  lying  on  her  sternum  her  whole  body  shook  violently  at  each 
diaphragmatic  contraction.  When  the  patient  was  standing  fif- 
teen or  twenty  feet  distant,  a  loud  thumping  noise  could  be  heard, 
emanating  from  the  chest,  like  violent  palpitation  of  the  heart  ; 
but  upon  close  examination  it  was  found  that  the  disturbance 
was  not  synchronous  with  the  heart-beat. 

With  great  difficulty,  owing  to  the  uncertain  convulsive  move- 
ments of  the  animal,  I  drew  about  three  gallons  of  blood  from 
the  jugular.  This  was  followed  by  heavy  and  repeated  doses  of 
fluid  extract  of  belladonna  and  cannabis  Indica  every  hour. 

My  prognosis  was  very  unfavorable,  as  death  seemed  imminent. 
After  twelve  to  fifteen  hours  the  symptoms  rapidly  abated,  and 
within  twenty-four  hours  after  my  visit  she  was  apparently  in 
her  usual  health. 

In  another  case,  a  high-grade  draft  mare  of  vigorous  constitu- 
tion, with  a  well-nourished  healthy  foal  about  fifteen  days  old  at 
her  side,  was  taken  from  the  pasture  for  the  first  time  since  foal- 
ing and  put  to  light  farm  work.  In  a  few  hours  she  had  devel- 
oped all  the  symptoms  enumerated  in  the  preceding  cases,  and 
when  I  arrived  she  was  unable  to  regain  her  feet.  She  rapidly 
grew  worse,  and  died  the  same  day,  within  twelve  hours  from  the 
time  she  was  brought  from  the  pasture  in  prime  condition,  and 
only  five  to  eight  hours  after  the  beginning  of  the  attack. 

Another  case  was  that  of  a  little  imported  pony  mare  in  high 
condition,  with  a  well  nourished  foal  at  her  side,  six  or  eight 
weeks  old.  The  pony  was  brought  from  the  pasture  for  the 
first  time  since  foaling,  saddled,  and  placed  in  the  hands  of 
children,  who  used  her  for  a  few  hours  in  the  morning.  At 
noon  the  stableman  found  some  difficulty  in  removing  the  bit 
from  her  mouth. 

This  attracted  no  particular  attention,  but  when  the  owner  at- 
tempted to  bridle  her  again  after  dinner,  and  failed  on  account 
of  firm  trismus,  it  was  evident  that  something  serious  was  wrong. 
A  veterinarian  was  at  hand  in  a  few  hours,  but  the  pony  rapidly 
developed  all  the  symptoms  enumerated  in  the  preceding  cases. 
She  was  bled  from  one  jugular  on  the  first,  and  the  other  on  the 


Parturient  Eclampsia  in  the  Mare  919 

second  day.  In  about  forty  hours  after  the  beginning  of  the  at- 
tack, the  symptoms  suddenly  abated,  and  within  forty-eight 
hours  the  pony  was  apparently  as  well  as  ever. 

We  have  here  a  series  of  cases  presenting  symptoms  no  more 
varied  than  we  would  expect  to  find  in  different  individuals  in 
different  stages  of  the  development  of  the  disease,  yet  passing 
from  one  into  the  other  by  imperceptible  gradations,  all  apparently 
due  to  the  same  cause. 

In  the  earlier  stages,  and  in  the  ver}-  mild  ca.ses  throughout, 
all  showed  the  restlessness,  the  staring,  pirouetting  eyes,  the 
clonic  spasms,  especially  marked  in  the  diaphragm.  In  propor- 
tion to  the  nervousness,  the  pulse  and  temperature  are  little 
altered.  If  unchecked,  the  clonic  spasms  are  largely  succeeded 
by  those  of  a  more  tonic  nature,  trismus  becomes  a  marked 
symptom  early  in  the  malady,  the  restlessness  and  convulsions 
increase  in  intensity,  the  respiration  becomes  more  labored,  the 
mucous  membranes  livid  from  partial  asphj^xia,  the  whole  muscu- 
lar system  extremely  tetauized.  The  animal  finally  becomes 
unable  to  .stand,  or  to  find  relief  in  lying  on  the  sternum,  but  lies 
prostrate  on  the  side  in  con.stant  convulsions  until  it  succumbs 
from  asphyxia. 

The  history  is  quite  uniform.  The  disease  occurs  wholly  in 
vigorous  mares,  in  high  condition,  of  mature  age,  but  not  old. 
They  have  recently  foaled  naturally  and  easily,  and  have  healthy, 
well  nourished  foals  at  their  sides.  The  mammary  glands  are 
well  developed  and  active  in  all  cases.  In  nearly,  if  not  all  the 
cases  I  have  related,  the  mares  had  been  enjoying  unrestricted 
freedom  at  pasture  constantly  since  foaling,  until  taken  up  a  few 
hours  prior  to  the  attack,  which  was  suddenly  ushered  in  without 
warning. 

It  seems  that  a  sudden  change  of  surroundings,  a  change  from 
freedom  to  the  stable  or  harness,  probably  by  causing  maternal 
anxiety  for  the  foal,  has  an  essential  influence  in  the  immediate 
causation  of  the  disease.  The  symptoms  indicate  a  grave  dis- 
turbance of  the  central  nervous  system,  expressed  for  the  most 
part  in  convulsions  and  spasms  of  the  striated  muscles.  The 
symptoms  we  have  enumerated  as  occurring  in  the  mare  bear  a 
close  resemblance  to  those  of  eclampsia  of  other  lower  animals 
and  of  woman,  as  well  as  to  the  early  stages  of  parturient  apo- 
plexy of  the  cow. 


920  Veteri7iary  Obstetrics 

The  disease  in  the  mare  is  ushered  in  suddenly,  runs  a  rapid 
course  of  twenty-four  to  forty-eight  hours,  and  terminates  as 
abruptly  as  it  began,  in  complete  recovery,  or  in  death. 

The  diagnosis  should  apparently  be  quite  easy  in  all  cases. 
The  history  of  the  case,  so  far  as  observed,  seems  of  special  value. 
The  clonic  and  tonic  spasms,  the  extreme  trismus,  and  the 
peculiar  spasms  of  the  diaphragm,  are  quite  characteristic.  It 
may  be  confounded  with  : 

(a)  Tetanus,  from  which  it  is  distinguished  by  the  sudden 
onset,  the  earlier  and  more  complete  trismus,  the  peculiar  spasm 
of  the  diaphragm,  the  greater  nervous  irritability  and  greater 
tendency  to  clonic  spasms,  the  greater  tendency  to  lie  down,  the 
dilation  of  the  pupil  and  pirouetting  of  the  eyes,  the  absence  of 
the  protrusion  of  the  membrana  nictatans,  the  absence  of  any 
antecedent  wound,  the  far  more  rapid  course  and  the  usually 
more  favorable  termination. 

(b)  Cerebro-spinal  meningitis,  from  which  it  is  to  be  separated 
by  its  history,  its  more  sudden  onset,  its  cramp  unaccompanied 
by  paralysis,  its  well  marked  trismus,  rapid  course  and  more 
favorable  termination. 

( c)  Azoturia,  from  which  it  differs  essentially  in  attacking 
animals  not  subject  to  that  affection — that  is,  mares  enjoying 
unrestrained  liberty  and  having  young  foals.  Aside  from  the 
fact  that  azoturia  cannot  be  induced  in  such  animals,  the  spasms 
are  more  general  over  the  entire  body,  the  trismus  is  character- 
istic, and  the  urine  neither  abundant  nor  highly  colored. 

The  treatment  should  evidently  consist  first  of  quietude  and 
comfort.  The  foal  should  be  allowed  with  the  mare.  In  my 
cases,  free  blood-letting  apparently  alleviated  the  symptoms,  if 
resorted  to  early. 

Fluid  extracts  of  belladonna  and  cannabis  Indica,  in  large  and 
repeated  doses,  apparently  allayed  the  excitability,  and  exerted 
a  favorable  influence  upon  the  course  of  the  disease. 

b.  Parturient  Paresis  in  the  Cow.      Milk  Fever. 

Parturient  Apoplexy. 
Parturient  Paresis  has  long  been  known  as  an  exceedingly 
common,  and  until  recently  highly  fatal  malady  of  dairy  cows. 
It  has  apparently  been  known  as  long  as  dairying  has  been  fol- 
lowed as  a  scientific  pursuit,  and  cows  have  been  bred  especially 
for  dairying  purposes. 


Parturient  Paresis  in  the  Cow  921 

Somewhat  rarely  it  may  attack  cows  belonging  to  the  dis- 
tinctively beef  breeds,  but  even  then  it  is  usually  in  those  which 
are  heavy  milkers. 

The  disease  occurs  usually  in  adult  cows,  rarely  in  the  young 
or  aged.  Harms,  citing  Bavarian  statistics,  gives  the  following 
table  of  the  ages  at  which  127  cows  were  attacked  by  milk  fever. 

At  the  age  of     3   years i 

1^  1^  4       "     4 

5       "     20 

"  6       "     14 

7  "     22 

8  "     ,8 

9  "     22 

10  "     12 

11  "     3 

12  "     6 

13  "     2 

14  "     I 

15  "     2 

Harms,  quoting    Haycock,   gives   the    following  duration   of 

time  after   parturition,    at    which    parturient    paresis   made   its 
appearance. 

5  times  immediately  after  calving. 

8  "  20  hours  "  •' 

5  "  23      " 

5  "  24      " 

3  "  30      " 

2  "  36      •• 

I  "  42      " 

We  have  diagnosed  parturient  paresis,  both  before  and  during 
parturition.  In  these  cases  all  the  cardinal  symptoms  of  the 
malady  presented  themselves,  and  the  course  and  termination  were 
identical  with  those  usually  observed. 

Harms,  early  in  his  career,  diagnosed  cases  of  milk  fever  before 
birth,  during  the  act,  and  as  long  after  parturition  as  30  days  ; 
but  later  he  concluded  that  he  had  been  in  error  and  had  been 
dealing  with  spinal  meningitis  or  hydrocephalus,  two  diseases 
which  heregardedas  very  difficult  to  differentiate  from  milk  fever. 
According  to  his  view,  parturient  paresis  in  the  cow  does  not 
occur  at  all  before  the  fetal  membranes  have  been  expelled.  He 
cites  other  practitioners,  however,  among  whom  is  Thomsen  of 
Flemsbury,  who  had  a  cow  fall  with  paresis  while  he  was  remov- 


92  2  Veterinary  Obstetrics 

ing  the  afterbirth  manually,  and  Kohler,  who  found  the  detached 
membranes  in  the  uterus  in  cases  of  paresis. 

Other  observers  have  seen  cases  in  which  the  malady  has 
occurred  under  other  conditions.  We  were  called  to  attend  a 
cow  because  of  presumed  dystokia,  and  found  her  standing  with 
portions  of  the  membranes  hanging  from  the  vulva.  Upon  ex- 
amination it  was  found  that  the  fetus  was  in  its  normal  position 
and  alive,  and  that  the  cervix  was  fully  dilated.  All  that  ap- 
peared to  be  wanting  was  a  moderate  expulsive  effort  on  the  part 
of  the  cow,  but  this  did  not  occur.  She  seemed  well  in  a  general 
way,  except  that  she  was  unsteady  upon  her  feet.  The  fetus 
was  extracted  under  very  moderate  traction,  without  any  aid 
from  the  mother.  Some  two  hours  later  she  fell,  exhibiting  all 
the  symptoms  of  parturient  paresis,  and  perished  therefrom  a 
few  hours  later. 

In  another  instance  in  our  practice,  a  typical  case  of  paresis 
occurred,  where  the  animal  was  down  and  comatose,  and  the 
placenta  was  still  feebly  retained  in  the  uterus. 

The  disease  is  one  of  well-nourished  animals.  It  does  not 
occur  in  tho.se  cows  which  have  been  starved  or  have  been  kept 
upon  food  of  very  bad  quality,  and  consequently  are  in  poor 
condition.  On  the  other  hand,  the  excessively  fat  cow  does 
not  show  so  great  a  tendency  to  the  disease  as  the  one  which 
is  in  good  flesh.  It  is  a  disease  belonging  to  the  highly-nourished 
animal,  and  not  to  the  obese  or  the  emaciated. 

In  all  those  cases  of  parturient  paresis  occurring  subsequent 
to  parturition,  and  virtually  all  of  them  occur  during  this  period, 
the  disease  follows  an  easy  birth.  Along  with  this,  in  almost 
every  case,  there  is  prompt  expulsion  of  the  fetal  membranes. 

Symptoms.  When  the  animal  is  under  close  observation, 
preceding  the  full  development  of  the  symptoms  of  parturient 
paresis  there  is  usually  first  noted  a  staring  expression  of  the 
eye,  with  dilation  of  the  pupil  and  a  wild  look.  The  eyes  may 
be  pirouetted  or  rolled  in  their  orbits.  There  may  be  occasional 
muscular  twitchings  or  contractions,  and  a  condition  of  unrest. 
In  rare  cases  there  are  very  distinct  clonic  spasms,  especially  of 
the  neck,  with  grinding  of  the  teeth  and  slobbering.  The  ani- 
mal acts  as  if  affected  with  mania,  and  executes  various  move- 
ments with  the  head.  In  one  case  we  observed  that  the  cow 
would  bite  at  her  shoulder.     If  the  cow  is  cau.sed   to  move  she 


Parturient  Paresis  in  the  Cow  923 

does  so  with  a  more  or  less  unsteady  gait.  She  seems  especially 
weak  and  uncertain  in  her  hind  limbs,  and  sways  somewhat  from 
side  to  side  or  knuckles  over.  She  may  show  considerable  un- 
easiness and  nervousness,  and  lie  down,  only  to  get  up  again  in 
a  few  minutes,  and  perhaps  with  some  difficulty. 

As  the  disease  progresses  the  animal  goes  down  and  is  unable 
to  rise.  At  first  she  lies  upon  her  sternum,  usually  upon  the 
left  side,  in  a  somewhat  natural  attitude,  with  the  head  up. 
Later  she  shows  a  tendency  to  rest  the  muzzle  on  the  ground  or 
the  head  in  the  right  flank  with  the  nose  lying  upon  the  ground. 
Still  later  she  tends  to  lie  prone  upon  the  side. 

Early  in  the  disease  coma  sets  in,  and  the  animal  becomes 
more  or  less  insensiBl¥.'  'Convulsive  struggles  occur  for  a  time, 
in  which  the  patient  throws  herself  about  violently  ;  she  may 
make  unsuccessful  and  unconscious  efforts  to  arise,  and  may  suc- 
ceed in  getting  upon  her  knees  and  floundering  about  violently. 
She  may  throw  the  head  from  side  to  side  with  great  violence, 
and  in  doing  so  may  shift  from  sternal  to  lateral  recumbency, 
and  from  time  to  time  may  resume  sternal  decubitis.  As  the 
disease  advances,  there  is  a  constantly  increasing  tendency  to  lie 
flat  upon  the  side. 

At  first  the  pupils  are  dilated  and  the  eyes  have  a  wild  and 
glaring  look,  but  later  they  become  dry  and  glassy-looking, 
probably  because  the  eyelids  are  not  closed  frequently  in  order 
to  distribute  the  tears  over  the  cornea,  and  thus  fail  to  keep  it 
moist.  An  abundance  of  tears  may  flow  down  over  the  cheeks 
and  keep  them  wet. 

From  the  mouth  there  is  an  involuntary  flow  of  saliva,  due 
rather  to  failure  of  the  animal  to  swallow  it  than  to  any  increase 
in  the  amount  secreted. 

The  temperature  is  sub-normal.  Rarely  in  the  earlier  stages 
of  the  disease,  accompanied  by  more  or  less  violent  muscular 
twitchings,  there  may  be  elevation  of  temperature.  Later,  when 
the  disease  has  existed  for  some  hours  and  there  has  been  partial 
improvement,  and  a  relapse  occurs,  not  of  paresis,  but  of  inhala- 
tion pneumonia  or  other  inflammatory  complication,  the  tempera- 
ture may  become  elevated.  The  respiration  is  deep  and  slow  as 
a  general  rule,  though  in  some  cases  it  may  be  rapid  and  shallow. 
There  is  sometimes  a  moan  during  expiration. 

The  disturbances  in  the  alimentary  tract  consist  essentially  of 


924  Veterinary  Obstetrics 

a  profound  paralysis.  There  is  difficulty  in  deglutition,  so 
that  in  former  times  many  cows  were  killed  in  attempting  to 
drench  them  with  fluids,  which,  instead  of  being  swallowed, 
passed  into  the  lungs,  causing  fatal  strangling  or  bringing  about 
an  equally  fatal  foreign-bod}^  pneumonia.  The  rumen  is  para- 
lyzed, and  as  a  consequence  tends  to  become  filled  with  gas  owing 
to  decomposition  of  its  contents.  This  is  especially  marked  if 
the  animal  lies  upon  her  side.  This  symptom  is  one  of  great 
danger  for  the  animal,  because  the  tympany  tends  to  press  the 
food  up  through  the  oesophagus  into  the  pharynx,  whence  it 
drops  into  the  larynx  and  is  inhaled,  to  either  cause  fatal 
strangling  or  later  a  fatal  foreign-body  pneumonia.  The  in- 
testines are  likewise  paralyzed,  and  little  orno  defecation  occurs. 
If  the  hand  is  introduced  into  the  rectum,  a  small  amount  of  dry 
feces  is  found. 

The  kidneys  cease  to  function,  and  little  or  no  urine  is  poured 
into  the  bladder.  Some  veterinarians  have  urged  that  it  is 
essential  in  the  treatment  of  the  disease  for  the  catheter  to  be 
frequently  passed  in  order  to  prevent  rupture  of  the  bladder. 
As  a  matter  of  fact,  unless  the  bladder  is  distended  when  the 
disease  comes  on  it  does  not  become  so  until  after  the  malady 
has  ceased. 

The  .secretion  of  milk  is  wholly  in  abeyance.  There  may  be  a 
small  amount  of  milk  in  the  udder  at  the  time  that  the  cow  goes 
down,  and  this  may  remain  for  a  time,  but  there  appears  to  be 
some  tendency  for  it  to  become  resorbed  and  the  udder  very 
flaccid. 

The  pulse  at  first  may  be  .slow  and  weak,  becoming  later  more 
frequent  and  irregular. 

The  general  sensation  is  much  depressed.  Early  in  thedisea.se 
the  eye  seems  somewhat  .sensitive  to  light  or  touch,  but  later  the 
cornea  may  be  touched  without  causing  any  reaction,  and  the 
skin  may  be  pricked  at  any  point  with  a  pin  or  other  sharp  ob- 
ject, without  producing  any  evidence  of  feeling. 

As  the  disease  progres.ses,  the  coma  and  paralysis  become  more 
and  more  profound,  and  death  may  occur  at  any  time  without 
warning,  or  the  coma  may  gradually  deepen  and  the  animal  ap- 
pear almost  lifeless  for  hours  before  death  occurs.  As  the  fatal 
termination  approaches,  the  coma  and  paralysis  become  more  and 
more  profound,  the  breathing  more  shallow,  and  the  pulse  weaker 
and  more  irregular,  while  the  temperature  continues  to  sink. 


Parturient  Paresis  in  the  Cow  925 

The  course  of  the  disease  is  rapid.  Generally,  the  earlier  the 
advent  of  the  malady  after  parturition,  the  more  rapid  its  course. 
The  animal  may  die  within  6  or  8  hours  from  the  beginning  of 
the  attack,  or  the  disease  may  be  prolonged  to  two  or  three  days. 

Complications  of  great  variety  may  occur.  In  some  especially 
stormy  cases  there  is  complete  prolapse  of  the  uterus  as  one  of 
the  earliest  symptoms,  and  in  these  death  usually  ensues  very 
quickly.  In  two  cases  in  our  experience,  the  animals  perished 
within  two  or  three  hours  after  the  advent  of  the  first  symptoms 
of  the  disease. 

One  of  the  most  common  and  serious  complications  observed 
in  the  course  of  the  disease  is  that  of  foreign-body  pneumonia, 
or  of  strangling  owing  to  the  inhalation  of  solids  or  liquids.  A 
few  years  ago  it  was  common  to  drench  a  cow  with  large  vol- 
umes of  oil  or  of  solutions  of  saline  cathartics  or  other  medicines, 
which  in  many  cases  flowed  directly  into  the  lungs  because  of 
the  unconsciousness  of  the  animal  and  the  paralysis  of  the 
pharynx.  In  other  instances  in  the  comatose  animal,  there  is 
an  involuntary  passage  of  food  from  the  rumen  through  the 
oesophagus  into  the  pharynx,  from  which  it  is  inhaled  into  the 
the  lungs.  In  either  case  the  animal  may  be  quickly  strangled 
by  the  blocking  of  the  bronchial  tubes  from  the  food  or  medi- 
cines. It  was  formerly  a  common  experience  for  the  veteri- 
narian to  give  a  large  dose  of  medicine  and  have  the  animal 
perish  before  he  could  get  oflF  the  premises. 

When  immediate  death  from  the  inhalation  of  food  or  drugs 
does  not  ensue,  the  paralysis  and  coma  may  continue,  and  the 
symptoms  of  parturient  paresis  pass  imperceptibly  into  those  of 
pneumonia.  In  other  cases  the  animal  partially  recovers,  and 
seems  brighter,  and  may  even  recover  so  far  as  to  regain  her  feet 
and  possibly  take  some  food.  After  some  hours,  or  even  a  day 
or  more,  she  may  show  signs  of  pneumonia  with  elevation  of 
temperature,  and  go  down  again  to  finally  perish  from  the 
complication. 

Diagnosis.  The  diagnosis  is  usually  rendered  clear  by  the 
period  of  the  occurrence  of  the  di.sease,  the  condition  and  char- 
acter of  the  animal,  and  the  symptoms.  In  some  cases,  how- 
ever, the  differential  diagnosis  may  be  exceedingly  difficult, 
and  afford  abundant  room  for  a  conflict  of  opinion  between 
practitioners. 


926  Veterinary  Obstetrics 

Harms  v^xy  properly  points  out  that  the  peculiar  attitude  of 
the  cow  does  not  always  indicate  parturient  paresis,  but  that 
other  diseases,  like  acute  hydrocephalus,  spinal  myelitis  and 
meningitis,  may  cause  the  animal  to  assume  the  same  position. 
Harms  considers  these  the  only  diseases  which  may  be  mistaken 
for  parturient  paresis,  and  suggests  that  puerperal  mania,  puer- 
peral fever,  simple  lumbar  paralysis  and  fracture  of  the  pelvis 
cannot  deceive  the  scientific  veterinarian.  Harms  points  out 
that  in  his  experience  the  diagnosis  of  milk  fever  may  be  ex- 
cluded in  those  cows  which  have  not  calved  recently,  which  show 
loss  of  sensation  in  the  hind  parts  of  the  body  only,  or  have  a 
normal  or  elevated  rectal  temperature.  Cows  which  retain  an 
appetite  until  they  fall,  or  even  after  they  are  down  and  unable 
to  rise,  he  does  not  regard  as  being  affected  with  parturient  paresis. 
On  the  other  hand,  he  claims  that  hydrocephalus  may  be  ex- 
cluded and  milk  fever  diagnosed  if  the  cow  has  calved  within  a 
few  days,  if  the  loss  of  sensation  involves  the  entire  body,  if  the 
rectal  temperature  is  sub-normal,  and  the  paralysis  is  so  profound 
that  the  animal  cannot  rise  upon  its  feet  even  with  assistance. 

The  relation  of  calving  to  the  diagnosis  of  parturient  paresis, 
in  our  judgment,  cannot  be  relied  upon,  although  it  constitutes 
important  evidence.  While  Harms  believes  that  the  disease 
occurs  only  after  parturition,  and  we  agree  with  him  in  the 
main,  we  are  nevertheless  forced  to  hold,  from  our  personal 
observation,  that  the  malady  is  not  confined  to  the  post-parturi- 
ent period,  but  may  rarely  occur  before  or  during  the  act  of 
parturition.  The  fact  that  a  cow  has  recently  calved  does  not 
prevent  the  occurrence,  during  this  period,  of  other  diseases 
which  may  closely  simulate  parturient  paresis. 

Schmidt  (American  Vet.  Review,  Vol.  22,  1898)  draws  atten- 
tion to  the  fact  that  indigestion  in  the  cow  may  very  closely 
simulate  parturient  paresis. 

In  one  case  which  we  observed,  a  cow  went  down  in  the  past- 
ure with  what  strongly  resembled  parturient  paresis  in  almost 
all  essential  respects,  including  paralysis,  coma,  and  subnormal 
temperature,  but  she  had  calved  six  weeks  previously.  The 
disease  was  apparently  due  to  a  slight  purulent  mammitis.  It 
is  interesting  to  note,  in  connection  with  this  ca.se,  that  the  in- 
jection of  oxygen  into  the  udder  apparently  led   to  a  complete 


Parturie7it  Paresis  in  the  Cow  927 

recovery.     This  would  lead   many  to  believe   that   the   malady 
was  really  parturient  paresis. 

Causes.  While  we  do  not  comprehend  the  fundamental 
nature  of  milk  fever  'in  the  cow,  we  nevertheless  know  fairly 
well  the  conditions  which  predispose  or  lead  up  to  the  disease. 

1.  Chief  among  the  causes,  stands  the  quality  of  the  cow  as  a 
deep  or  profuse  milker.  Milk  fever  is  pre-eminently  a  disease  of 
the  high-class  dairy  cow,  and  has  herertofore  stood  as  a  perpetual 
menace  against  the  improving  of  dairy  breeds,  because  the  more 
excellent  the  individual  as  a  dairy  animal  the  more  vulnerable 
to  the  disease.  On  the  other  hand,  cows  belonging  to  the  beef 
breeds,  or  poor  milkers  among  dairy  cows,  are  virtually  immune. 

2.  The  state  of  nutrition  of  the  animal  has  a  very  marked  and 
well  known  influence  upon  the  occurrence  of  parturient  paresis. 
This  is  a  disea.se  of  the  plethoric  cow,  and  not  of  those  which 
are  emaciated  or  excessively  fat.  It  occurs,  we  may  say,  in 
those  animals  which  are  in  the  highest  possible  condition,  and 
apparently  in  perfect  health  up  to  the  hour  of  attack. 

3.  Food  and  housing  have  been  claimed  to  influence  the  tend- 
ency of  the  cow  to  parturient  paresis,  and  this  is  in  many  re- 
spects very  true.  The  malad}-  is  seen  much  more  frequently  in 
some  seasons  and  in  some  communities  than  in  others,  which  is 
varioush"  attributed  to  the  food  or  weather.  These  questions 
are  inseparable  from  that  of  nutrition.  If  the  weather  is  bad, 
the  food  may  be  bad.  Undue  exposure  may  lower  the  condition 
of  the  animal,  and  thus  prevent  the  high  condition  which  predis- 
poses to  milk  fever. 

We  observe  the  disease  in  the  stable  and  in  the  pasture,  and 
the  relative  frequency  will  vary  according  to  conditions.  Par- 
turient paresis  may  occur  chiefly  during  the  spring  or  earh' 
summer,  in  cows  which  are  upon  very  rich  pastures  ;  or  in  other 
cases  the  disease  may  be  seen  most  frequently  in  those  animals 
which  are  kept  in  the  stable.  This  will  vary  according  to  the 
comparative  excellency-  of  the  pa.stures  or  of  the  food  and  feeding 
in  the  stable. 

4.  Abrupt  changes  in  food,  housing  or  other  conditions  may 
apparently  influence  the  tendency  to  the  disease.  In  the  other 
members  of  this  group  of  diseases  we  recognize  very  clearly  the 
effect  of  psychic  influences,  such  as  removing  the  young  from 
the  mother  or  bringing  the  mother  and  her  young  into  the  pres- 


g28  Veterinary  Obstetrics 

ence  of  strange  animals  or  surroundings,  thereby  causing  ma- 
ternal anxiety.  This  apparently  has  an  effect  in  some  cases  in 
the  cause  of  parturient  paresis  of  the  cow. 

5.  It  is  quite  universally  recognized  that,  when  parturient 
paresis  occurs  soon  after  calving,  at  which  epoch  virtually  all 
cases  occur,  the  malady  uniformly  follows  a  very  prompt  and 
easy  birth.  No  case  has  been  recorded,  so  far  as  we  can  find, 
where  parturient  paresis  in  the  cow  has  followed  dystokia. 

Pathology.  As  already  stated,  the  pathology  of  the  dis- 
ease is  unknown.  Post-mortem  examination  reveals  changes 
of  an  interesting  character,  which  tend  to  throw  some  light  upon 
the  symptoms  and  course  of  the  disease,  without,  however, 
making  clear  its  exact  character. 

Because  of  the  well-marked  coma  and  the  general  disturbance 
of  the  nervous  system,  the  condition  of  the  brain  and  the  spinal 
cord  become  of  great  interest.  The  dura  mater  is  apparently 
sound,  though  in  some  cases  a  serous  exudate  exists  beneath  it. 
The  pia  mater  is  said  to  be  somewhat  congested  ;  the  veins,  es- 
pecially, are  distended  with  blood.  The  interpretation  of  the 
conditions  in  the  brain  varies  with  different  observers.  Some 
have  found  the  brain  substance  anaemic,  while  others  have  con- 
sidered it  congested.  Hemorrhages  are  sometimes  found  upon 
the  surface  of  the  brain.  Harms  found  emphy.sema  beneath  the 
pia  mater  and  in  the  veins  of  the  canal  of  the  spinal  cord. 

The  heart  is  usually  pale  and  distended  with  blood,  and  occa- 
sionally shows  ecchymoses  of  varying  size. 

The  condition  of  the  lungs  is  exceedingly  variable.  Harms 
found  them  edematous  or  emphysematous,  but  observed  no 
foreign  bodies  in  them.  We  have  repeatedly  discovered  particles 
of  food  far  down  in  the  bronchial  tubes,  and  in  some  cases  of 
sudden  death  have  found  the  larger  bronchi  completely  occluded 
by  food  masses.  In  other  instances  we  have  been  able  to  rec- 
ognize the  presence  of  drugs  in  the  bronchial  tubes,  which  had 
been  forced  upon  the  cow  in  the  form  of  a  drench  some  hours 
previously. 

The  alimentary  tract,  liver,  spleen  and  urinary  organs  are 
usually  comparatively  normal.  In  the  uterus  there  are  no  very 
remarkable  changes.  In  harmony  with  the  history  of  the  di.sea.se, 
the  uterus  is  not  normally  contracted.  Like  other  organs  of  the 
body,  the  uterus  is  anaemic. 


Parturient  Paresis  in  the  Coiv  929 

The  theories  regarding  the  nature  of  parturient  paresis  are  in- 
numerable, and  difficult  of  classification.  These  may  be  divided 
into  four  great  classes,  according  to  the  belief  veterinarians  hold 
as  to  the  organ  or  system  from  which  the  disease  takes  its 
origin. 

1.  Many  hold  that  the  disease  has  its  origin  in  some  essential 
change  in  the  brain  or  spinal  cord.  They  believe  the  disease  to 
consist  of  a  congestion  of  the  entire  central  nervous  system,  with 
overfilling  of  the  veins  of  the  brain  and  spinal  cord.  Other  veter- 
inarians hold  that  the  disease  consists  of  anaemia  and  paralysis  of 
the  central  nervous  system. 

2.  Another  group  of  veterinarians  believes  that  the  disease 
has  its  es.sential  origin  in  the  uterus.  In  this  group  each  indi- 
vidual has  an  opinion  of  his  own,  which  differs  somewhat  from 
that  of  each  of  his  colleagues.  Some  of  them  believe  that,  from 
the  uterine  mucosa,  there  is  absorbed  into  the  system  an  amount 
of  infectious  material  or  the  products  of  bacterial  activity  within 
the  uterine  cavity,  which,  acting  upon  the  central  nervous  sys- 
tem, produce  the  disease.  The  character  of  this  toxic  substance 
has  not  been  revealed,  nor  has  any  clear  evidence  been  adduced 
to  show  that  such  exists.  It  has  not  been  shown  why,  if  the 
disease  consists  of  the  absorption  of  toxic  substances  from  the 
uterus,  cows  which  are  very  thin  in  flesh,  are  poor  milkers  or 
have  suffered  from  dy.stokia  should  not  just  as  readily  suffer 
from  milk  fever  as  deep  milkers  which  are  in  high  condition 
and  have  calved  easily.  Others,  like  Stockfleth,  hold  that  milk 
fever  is  the  result  of  embolism  of  the  veins  of  the  uterus,  the 
emboli  escaping  to  other  portions  of  the  body. 

3.  A  third  group  of  veterinarians,  including  Schmidt  of  Kol- 
ding,  holds  that  the  disease  arises  from  the  mammary  gland,  and 
consists  of  a  toxaemia  due  to  the  absorption  of  colostrum,  per- 
haps incompletely  formed,  or  other  secretions  which  possess  a 
highly  deleterious  character. 

4.  Harms  holds  that  the  disease  is  a  form  of  aeraemia,  or  air 
in  the  blood.  In  his  post-mortem  examinations  he  found  air  in 
the  veins  of  the  brain,  spinal  cord,  lungs  and  other  organs. 
This  view  has  not  been  generally  accepted. 

As   already   stated,    post-mortem   examination    has   virtually 
failed  to  reveal  anything  definite  regarding  the  actual  cause  or 
character  of   the  malady.      This    and  that    lesion  has  been  re- 
59 


930  Veterinary  Obstetrics 

corded,  onl}-  to  have  its  existence  or  importance  disputed  by 
others  of  equal  authority.  One  finds  hyperaemia  of  the  brain, 
and  another  anaemia  of  the  brain,  with  the  possibiHty  that 
either  or  both  may  be  correct.* 

Handling,  i.  The  essential  therapeutics  of  parturient 
paresis  consists  of  the  inflation  of  the  udder  with  atmos- 
pheric air  or  oxygen.  So  far  as  clinical  experience  reveals,  it 
is  not  material  which  of  these  is  used.  As  soon  as  the  patient 
can  be  reached,  and  a  definite  diagnosis  of  parturient  paresis 
made,  a  sufficient  volume  of  oxygen  or  atmospheric  air  should 
be  introduced  into  each  quarter  of  the  udder  to  quite  thoroughly 
distend  all  parts  Of  the  gland.  In  order  to  avoid  the  escape  of 
the  air  through  the  teat  canal,  it  may  sometimes  be  desirable  to 
apply  temporarily  a  soft  ligature  near  the  end  of  the  teat,  which 
is  to  be  removed  after  the  expiration  of  three  or  four  hours. 

The  ligature  should  preferably  consist  of  a  soft  piece  of  tape, 
which  should  be  tied  around  the  teat  sufficiently  tight  to  barely 
prevent  the  injected  air  from  escaping  through  the  teat  orifice. 
If  tied  too  tight,  and  allowed  to  remain  for  several  hours,  necrosis 
of  the  teat  follows.  The  ligature  is  to  be  closely  watched,  and 
promptly  removed  whenever  serious  injury  to  the  teat  is  threat- 
ened. The  danger  might  be  very  largely  avoided  if  a  long  piece 
of  tape  were  used,  and  wound  several  times  about  the  teat,  from 
the  apex  upwards.  Strips  of  adhesive  plaster,  applied  directly 
over  the  teat  orifices  and  extended  upward  along  the  teat,  would 
probably  fill  all  requirements  and  obviate  pressure  gangrene. 

The  necessity  for  ligating  the  teat  is  very  questionable.  The 
amount  of  gas  injected  is  subject  to  no  fixed  rule.  The  udder 
should  be  firmly  distended.  Usually  the  sphincters  of  the  teats 
will  retain  sufficient  gas  and  permit  any  excess  to  escape. 
Some  believe  that  the  greater  the  distension  of  the  udder  with 
air,  the  more  prompt  and  effective  the  treatment.  Occasionally 
this  is  overdone,  and  we  have  observed  extensive  emphysema  of 
the  udder,  thighs  and  croup  from  rupture  of  the  mammary  epith- 
elium as  a  result  of  over-distension.     No  harm  ensued.     If  the 

*For  a  full  resum6  and  discussion  of  the  various  theories  of  the  nature  of 
parturient  paresis,  the  reader  is  referred  to  the  contribution  of  J.  Schmidt, 
Kolding,  Monatshefte  fiir  Praktische  Thierheilkunde.  Bd.  IX.,  S.  241,  a 
translation  of  which  appears  in  the  Am.  Vet.  Review,  Vol.  22,  p.  392,  Sept., 
1898. 


Parturient  Paresis  in  the  Cow  931 

volume  seems  insufficient,  if  the  response  is  tardy  or  feeble, 
more  air  or  oxygen  may  be  introduced  at  any  time. 

Should  the  first  inflation  fail  to  produce  the  desired  results 
after  an  interval  of  3  to  6  hours,  a  second  inflation  of  the  gland 
should  be  made.  We  have  no  evidence  that  any  harm  may  occur 
from  repeated  inflations  of  the  udder  with  air  or  oxygen,  so  long 
as  no  infection  is  carried  into  the  gland. 

Since  the  mammae  are  at  this  stage  in  a  very  highly  vunerable 
state,  it  is  essential  to  safety  that  due  precautions  be  taken 
against  introducing  infection  into  the  gland  upon  the  portion  of 
the  apparatus  inserted  into  the  teat,  or  forcing  it  into  the  gland 
with  the  oxygen  or  air  which  is  being  introduced. 

The  precautions  to  be  taken  are  analogous  to  those  for  any 
surgical  operation.  They  include  the  disinfection  of  the  operator's 
hands  ;  of  the  cow's  udder,  especially  the  teats;  and  of  the  injec- 
tion apparatus,  especially  the  tube  which  is  to  be  introduced 
into  the  teats  ;  and  the  protection  of  each  of  these  parts  from 
infection  during  the  operation. 

The  udder  should  be  carefully  placed  upon  a  clean  cloth  sat- 
urated with  a  reliable  disinfectant,  or  upon  a  clean  tray,  after 
which  the  entire  gland,  and  especially  the  teats,  is  to  be 
thoroughly  washed  and  disinfected.  The  apparatus  to  be  used 
for  injecting  the  air  or  oxygen,  especially  the  tube  to  be  inserted 
into  the  teat,  should  be  sterilized  by  boiling. 

Before  inserting  the  tube  into  the  teat,  all  antiseptics  should 
be  carefully  washed  away  from  the  tube  and  the  end  of  the  teat 
with  sterile  water.  The  introduction  of  antiseptics  into  the 
milk  gland  upon  a  tube  or  other  instrument  is  as  dangerous 
as  the  introduction  of  most  forms  of  bacteria.  The  opera- 
tion is  to  be  aseptic,  not  antiseptic 

The  mechanism  by  which  the  inflation  is  brought  about  is  not 
es.sential,  so  long  as  the  general  rules  of  asepsis  are  maintained. 
Various  forms  of  apparatus  have  been  introduced  for  the  purpose 
of  avoiding  infection,  but  few%  if  any  of  them  are  free  from  ob- 
jection. No  difference  what  the  particular  type  of  apparatus,  the 
general  rules  of  aseptic  surgery  must  be  carefully  applied  by  the 
veterinarian  ;  the  apparatus  is  not  sufficient  in  itself.  Many  of 
these  devices  consist  of  a  rubber  bulb,  attached  to  an  elongated 
tube,  into  which  is  inserted  a  filter  of  asbestos,  cotton  or  other 
substance.     Beyond  this,  the  rubber  tubing  ends  with  an  ordinary 


932  Veterinary  Obstetrics 

milk  or  teat  tube,  which  is  inserted  into  the  milk  canal.  This 
form  of  apparatus  is  probabl}^  the  most  objectionable  of  any 
that  has  been  devised,  because  the  filter  is  difficult  of  steriliza- 
tion and,  becoming  befouled,  acts  as  a  constant  menace  to  the 
udder  of  the  patient. 

The  simplest  apparatus,  the  one  which  can  be  most  readily 
sterilized  by  boiling,  is  the  best.  There  is  no  great  danger  of 
the  introduction  of  infection  with  the  air  which  is  introduced,  if 
moderate  care  is  taken  not  to  stir  up  dust  in  the  stall  while  the 
operation  is  in  progress,  and  this  danger  may  be  eliminated  in  a 
variety  of  ways  which  are  very  simple.  If  a  wash-bottle  is  con- 
structed, and  the  air  be  forced  through  the  water,  and  thence 
into  the  udder,  any  floating  particles  of  dirt  will  be  retained  in 
the  water,  leaving  the  air  free  from  infection. 

Laymen  have  used  the  ordinary  bicj'cle  pump  for  injecting  air 
into  the  udder,  and  the  process  has  been  bitterly  criticised  by 
some  veterinarians.  Such  a  pump,  or  one  on  a  similar  plan,  with 
very  ordinary  precautions,  is  safer  than  the  apparatus  usually 
sold  for  the  purpose.  A  pump  of  this  type,  with  sterilizable 
piston,  can  be  made  a  very  convenient  and  safe  appliance.  It 
may  be  enclosed  in  a  sterilizable  metal  case,  and  kept  sterilized 
ready  for  use.  At  time  of  use,  a  few  layers  of  sterile  gauze  over 
the  intake  effectively  filter  the  air. 

A  very  convenient  and  safe  apparatus  for  the  work  is  the 
oxygen,  or  compressed  air  tank.  Under  proper  precautions,  the 
tank  may  be  charged  by  the  practitioner  with  either  air  or  oxygen, 
and  is  ready  for  safe  use  at  any  moment.  The  tube  for  insertion 
into  the  teat  may  be  carried  in  alcohol,  so  that  it,  too,  is  ready 
in  a  moment. 

A  yet  more  convenient  and  safer  apparatus  for  the  inflation  of 
the  udder  may  be  readily  arranged  by  having  a  very  small  and 
strong  compressed  air  tank,  fitted  with  an  opening  armed  with  a 
stop  cock.  It  could  be  made  of  the  size  of  a  pint  bottle,  and 
strong  enough  to  contain  sufficient  air  for  the  inflation  of  an 
udder.  Two  or  more  such  tanks  could  be  kept  on  hand  so  that 
one  may  always  be  charged  and  ready  for  use.  The  detached 
tube  may  be  enclosed  in  a  sterilizable  metal  container  and  quickly 
prepared  for  use. 

The  tank  may  be  charged  by  the  veterinarian,  the  air  being 
filtered    through    sterile    gauze  as  it   enters    the    pump.     Thus 


Parturient  Paresis  in  the  Cow  933 

charged,  under  suitable  precautions,  the  apparatus  is  always 
ready,  compact,  light,  easily  applied,  and  free  from  danger  of 
causing  infection. 

The  milk  tube  or  other  tube  inserted  into  the  teat  should  be 
very  short,  barely  long  enough  to  freely  enter  the  milk  cistern. 
A  longer  tube  may  wound  the  parts  during  unexpected  struggles. 

It  is  apparently  immaterial  whether  any  milk  which  may  be 
in  the  udder  is  withdrawn  before  the  injection  or  not. 

Some  practitioners  advise  treatment  supplementary  to  the  in- 
flation of  the  udder,  but  they  have  not  yet  clearly  shown  by 
clinical  data  that  any  good  has  come  from  such  additions.  Gen- 
erally those  who  desire  to  add  something  to  the  udder  inflation 
prescribe  powerful  heart  stimulants,  like  strychnine  or  caffein. 

As  a  remnant  of  by-gone  days,  some  veterinarians  still  advise 
and  practice  catheterization.  The  secretion  of  urine  ceases  with 
the  advent  of  the  disease.  Over-distension  could  not  have  existed 
in  the  healthy  cow,  and  cannot  occur  in  the  paresis  patient.  A 
pint  or  a  gallon  of  urine  in  the  bladder  can  do  no  harm  ; 
catheterization  may  do  much. 

The  attitude  of  the  patient  is  of  very  great  importance.  From 
the  first  she  should  be  carefully  and  zealously  guarded  against 
assuming  lateral  recumbency,  or  this  position  promptly  cor- 
rected if  already  attained.  The  cow,  like  other  ruminants, 
promptly  suffers  from  tympany  of  the  rumen  whenever  lateral 
recumbency  is  maintained  for  a  prolonged  period.  The  disten- 
sion of  the  rumen,  by  its  pressure  upon  the  diaphragm,  interferes 
seriously  with  respiration  and  with  the  action  of  the  heart  and 
other  organs.  The  most  serious  danger  from  this  position  is 
that,  in  the  paretic  state  of  the  animal,  there  is  imminent  risk  of 
the  involuntary  passage  of  food  from  the  rumen  into  the  pharynx, 
and  its  inhalation  into  the  lungs,  to  cau.se  fatal  strangling,  or 
foreign-body  pneumonia.  It  is  consequently  essential  to  keep 
the  animal  in  sternal  recumbency.  This  may  be  facilitated  by 
packing  bundles  of  straw  about  the  animal.  In  cases  of  violence 
it  may  be  desirable  to  secure  the  two  anterior  feet  in  such  a  way 
that  the  limbs  cannot  be  extended.  This  is  best  accomplished 
by  attaching  a  short  strap  or  cord  to  each  anterior  foot,  carry- 
ing these  upward  over  the  withers,  and  tying  them  together  in 
such  a  manner  as  to  keep  the  anterior  feet  completely  flexed  upon 
the  carpus. 


934  Veteriyiary  Obstetrics 

It  is  quite  unnecessary  to  suggest  that  the  animal  be  well 
bedded  and  otherwise  made  comfortable. 

The  practitioner  should  be  on  his  guard  against  the  dangers 
of  moving  the  recumbent  animal  from  place  to  place.  If  the 
patient  has  fallen  in  a  bad  situation,  out  of  doors  or  elsewhere, 
it  may  appear  desirable  that  she  should  be  conveyed  to  a  stable 
or  other  suitable  place  for  handling.  In  bringing  about  this 
transfer  it  is  well-nigh  unavoidable  that  she  be  placed  in  lateral 
recumbency,  and  that  she  must  undergo  a  form  of  handling  which 
will  strongh-  tend  to  cause  the  regurgitation  and  inhalation  of 
some  of  the  contents  of  the  rumen. 

It  is  therefore  best,  in  all  cases,  to  make  the  patient  comfort- 
able, if  possible,  where  she  falls.  Abundant  bedding,  blankets 
if  the  weather  is  cold,  or  an  improvised  tent  or  shed  if  the  weather 
is  hot  or  rainy,  usually  suffices  as  well  as  a  stable  and  avoids  the 
danger  of  transfer.  When  moving  the  recumbent  animal  is  im- 
perative, she  should  be  kept  on  her  chest  until  all  is  in  readi- 
ness, the  transfer  then  made  promptly,  and  the  patient  quickly 
replaced  upon  her  sternum. 

When  the  practitioner  is  called  to  attend  a  case  of  parturient 
paresis,  he  should  rigidly  abstain  from  drenching  the  patient, 
and  carefully  enquire,  before  he  takes  charge,  if  any  drugs  or 
medicines  have  been  given  by  the  mouth.  If  cows  suffering 
from  parturient  paresis  have  been  drenched,  the  mortality  is 
exceedingly  high,  because  portions  of  the  drench  usually  pass 
down  the  trachea  into  the  lungs.  It  does  not  matter  at  what 
stage  of  the  disease  the  attempt  to  drench  the  animal  occurs. 
While  she  is  still  upon  her  feet,  and  merely  beginning  to  stagger, 
she  is  nevertheless  very  liable  to  become  strangled.  There  appears 
to  be  from  the  first  an  anaesthesia  or  paresis  of  the  larynx  and 
other  parts,  which  prevents  coughing  or  any  other  signs  of 
strangling.  If  the  animal  has  received  a  drenth,  especiall}'  one 
which  would  be  highly  irritant  to  the  lungs  or  could  not  be  ab- 
sorbed from  the  respiratory  mucous  membrane,  an  unfavorable 
prognosis  should  at  once  be  given,  and  the  handling  begun  with 
a  definite  understanding  that  the  animal  will  probably  die  from 
inhalation  pneumonia  as  a  result  of  the  drench. 

%  ;!<  ;i;  ^:  ;1< 

The  history  of  the  origin  of  the  present  plan  for  handling 
parturient  paresis  dates  back  to  the  investigations  of  Schmidt  of 


Parturient  Paresis  in  the  Cow  935 

Denmark,  in  1897,  when  he  introduced  his  plan  of  handhng  the 
disease  by  the  introduction  into  the  udder  of  a  solution  of  iodide 
of  potassium,  commingled  with  atmospheric  air.  Later,  various 
practitioners  found  that,  failing  to  have  the  potassium  iodide  at 
hand,  the  distension  of  the  udder  by  other  liquids,  such  as  very 
weak  disinfecting  solutions  or  normal  salt  solution,  possessed  a 
similar  efficiency.  Then  oxygen  was  substituted  for  the  potas- 
sium iodide  solution,  and  its  efficiency  was  found  to  be  even 
greater.  From  this  experience  it  was  readily  surmised  that,  in 
default  of  pure  oxygen,  the  mixture  of  oxygen  and  nitrogen  of 
atmospheric  air  might  answer  the  purpose,  and  clinical  experience 
early  demonstrated  this  to  be  a  fact.  Today  oxygen  and  atmos- 
pheric air  are  used  indifferently,  and  with  very  great  success. 

The  discovery  of  Schmidt,  with  its  gradual  development, 
leading  to  the  now  universally  accepted  mode  of  handling 
parturient  paresis,  constitutes  one  of  the  most  remarkable 
and  beneficent  advances  in  therapeutics  in  the  history  of 
veterinary  medicine.  It  has  transformed  one  of  the  most 
fatal  of  diseases  into  one  which,  when  promptly  handled, 
is  almost  robbed  of  its  mortality. 

Prior  to  the  investigations  of  Schmidt,  parturient  paresis 
was  a  great  obstacle  to  the  advancement  of  efficiency  in 
dairy  cows.  As  soon  as  a  cow  showed  high  efficiency, 
imminent  danger  to  her  life  from  parturient  paresis  at 
once  arose,  and  the  ranks  of  the  best  dairy  cows  annually 
suffered  appalling  losses. 

Under  the  treatment  with  air  or  oxygen,  the  mortality  in 
parturient  paresis  in  the  cow  has  dropped  from  60-75%  to 
less  than  5%,  in  those  cases  which  are  promptly  attended  and  in 
which  there  has  been  no  meddling  by  the  administration  of 
medicines  by  the  mouth. 

From  the  standpoint  of  prophylaxis,  the  attitude  of  the  pro- 
fes.sion  has  been  quite  generally  modified  by  the  advent  of  the 
present  method  of  handling.  Formerly  it  was  advised  in  many 
cases  to  withdraw  a  portion  of  the  milk  from  the  udder  before 
the  cow  calved,  and  to  keep  her  well  milked  immediateh'  after 
calving,  but  this  rule  has  been  reversed,  and  it  is  now  advised  to 
leave  the  udder  full}-  distended  with  colostrum  or  milk. 

It  was  formerly  advised,  also,  that  a  purgative  be  given  either 
just  before  or  immediately  succeeding   parturition,  in  order  to 


936  Veterinary  Obstetrics 

prevent  parturient  paresis  ;  but  this  has  been  generally  discarded 
since  the  advent  of  the  inflation  treatment. 

It  is  now  uniformly  advised,  in  case  there  appears  to  be 
any  danger  of  an  attack  of  parturient  paresis,  that  the 
udder  be  inflated  at  once  with  oxygen  or  air  as  a  prophy- 
lactic measure. 

The  history  of  the  therapeutics  of  parturient  paresis  is  exten- 
sive and  interesting.  Almost  every  form  and  character  of  treat- 
ment possible  has  been  advised,  and  favorable  reports  of  the  use 
of  each  have  been  made.  Purgatives  long  held  a  very  high  place, 
in  spite  of  the  fact  that  they  were  generally  poured  into  the 
lungs  instead  of  the  rumen,  and  quite  generally  hastened  the 
fatal  termination.  Stimulants,  narcotics,  sedatives,  in  endless 
profusion,  were  recommended  b}'  one,  only  to  be  condemned  by 
others  and  finally  to  be  discarded. 

Blood-letting  was  advised  and  abandoned.  Hypodermic  in- 
jections of  strychnine,  eserine,  pilocarpine  and  many  drugs 
were  advised,  with  the  great  advantage  that  they  did  not  get 
into  the  lungs  and  strangle  the  animal,  but  the  results  from  their 
use  were  not  satisfactory.  External  applications  were  used,  such 
as  stimulating  liniments  to  the  spine,  and  ice  to  the  head.  Intra- 
uterine injections  of  solutions  of  alum  or  other  substances  were 
advised.  In  spite  of  all  these  innumerable  methods  which  were 
recommended  by  this  or  that  practitioner,  the  high  mortality  of 
the  disease  still   held  its  sway. 

Puerperal  Eclampsia  in  the  Sow. 

Hegel  ( Repertorium,  Vol.  46,)  de  Bruin  (Geburtshilfe  bei 
den  Kleineren  Haustieren )  and  others,  describe  puerperal  eclamp- 
sia in  the  sow.  The  malady  is  characterized,  according  to  Hegel, 
by  spasmodic  movements  of  the  neck,  grinding  of  the  teeth,  con- 
vulsive movements  of  the  facial  mu.scles,  inabilit)'  to  stand  and 
elevation  of  temperature. 

De  Bruin  has  usually  ob.served  the  disease  two  to  five  days 
after  farrowing  and  expulsion  of  the  fetal  membranes.  Usually 
the  birth  has  been  easy.  The  symptoms  are  chiefly  a  more  or 
less  complete  suspension  of  lactation,  with  paresis,  coma,  and  in- 
testinal torpidity. 

The  prognosis  is  good,  and  most  cases  tend  to  spontaneous  re- 
covery after  a  few  days. 


The  Milk  Disease  of  the  Sheep  937 

Hegel  advises  bleeding  from  the  tail,  cold  poultices  to  head 
and  back,  purgatives,  tobacco  clysters,  etc.,  and,  if  trismus  per- 
sists, the  application  of  chloroform  and  oil  to  the  masseter  region. 

De  Bruin  warns  the  practitioner  against  drenches,  always 
dangerous  for  swine  because  of  strangling.  He  advises  the  use 
of  electuaries  composed  of  10  grammes  sulphate  of  magnesia,  50 
grammes  powd.  anise  seed,  and  common  syrup  sufficient  to  make 
a  paste.  This  is  placed  upon  the  tongue  with  a  wooden  spatula, 
and  the  entire  quantity  used  during  one  day.  He  further  advises 
applying  tincture  of  camphor  over  the  body  to  arouse  the  skin 
secretions. 

The  Milk  Disease  of  Sheep.     Parturient  Paresis 
IN  Sheep  and  Goats. 

De  Bruin  describes  a  malady  of  ewes,  closely  resembling  the 
parturient  paresis  of  the  cow,  under  the  designation  of  milk  dis- 
ease. It  occurs  chiefl}'  in  ewes  from  which  the  sucking  lambs 
have  been  removed  after  having  lambed  normally  some  six  weeks 
previously.  The  disease  appears  usually  2-24  hours  after  the 
removal  of  the  lambs  from  the  ewes. 

The  symptoms  consist  of  absence  of  appetite,  rumination  or 
other  digestive  functions.  The  ewe  ceases  to  bleat  or  hunt  for 
her  lamb,  becomes  paretic,  with  glassy  eyes,  loss  of  corneal  reflex, 
coma,  and  the  general  symptoms  of  parturient  paresis  of  cows. 

The  prognosis  is  good,  and  the  method  of  handling  it  is  the 
same  as  for  parturient  paresis  in  the  cow. 

De  Bruin  describes,  under  a  separate  heading,  a  parturient 
eclampsia  of  sheep,  goats  and  swine,  regarding  this  malady  as 
essentially  different  in  etiology  or  pathology  from  the  milk  dis- 
ease described  above. 

The  real  ground  for  differentiation  is  not  clear.  In  these  cases 
the  animals  show  definite  tonic  and  clonic  spasms.  The  disease  is 
usually  acute  and  stormy.  It  appears  ordinarily  soon  after  birth, 
though  it  may  occur  ante-partum.  There  is  present  trismus, 
opisthotonos,  and  general  convulsions,  with  pirouetting  of  the 
eyes,  followed  by  coma. 

Chloral  hydrate  in  enemas,  and  hypodermic  injections  of  mor- 
phine, are  recommended  for  handling,  and  good  results  are  re- 
ported. De  Bruin  does  not  mention  inflation  of  the  mammae  with 
air  or  oxygen  ;  nor  does  he  intimate  why  this  should  not  be  quite 


938  Veterinary  Obstetrics 

as  successful  in  the  eclampsia  of  the  sheep  and  goat  as  in  the 
paresis  of  the  cow. 

Puerperal  Eclampsia  of  the  Bitch. 

Next  to  the  cow,  probably  the  bitch  suffers  most  frequently 
from  puerperal  eclampsia  or  paresis.  The  malady  has  rarely  been 
observed  prior  to,  or  immediately  following  parturition.  Usually 
it  occurs  from  2  to  8  days  after  giving  birth  to  young.  Occa- 
sionally it  occurs  10  to  14  days  after  parturition,  and  rarely  as 
late  as  30  days.  Ordinarily  it  follows  easy  parturition.  It  is 
most  frequently  observed  in  highly  bred  nervous  animals,  and 
occasionally  follows  the  psj'^chic  disturbance  incident  to  removal 
of  the  puppie,s  from  the  patient. 

The  symptoms  are  analogous  to  the  eclampsia  already  de- 
scribed in  the  mare,  ewe,  goat  and  sow.  The  first  symptoms  are 
those  of  anxiety,  restlessness  and  uncertain  gait.  The  patient 
falls  in  convulsions,  the  voluntary  muscles  being  affected  with 
severe  tonic  and  clonic  spasms.  As  in  other  eclamptic  diseases, 
the  body  excretions  are  largely  in  abeyance,  the  bowels  are 
torpid,  the  urinary  secretions  are  suspended,  and  the  mammae 
are  flaccid  and  devoid  of  milk. 

During  the  convulsions,  the  patient  remains  conscious.  Later 
the  convulsions  may  be  followed  by  coma  and  unconsciousness. 
During  the  convulsions,  the  visible  mucosa  are  cyanotic.  The 
affection  greatly  resembles  strychnine  poisoning,  but  De  Bruin 
points  out  the  important  difference  that  in  strychnine  poisoning 
the  patient  is  easily  excited,  while  in  eclampsia  no  hypersensi- 
tiveness  is  apparent. 

The  course  of  the  Disease,  like  in  other  members  of  the 
eclamptic  group,  is  usually  stormy,  and,  unless  energetically 
handled,  ends  fatally  in  24  to  48  hours.  The  prognosis  is 
good  when  the  disease  is  promptly  handled. 

De  Bruin  strongly  recommends  20-40  mg.  (0.3-0.6  grains)  of 
morphia  hydrochlor,  hypodermically,  repeated  in  a  few  hours  if 
necessary.  Others  advise  chloroform  inhalations  or  chloral  hy- 
drate enemas.  Some  have  recommended  the  administration  of 
ether  or  chloroform  syrup  by  the  mouth  ;  but,  as  in  all  disea.ses  of 
this  group,  the  powers  of  deglutition  are  uncertain,  and  there  is 
constant  danger  from  the  introduction  of  medicines  into  the 
lungs. 


DISEASES  OF  THE  MAMMARY  GLANDS. 

In  mammalia,  the  mammary  glands  constitute  an  essential 
part  of  the  reproductive  system,  because  it  is  through  these  that 
the  new-born  is  enabled  to  live  for  a  time  after  its  birth,  before 
it  acquires  the  experience  and  power  necessary  to  provide  its  own 
food.  The  mammse  ordinarily  come  into  function  at  the  time 
when  young  are  born.  As  soon  as  the  young  animals  have 
acquired  sufficient  age  and  strength  to  lead  an  independent  ex- 
istence, the  glands  cease  to  secrete  milk,  until  their  function  is 
aroused  anew  at  the  next  period  of  birth. 

Following  the  general  rule  of  vulnerability  of  organs,  the 
mammae  are  most  subject  to  disease  and  accident  during  their 
period  of  activity,  and  rarely  suffer  during  their  interval  of  rest. 
The  diseases  of  the  milk  glands  may,  accordingly,  very  properly 
be  dealt  with  as  a  part  of  obstetrics,  because  they  not  only  jeop- 
ardize the  life  and  well-being  of  the  mother  chiefly  during  the 
puerperal  state,  but  also  have  great  importance  for  the  life  of  the 
young  at  the  beginning  of  its  extra-uterine  existence. 

Anatomically  the  milk  glands  of  animals  belong  to  the  acinous 
type.  The  glands  consi.st  of  numerous  acini  or  glandular  vesi- 
cles, lined  with  cuboidal  epithelium.  From  each  of  these  cells 
there  emanate  small  milk  canals,  which  finally  unite  with  each 
other  into  common  canals  of  larger  size.  These  may  empty  into 
a  large  cistern  and  thence  through  a  common  opening  at  the  end 
of  the  teat.  Fig.  5A,  p.  37,  or  two  or  more  cisterns  form,  each  of 
which  opens  through  a  separate  milk  duct,  or  the  milk  canals 
may  remain  separate,  without  milk  cisterns  and  open  directly  at 
the  end  of  the  nipple.  There  are  consequently  two  great  types  of 
milk  glands — the  one  with  a  cistern,  in  which  a  considerable 
volume  of  milk  accumulates  ;  and  the  other  without  a  cistern, 
in  which  the  milk  canals  lead  from  the  glandular  substance  di- 
rectly to  the  end  of  the  teat. 

Solipeds,  ruminants  and  swine  have  capacious  milk  cisterns  ; 
in  carnivora  milk  cisterns  are  absent.  The  general  anatomy  of 
the  milk  glands  has  been  briefly  outlined  on  page  35. 

The  variations  in  the  structure  of  the  milk  glands  in  different 
animals  are  very  interesting  in  relation  to  their  tendency  to  disease. 
The  highly-developed  glands  of  ruminants,  with  a  single  large 
cistern  and  a  very  large  excretory  canal  through  the  end  of  the 

939 


940  Veterinary  Obstetrics 

teat,  are  subjected  to  very  great  danger  from  acute  infection. 
In  animals  where  extensive  milk  cisterns  do  not  exist,  like  the 
mare,  and  in  carnivora,  which  have  no  cisterns  at  all,  the  tendency 
to  acute  mammary  infection  is  very  much  less. 

On  the  other  hand,  we  find  that  in  the  carnivora,  especially  in 
the  bitch,  without  any  milk  cistern,  there  is  a  pre-eminent  ten- 
dency for  the  glands  to  become  the  seat  of  malignant  new-growths. 
When  infection  occurs  in  the  capacious  single  milk  cistern  of  a 
ruminant,  the  entire  quarter  is  almost  inevitably  involved.  In 
those  animals  with  two  or  more  cisterns,  or  with  numerous  milk 
canals  without  cisterns,  a  single  lobule  of  the  gland  may  become 
infected  and  the  others  remain  sound. 

For  convenience  of  description  we  may  divide  the  diseases  of 
the  udder  into  :  (i)  Acute  Infections,  (2)  Chronic  Infections, 
(3)   Wounds  and  Injuries,  (4)   Neoplasms. 

Acute  Infections  of  the  Mamm^h.     Mammitis. 

Mastitis. 

Mammitis  consists  essentially  of  an  infection  of  the  mammary 
gland,  and,  like  the  infections  of  other  organs  or  tissues,  may  be 
extremely  variable  in  character.  The  different  species  of  domestic 
animals  show  great  variations  in  their  susceptibility  to  mammitis, 
and  in  the  type  or  types  which  the  disease  may  assume.  By 
some  authors,  the  inflammations  of  the  gland  have  been  divided 
into  catarrhal,  phlegmonous  and  interstitial  mammitis.  Others 
add  to  these,  purulent  and  gangrenous  mammitis. 

Until  we  understand  better  the  exact  nature  of  the  various 
forms  of  mammitis,  especially  in  relation  to  the  bacteriologic 
cause  of  each,  any  classification  which  may  be  made  is  merely  a 
matter  of  convenience  for  purposes  of  description,  which  may 
facilitate  our  understanding  of  certain  more  or  less  distinct  types 
of  disease  observed. 

The  various  species  of  domestic  animals  show  such  marked 
differences  in  the  prevailing  type  or  types  of  diseases  of  the  milk 
glands  that  it  is  advantageous  to  consider  those  of  each  species 
separately,  although  in  many  respects  they  may  be  identical. 

a.  Mammitis  or  Mastitis  in  the  Cow. 

The  cow  constitutes  the  chief  dairy  animal,  for  which  purpose 
she  has  been  specially  bred  for  centuries,  and   has  been  brought 


Acute  Mamniitis  941 

to  a  high  state  of  perfection  as  a  milk-producing  animal.  With 
this  specialization  of  function,  there  has  arisen  a  vulnerabilitj^  of 
the  milk  glands  to  injuries  and  diseases,  which  surpasses  that  seen 
in  any  other  domestic  animal.  We  consequently  meet  with  a 
great  variety  of  inflammatory  diseases  of  the  milk  glands  in 
cows.  These  variations  are  due  in  part  to  the  intensity  of  the 
infection  and  the  comparative  power  of  resistance  of  the  gland, 
and  are  in  large  part  due  to  the  specific  differences  in  the  infec- 
tions themselves. 

Mammitis  in  dairy  cows  has  a  wide  economic  and  sanitary  in- 
terest. The  pathologic  milk  of  mammitis  is  usually  rejected  as 
human  food  by  the  repulsive  taste,  smell  or  visible  appearances. 
Pathologic  milk,  unrecognizable  by  the  special  senses,  like  that 
from  a  tubercular  udder,  may  possess  far  greater  danger  for  man. 

According  to  the  avenue  of  infection,  the  inflammations  of 
the  mammary  glands  may  be  divided  into  two  groups,  very  un- 
equal in  size  and  importance  : 

1.  The  infections  which  gain  entrance  into  the  cavit}'  of  the 
milk  gland  from  the  exterior,  through  the  milk  orifice  or  orifices 
in  the  teat,  or  through  some  wound  involving  the  tissues  which 
constitute  the  walls  of  these  cavities. 

2.  A  lesser  group  of  infections,  which  reach  the  tissues  of  the 
gland  from  some  other  portion  of  the  body,  through  the  medium 
of   the  lymph  or  blood  channels,  e.  g.,  tubercular  mammitis. 

I.  Acute  Mammitis.     Acute  Mastitis. 

Acute  mastitis  may  be  defined  as  an  infection  of  the  milk 
gland,  due  to  the  entrance  into  its  substance  of  the  micro-organ- 
isms ordinarily  inducing  wound  infection.  We  might  liken 
acute  mammitis  to  wound  infection  itself,  and  regard  the  epithe- 
lial lining  of  the  milk  cisterns,  ducts  or  acini,  or  all  these  areas 
combined,  as  representing  the  wound  area  which  has  become 
infected. 

As  in  wound  infection,  so  in  acute  mammitis,  the  infecting 
agent  may  be  of  very  diverse  character.  Investigators,  in  deal- 
ing with  acute  mammitis,  have  found  virtually  all  the  types  of 
organisms  which  are  recognizable  in  wound  infection,  such  as 
diplococci,  streptococci,  staphylococci  and  bacilli. 

In  accordance  with  the  clinical  historv   of  wound   infection, 


942  Veterinary   Obstetrics 

some  have  believed,  with  apparently  good  reason,  that  there 
are  variations  in  the  virulence  of  raammitis,  somewhat  in  harmony 
with  the  species  of  the  infecting  agent.  As  in  ordinary  wound 
infection,  so  in  mammitis,  streptococci  apparently  lead  in  viru- 
lence, while  the  staphylococci  are  believed  to  induce  a  milder 
form  of  inflammation. 

The  avenue  of  entrance  of  the  infecting  organisms  is  regularly 
through  the  orifice  of  the  teat.  Their  source  of  origin  may 
offer  great  variet)-,  but  ordinarily  the  infecting  organisms  are 
abundant,  and  only  require  some  favorable  opportunity  for  pass- 
ing through  the  teat  orifice  and  gaining  the  interior  of  the  gland. 
The  more  abundant  and  virulent  the  micro-organisms  in  the  imme- 
diate environment  of  the  cow,  the  more  probable  the  infection. 
The  bedding,  floor  and  stall  constantly  afford  more  or  less  infective 
material,  the  virulence  of  which  may  be  partly  dependent  upon 
the  cleanliness  of  the  stall,  but  in  the  main  is  not  understood.  The 
dairyman  may  reduce  the  degree  of  filth,  and  hence  of  infection, 
to  the  minimum.  Accidental  conditions  which  we  do  not  under- 
stand sometimes  seem  to  cause  a  sudden  increase  of  virulence  or 
volume  of  infection  in  the  stable,  which  may  express  itself  for  a 
time  in  the  form  of  enzootic  mammitis. 

In  a  large  proportion  of  cases,  there  are  good  clinical  evi- 
dences of  the  source  of  origin  of  the  infecting  material.  When- 
ever a  suppurating  wound  exists  upon  a  teat,  or  some  adjacent 
part  of  the  udder,  and  the  pus  has  an  opportunity  to  flow  down 
the  teat  to  come  in  contact  with  the  teat  orifice,  mammitis  al- 
most invariably  follows,  unless  some  adequate  precautions  are 
promptly  taken  by  the  veterinarian  to  bar  the  entrance  of  the 
infection  through  the  milk  canal.  Retained  and  decomposing  after- 
birth, or  any  putrid  discharge  from  the  uterus  or  vagina,  always 
tends  very  .strongly  to  induce  mammitis.  The  pus  flowsdown  over 
the  thighs  and  udder,  and  thence  along  the  teat,  naturally  the 
posterior  teat,  and,  gaining  the  apex  of  this,  the  infection  finds 
its  way  upward  through  the  orifice  in  the  teat,  and  mammitis  at 
once  results.  Possibly  more  direct  and  effective  is  the  infection 
through  the  teat  orifice,  when  a  retained  afterbirth  hangs  down 
so  low  that  it  comes  in  direct  contact  with  the  teat  and  is  actually 
pressed  against  the  teat  orifice.  Or  the  tail,  saturated  with  the 
discharges  from  the  vulva,  may  be  lashed  against  the  ends  of  the 
teats  and  force  the  infection  into  the  teat  orifice.     Not  only  may 


Acute  Mamynitis  943 

such  a  cow  bring  about  an  infection  of  her  own  udder,  but  with 
her  soiled  tail  she  may  convey  the  infection  to  another  cow  in  an 
adjacent  stanchion,  or  the  neighboring  cow  may  strike  her  tail 
against  the  soiled  parts  of  the  diseased  animal,  and  thence  carry 
the  infection  to  her  own  udder. 

There  is  frequently  convincing  clinical  evidence  that  a  milker 
carries  the  infection  to  a  healthy  teat.  He  may  get  the  infec- 
tion upon  his  hands  from  an  animal  which  is  suffering  from 
mammitis,  and  may  readily  convey  it  to  another  teat  of  the  same 
udder,  or,  without  washing  his  hands,  may  carry  it^  farther  and 
deposit  the  infection  upon  the  teats  of  a  healthy  cow,  and  induce 
the  disease.  It  is  not  essential  that  the  milker  should  get  the 
infection  from  a  diseased  milk  gland.  He  can  as  readily  and 
as  seriousl}'  infect  his  hands  by  handling  a  putrid  afterbirth,  or 
an  aborted  fetus,  or  an  infected  wound  upon  any  animal,  and,  by 
negligence  or  oversight,  carry  the  infection  to  the  udder  of  a 
healthy  cow. 

It  has  been  suggested  that,  when  cows  lie  down,  straws  from 
their  bedding  may  be  pushed  through  the  orifice  into  the  milk  cis- 
tern and  carry  with  them  virulent  and  infectious  material,  and 
there  have  probably  been  sufficient  observations  upon  this  point 
to  establish  the  fact  that  such  infections  really  occur.  Every 
veterinarian  in  dairy  practice  has  probably  observed  numerous 
cases  of  infection  by  means  of  the  milk  tube.  Laymen  very 
generally  believe  that  they  can  meddle  with  the  inside  of  a  cow's 
teat  with  the  same  degree  of  abandon  with  which  they  may 
handle  the  outside,  and  many  of  them  do  not  hesitate,  upon  the 
least  excuse,  to  insert  a  milk  tube,  a  sound,  a  wire,  a  knitting 
needle,  or  almost  any  implement,  into  the  teat,  and  do  not  an- 
ticipate therefrom  any  serious  consequences. 

Thus,  in  many  ways  infection  of  a  virulent  character  may  be 
forced  through,  or  find  its  entrance  into,  the  milk  cistern. 
Once  it  has  reached  the  milk  cistern  and  milk  canals,  it  is  in  a 
favorable  environment  for  growth.  The  infection  may  then  ex- 
tend according  to  virulence  and  the  resistance  of  the  tissues, 
along  the  larger,  and  thence  along  the  smaller  milk  ducts,  and 
may  finally  reach  the  milk  acini  and  attack  the  secretory  epithe- 
lium of  those  structures,  and  produce  any  symptoms  or  patho- 
logic conditions  which  the  various  forms  of  organisms  are  capa- 
ble of  inducing  in  such  tissues. 


944  Veterinary  Obstetrics 

The  handling  of  parturient  paresis  by  intra-mammary  injection 
is  a  fruitful  source  of  mammitis,  as  already  related  while  discuss- 
ing that  affection. 

Most  infections  of  the  body  have  been  attributed  to  "  taking 
cold,"  and  it  is  assumed  that  mammitis  may  be  caused  or  its 
establishment  favored  by  exposure  to  cold,  dampness  or  drafts. 
Perhaps  these  factors  do  depress  the  system  and  favor  the  advent 
of  mammitis. 

Contusions  exert  an  important  inriuence  by  devitalizing  the 
tissues  and  rendering  them  more  vulnerable  to  infection.  Thus 
a  very  pendent  udder,  buffetted  back  and  forth  between  the  legs 
of  a  rapidly  moving  cow,  may  seriously  contuse  the  gland  and 
destroy  its  normal  power  of  resistance.  A  rough  milker  may 
readily  induce  contusions  of  the  udder  which  may  do  much  to 
cause  mammitis. 

It  is  unnecessary  for  the  infection  to  be  introduced  immedi- 
ately from  the  outside.  The  teat  orifice  and  lower  part  of  the 
cistern  already  contain,  in  the  milk,  some  bacteria,  usually  of  a 
kind  not  pathogenic  for  the  parts  so  long  as  the  gland  is  not  dis- 
turbed. Whenever  the  gland  is  contused,  or  other  accident  occurs 
to  depress  the  vitality  of  the  ti.ssues,  the  hitherto  harmless  (sap- 
rophytic) bacteria,  may  become  pathogenic. 

When  the  udder  is  overdistended,  the  tissues  become  weakened 
and  infection  is  favored.  The  whole  udder  projects  very  promi- 
nently in  the  cow,  and  is  accordingly  exposed  to  injury.  The 
posterior  teats  are  shorter  than  the  anterior,  are  more  rigid,  and 
are  directed  more  or  less  backward  in  a  direction  which  renders 
them  more  susceptible  to  injury  from  pressure  and  from  dirty 
bedding-straws  being  pushed  through  the  orifice  into  the  milk 
cistern. 

Symptoms.  Mastitis  occurs  almost  wholly  in  cows  in  full 
milk,  and  chiefly  very  soon  after  calving.  It  is  at  this  time 
that  the  udder  is  most  active,  and  consequently  offers  the  great- 
est vulnerability  to  infection,  and  it  is  at  this  period  that  the 
udder  is  most  exposed  to  virulent  infections  of  various  kinds. 
The  maximum  distension  of  the  udder  subjects  the  secretory 
tissues  to  a  compression,  which,  if  not  promptly  relieved  by  milk- 
ing, lowers  the  powers  of  resistance  in  the  parenchyma  of  the 
gland.  At  the  same  time,  the  engorgement  causes  the  udder  to 
oroject  farther,  more  directly  and  rigidly  from  the  body  walls, 


Acute  Manimitis  945 

exposing  the  udder  and  teats  to  increased  danger  from  contu- 
sions and  abrasions  ;  intensifies  the  danger  of  forcible  contact 
of  the  teat  orifice  with  infected  objects  ;  and  favors  the  entrance 
into  the  teat  of  straws  or  other  rigid  infection-bearing  bodies. 
The  disease  may  occur,  however,  at  any  date  during  the  period 
of  milking,  or  in  the  dry  cow.  We  have  observed  the  disease 
in  heifers. 

Usually  only  one  quarter  of  the  udder,  most  commonly  a  pos- 
terior one,  is  involved.  The  disease  may  simultaneously  or  con- 
secutively affect  two,  three  or  all  of  the  quarters. 

The  period  of  incubation  in  acute  manimitis  is  brief.  Experi- 
mental infection  has  induced  the  symptoms  of  manimitis  in  12- 
24  hours.  We  also  observe  a  similar  period  of  incubation  clini- 
cally following  operative  interference  of  the  mammae.  The 
forcible  insertion  of  a  milk  tube  ;  the  inflation  of  the  udder  in 
milk  fever  ;  or  the  overcoming  of  atresia  of  the  teat  by  incision 
or  puncture  is  frequently  followed  by  manimitis  in  12-24  hours. 

Lameness  is  a  common  and  early  symptom  of  the  disease. 
It  is  frequently  the  first  symptom  observed  by  the  owner, 
though  it  may  occur  at  any  time  during  the  disease.  The  lame- 
ness may  be  referable  to  three  different  causes. 

1.  In  the  first  stages  of  the  disease,  the  owner  may  observe 
lameness  as  the  first  symptom  of  manimitis.  In  such  cases  the 
lameness  is  apparently  an  expression  of  pain  in  the  affected 
quarter  or  quarters.  The  lameness  may  be  more  severe  when  a  hind 
quarter  is  involved  than  when  an  anterior  one  is  affected,  because, 
in  progression,  the  posterior  quarter  is  more  severely  compressed 
or  contused  by  the  hind  leg  as  the  limb  is  carried  forward  and 
weight  placed  upon  it.  Doubtless  not  all  the  pain  and  conse- 
quent lameness  is  due  to  the  sensitiveness  of  the  affected  quarter, 
but  must  be  largely  referred  to  lymphangitis  or  phlebitis  of  the 
chief  mammary  veins  and  lymphatics  in  their  course  through 
the  inguinal  canal,  where  any  tenderness  causes  intense  pain  dur- 
ing any  movements  of  the  limbs  or  body  which  may  bring  into 
play  the  surrounding  muscles.  When  both  sides  of  the  udder 
are  simultaneously  inflamed,  the  disinclination  to  move  becomes 
very  strong,  with  evidences  of  very  great  pain. 

2.  Pysemic  arthritis  may  arise  at  any  time  during  the  affec- 
tion, as  a  complication  of  manimitis,  and  induce  symptoms  par- 
allel in  all  respects  with  the  pyaemic  arthritis  already  described 

60 


946  Vetermary  Obstetrics 

on  page  902  as  a  sequel  to  puerperal  infection.  Such  arthritis 
cannot  be  differentiated  from  that  arising  from  septic  infianmia- 
tion  of  the  uterus,  except  it  occurs  at  a  time  when  the  uterine 
avenue  of  infection  ma^'  be  excluded. 

3.  Paretic  lameness  or  paralysis  occa.sionally  accompanies 
mammitis,  and  appears  in  two  somewhat  distinct  forms. 

a.  Acute  mammary  gangrene  with  acute  septicaemia  fre- 
quently causes  rapid  and  complete  paraly.sis  of  the  posterior 
portions  of  the  bodj- . 

In  particularly  stormy  mammitis  with  gangrene,  complete  par- 
alysis has  .sometimes  been  the  first  symptom  observed  by  the 
owner.  During  the  night,  or  other  interval  without  observation, 
other  preliminary  symptoms  may  have  come  and  gone,  and  when 
first  observed  the  cow  is  prostrate  and  unable  to  rise. 

b.  Mammary  toxaemia  or  pseudo-parturient  paresis  may 
occur  in  very  mild,  insidious  cases  of  mammitis.  Ere  the 
owner  or  veterinarian  realizes  or  suspects  .serious  consequences, 
the  cow  goes  down,  is  more  or  less  completely  paralyzed,  her 
temperature  may  be  sub-normal,  and  more  or  less  marked  coma 
may  appear.  Two  facts  serve  to  differentiate  this  from  parturient 
paresis.  It  occurs,  or  may  occur,  four  to  six  weeks  after  partu- 
rition, perhaps  in  an  animal  not  a  good  subject  for  parturient 
paresis,  and  a  history  of  the  case  will  reveal  the  existence  of  a 
more  or  less  evident  mammitis.  According  to  our  observation 
the  mammitis  in  such  cases  has  been  of  a  very  mild  type,  slight 
swelling,  the  disease  apparently  confined  chiefly  to  the  milk 
cistern  and  ducts  and  accompanied  by  well  marked,  though  not 
extreme,  changes  in  the  secretions  of  the  affected  quarter.  The 
milk  had  for  a  few  hours  been  thin,  wheye}-  and  flocculent,  but 
not  fetid. 

Apparently  such  paral3^sis  is  due  to  toxaemia  from  the  absorp- 
tion of  bacterial  products  from  the  di.sea.sed  udder.  In  one  ca.se 
observed  by  us,  inflation  of  the  udder  with  oxygen  promptly 
overcame  the  paralysis  and  coma,  and  apparently  also  disinfected 
the  diseased  quarter. 

The  local  symptoms  of  mammitis  consist  essentially  of  the 
cardinal  symptoms  of  inflammation,  with  the  various  conse- 
quences of  inflammation  in  these  ti.ssues. 

Heat  is  usually  a  prominent  symptom  in  the  affected  quarter, 
and  is  very  readily  recognized   by   the  sense  of  touch,  especially 


Acute  Manimitis  947 

when  compared  with  au  adjacent  healthy  quarter.  The  intensit3^ 
of  heat  is  not  indicative  of  the  seriousness  of  the  inflammation 
within  the  gland.  The  inflammatory  processes  may  be  chiefly 
taking  place  in  the  central  portion  of  the  gland, and  the  skin 
may  be  but  slightly  involved.  While  the  presence  of  heat  may 
aid  in  the  diagnosis,  it  is  of  comparatively  little  value  as  an  aid 
to  prognosis. 

The  pain  in  the  inflamed  gland  shows  every  possible  variation 
in  intensity.  As  in  the  case  of  heat,  so  the  degree  of  pain  does 
not  reveal  the  seriousness  or  extent  of  the  malady.  As  a  general 
rule,  the  pain  is  most  marked  upon  pressure  when  the  disease  is 
largel}'  concentrated  in  or  about  the  teat,  that  is,  when  the  disease 
most  seriously  involves  the  more  superficial,  sensitive  portions 
of  the  gland.  There  may  be  a  deep-seated  inflammation  of  the 
gland,  which  may  be  freely  palpated  without  causing  evidence 
of  great  pain.  When  necrosis  occurs  in  any  part  of  the  gland, 
sensation  in  that  portion  necessarily  ceases. 

The  redness  of  the  tissues  is  usually  in  harmony  with  the  de- 
gree of  heat  and  pain.  When  the  inflammation  is  at  all  super- 
ficially located,  the  redness  is  usually  very  intense,  and  in  marked 
contrast  to  the  color  of  the  adjacent  healthy  quarters.  When 
gangrene  occurs,  and  involves  the  skin,  that  portion  which  is 
gangrenous  assumes  a  necrotic-black  or  necrotic-green  hue,  and 
the  epidermis  ma}^  .slip  off  upon  touch,  exposing  the  naked  skin. 

Swelling  constitutes  one  of  the  most  prominent  and  important 
local  symptoms.  At  the  very  beginning  of  the  di.sease,  the  swell- 
ing is  usually  quite  evident  to  both  sight  and  touch.  It  becomes 
especially  marked  when  the  healthy  quarters  of  the  gland  have 
been  milked  out.  Upon  manipulation,  the  di.seased  quarter  is 
found  to  be  more  or  less  extensively  enlarged,  sometimes  to  double 
the  .size  of  the  corresponding  normal  quarter  when  filled  with 
milk.  There  is,  however,  a  somewhat  definite  limit  to  the  rapid 
swelling  of  the  gland,  owing  to  the  very  inextehsible  gland  cap- 
sule. As  the  inflammation  continues,  the  capsule  may  become 
slowly  increased  to  an  enormous  size. 

There  are  variations  in  the  character  of  the  swelling,  depend- 
ent somewhat  upon  the  chief  center  of  the  disease  and  the  viru- 
lence of  the  infecting  agent.  When  the  inflammation  is  deep- 
seated,  the  external  appearances  of  swelling  may  consist  very 
largely  of  edema,  which  appears  subcutaneously  about  the  upper 


948  Vetermary  Obstetrics 

part  of  the  udder,  and  may  extend  forward  along  the  floor  of  the 
abdomen  toward  the  anterior  limbs,  and  upward  and  backward 
between  the  thighs  to  the  vulva  and  perineum.  Sometimes  the 
volume  of  the  edema  is  very  great,  while  at  other  times  edema 
may  be  virtually  absent. 

In  other  instances,  the  swelling  assumes,  instead,  the  character 
of  induration,  or  we  might  say  it  is  chiefly  within  the  capsule  of 
the  gland,  involving  the  glandular  and  interlobular  connective 
tissues  and,  by  causing  parenchymatous  engorgement,  stretches 
the  gland  capsule  tight  and  causes  a  firm  compression  of  the 
content-s  within.  Manipulation  of  the  diseased  quarter  reveals 
great  tenseness  and  hardness  in  the  deeper  parts  of  the  organ. 

When  suppuration  appears,  and  pus  is  formed,  there  soon 
occur  the  cardinal  symptoms  of  abscessation,  with  the  prominent 
firm  swelling,  redness  and  pain,  to  be  followed  by  fluctuation. 
Usually  there  is  a  single  abscess  involving  much  or  all  of  a 
quarter.  Rarely  one,  two  or  all  the  quarters  become  the  seat  of 
multiple  recurrent  abscesses,  the  udder  enormously  enlarged, 
with  abscesses  scattered  here  and  there,  discharging  copiously  a 
thick,  fetid  pus. 

When  gangrene  supervenes,  the  redness,  pain  and  heat  may 
disappear,  the  swelling  may  become  .softer,  and,  if  the  skin  is  in- 
volved, the  surface  becomes  cold  and  the  epithelium  is  readily 
displaced. 

When  the  disease  continues  for  a  long  period  of  time,  and 
enters  upon  a  chronic  state,  sclerosis,  with  absence  of  pain  and 
heat,  may  follow,  and  the  gland  assume  an  enormous  .size. 

The  disturbance  of  function  in  the  gland  is  one  of  the  most 
marked  and  important  symptoms  of  mammitis.  From  the  very 
first,  there  is  a  more  or  less  marked  decrease,  or  a  total  suspension 
of  the  secretion  of  milk  in  the  affected  quarter.  At  the  same  time, 
there  usually  occurs  a  more  or  less  marked  diminution  in  the 
amount  of  milk  secreted  by  the  apparently  healthy  quarters. 

The  changes  in  the  character  of  the  milk  are  highly  important, 
and  reveal  to  a  certain  extent  the  virulence  of  the  malady.  The 
milk  loses  its  neutral  or  faintly  alkaline  character,  and  becomes 
somewhat  acid.  The  casein  becomes  precipitated  and  flocculent. 
The  clumps  of  casein  may  be  so  tough  and  of  such  large  size  as  to 
render  it  difficult  or  impossible  for  them  to  be  forced  out  through 
the  teat  orifice.    In  many  cases  they  probably  remain  incarcerated 


Acute  Maynniits  949 

in  the  larger  milk  ducts,  to  add  to  the  engorgement  of  the  gland. 
The  liquid  portions  of  the  milk  are  watery,  and  vary  in  color 
according  to  circumstances.  Usually  in  the  earlier  stages  the 
liquid  portion  of  the  milk  is  white,  faintly  bluish-white,  or  yellow. 
Sometimes  it  is  streaked  wdth  blood,  or  merely  somewhat  tinged 
with  blood,  to  give  it  a  faint  reddish  color.  When  gangrene  ap- 
pears, the  liquid  which  may  drip  or  be  expressed  from  the  teat 
has  a  tell-tale  necrotic-red  color,  which  at  once  reveals  the  con- 
dition of  the  deep-seated  tissues. 

The  albumen  in  the  milk  may  be  increased  ten-fold  ;  the  salts 
may  be  largely  increased  ;  while  the  fat  and  casein  almost  dis- 
appear. Sometimes  the  contents  of  the  milk  cistern  are  princi- 
pally or  wholly  of  pus. 

^he  milk  may  be  either  odorless  or  more  or  less  fetid.  In 
many  cases,  when  the  diseased  liquid  is  pressed  out  from  the  teat 
and  caught,  it  is  found  to  be  extremely  fetid,  giving  off  the  odor 
of  fetid  pus  from  wounds.  In  gangrene,  the  typical  gangrenous 
odor  may  be  present  in  the  fluid.  The  taste  of  the  diseased  milk 
shows  every  possible  variation,  usually  is  somewhat  salty  or  may 
be  bitter. 

Bacteriologically,  the  discharge  from  the  gland  may  be  highly 
variable,  and  include,  as  already  suggested,  various  forms  of 
diplococci,  streptococci  or  bacilli,  and  other  organisms  char- 
acteristic of  wound  infection.  The  infection  ma\'  be  pure  or 
mixed. 

The  systemic  disturbances  of  mammitis  are  not  always  in 
harmony  with  the  extent  and  intensity  of  the  local  lesions. 
Usually,  in  severe,  acute  mammitis,  there  are  well-marked  sys- 
temic disturbances,  consisting  essentially  of  fever  or  septicaemia. 
In  very  acute  cases  of  mastitis,  we  have  observed  the  tempera- 
ture rise  suddenly,  reaching  106°  F.  within  twenty-four  hours 
from  the  time  of  infection.  Generall}',  when  there  is  an  ex- 
tensive inflammation  of  the  udder,  a  more  or  less  marked  fever 
is  present,  with  all  the  symptoms  which  that  term  usually 
includes,  such  as  loss  of  appetite,  torpidity  of  the  bowels,  dry 
muzzle,  suspension  of  rumination  and  decrease  of  thirst.  The 
urinary  and  other  functions  are  decreased,  and  there  is  more  or 
less  profound  depression.  In  the  early  stages  of  the  disease, 
there  may  be  chills,  with  staring  coat.  When  the  disease  be- 
comes verv  severe,  there  ensues  a  loss  of  sensibility,  and   the 


950  Veterifiary  Obstetrics 

patient  ceases  to  care  for  her  calf  and  becomes  more  or  less  un- 
conscious of  her  surroundings.  When  gangrene  is  threatened  or 
present,  there  may  be  more  or  less  complete  paralysis,  as  already 
stated  ;  or  a  somewhat  similar  paralysis  may  occur  sometimes  as 
a  result  of  intoxication  owing  to  absorption  from  the  udder  of 
bacterial  products,  in  comparatively  mild  attacks. 

Course  and  Termination.  In  a  large  proportion  of  cases 
the  course  and  termination  of  the  disease  is  unfavorable.  Even 
in  those  cases  counted  as  recoveries,  the  glands  are  almost  inevi- 
tably more  or  less  damaged,  and  their  function  interrupted  either 
temporarily  or  permanently. 

The  complete  loss  of  one  or  more  quarters  by  atrophy,  indura- 
tion, abscessation  or  gangrene  is  common,  resulting  in  a  three-or 
two-teated  cow  of  greatly  diminished  value.  A  three- teated  cow 
may  yield  a  high  percentage  of  the  normal  amount  of  milk,  but 
the  diseased  and  functionless  gland  may  constitute  a  menace  to 
the  adjacent  quarters,  and  is  unsightly  and  unde.sirable.  When 
two  quarters  are^^lost,  the  decrease  in  the  milk  yield  is  so  great 
that  the  value  of  the  cow  as  a  dairy  animal  is  ordinarily  at  an  end. 

The  mortality  from  the  disease  is  by  no  means  insignificant. 
The  disease  may  terminate  in  resolution  ;  abscessation  ;  chronic 
mastitis,  with  atrophy  of  the  glandular  substance,  which  may  be 
accompanied  by  hyperplasia  of  the  connective  tissue  with  indu- 
ration and  enlargement ;  gangrene  ;  pyaemia  ;  or  septicaemia. 

a  Resolution  may  occur  early  in  the  attack,  at  any  period 
from  the  third  or  fourth  to  the  eighth  or  tenth  day,  or  even  later. 
In  very  acute  cases,  resolution  may  follow  in  the  counse  of  a  ver3^ 
few  hours  ;  in  fact,  in  some  very  virulent  cases  resolution  must 
occur  very  quickly  or  the  animal  neces.sarily  perishes.  When 
resolution  occurs,  the  swelling  and  pain  in  the  udder  abate,  the 
appetite  returns  and  the  milk  .secretion  becomes  re-established, 
while  the  general  appearance  of  the  animal  improves  in  harmony 
with  the  local  conditions.  The  milk  may  remain  somewhat  ab- 
normal for  a  time.  The  milk  flow  very  rarely  recovers  its  normal 
amount,  but  remains  somewhat  lessened  throughout  the  involved 
milking  period.  The  volume  may  or  may  not  become  fully  re- 
stored at  the  next  calving. 

Vennerholm  agrees  with  Franck  that  resolution  .seldom  follows, 
while  vStockfleth  estimates  that  resolution  occurs  in  at  least  50% 


Acute  Mainmitis  951 

of  the  cases.      In  our  experience  resolution  has  been  very  rare 
indeed. 

Too  frequently  the  acute  disease  passes  into  the  chronic  form. 
If  the  changes  brought  about  by  the  disease  are  not  too  serious, 
the  period  of  rest,  while  the  cow  is  dry,  may  afford  an  oppor- 
tunity for  the  complete  resolution  of  the  gland,  so  that  when  she 
again  calves  she  may  yield  almost  or  wholly  her  normal  amount 
and  quality  of  milk.  If  the  gland  has  been  once  seriously 
affected,  it  is  rendered  so  vulnerable  to  any  subsequent  infection 
that  the  disease  may  at  any  time  recur. 

b.  Suppuration  and  the  formation  of  abscesses  may  originate 
in  any  of  the  tissues  of  the  gland — in  the  subcutaneous  connec- 
tive tissue,  the  inter-lobular  connective  tissues,  or  the  paren- 
chyma of  the  gland. 

In  many  cases  we  observe  that  the  suppuration  affects  chieflj- 
the  epithelium  of  the  milk  canals  and  acini,  to  constitute  ca- 
tarrhal mastitis,  in  which  case  there  may  not  be  very  extensive 
swelling,  and  the  area  of  the  disease  may  be  more  or  less  con- 
fined to  the  milk  cistern  and  the  larger  milk  canals,  without  in- 
volving seriously  the  acini  themselves.  Rarely  an  abscess 
forms  in  the  milk  cistern,  without  involving  the  parenchyma 
of  the  gland  at  all.  Abscesses  in  the  milk  cistern  are  very  liable 
to  cause  the  destruction  of  the  milk  canals,  by  causing  their  com- 
plete atresia,  .so  that  they  can  never  re-open.  The  formation  of 
abscesses  in  the  udder  leads  almost  uniformly  to  the  permanent 
destruction  of  the  involved  quarter,  though  in  rare  instances 
there  may  be  a  partial  restoration  of  milk  production  after  the 
next  calving. 

Purulent  mastitis  may  lead,  in  somewhat  rare  instances,  to 
pyaemia  or  to  metastatic  complications  of  the  joints  or  tendon 
sheaths.  Abscesses  may  become  encapsulated,  with  indurated 
abscess  walls  which  surround  the  pus,  and  continue  as  hard 
swellings  in  the  affected  part. 

c.  Atrophy  of  the  gland  substance  occurs  frequently,  with  or 
without  induration. 

Following  many  cases  of  acute  mastitis,  a  chronic  inflamma- 
tion remains,  which  causes,  in  addition  to  the  atrophv  of  the 
substance  of  the  gland  itself,  an  extensive  hyperplasia  of  the 
inter-lobular  substance.  The  gland  becomes  indurated,  hard, 
and  incapable  of  secreting  milk.     The  indurated  gland  may  as- 


952  Veterinary  Obstetrics 

sume  enormous  proportions,  and  finally  take  the  character  of  a 
connective  tissue  tumor,  and,  b}'  its  weight,  drag  the  capsule  of 
the  quarter  downward  until  it  nearly  reaches  the  ground.  In  some 
cows  the  indurated  udder  is  so  enormous  in  size,  and  hangs  so 
low,  that  it  interferes  greatly  with  locomotion.  It  is  constantly 
subject  to  injuries  during  the  animal's  movements,  by  coming  in 
contact  with  obstacles  of  various  kinds,  which  cause  wounds 
and  contusions  and  bring  about  infections  of  the  enlarged  function- 
less  gland  which  may  give  more  or  less  annoyance. 

At  each  birth  period,  also,  indurated  glands  are  liable  to  be- 
come congested  and  inflamed,  and  give  rise  to  more  or  less  serious 
complications.     Such  a  gland  is  always  beyond  restoration. 

d.  Gangrene.  Gangrene  constitutes  the  most  .serious  termi- 
nation of  mastitis,  because  it  destroys  absolutely  the  function  of 
all  that  portion  of  the  gland  which  is  involved,  and  seriously  im- 
perils the  life  of  the  animal.  It  occurs  usually  as  a  direct  result 
of  the  intense  infection  of  the  part,  which  leads  to  the  destruc- 
tion of  the  circulation  in  the  affected  gland.  It  may  appear  very 
quickly,  or  may  be  somewhat  delayed  in  its  advent.  Gangrene 
may  involve  the  parenchymal  and  inter- lobular  tissues  alone,  or 
ma}'  include  the  .skin.  It  may  be  confined  to  one  of  the  quarters 
or  a  portion  of  it,  or  may  involve  the  half  or  all  of  the  gland. 
The  gangrenous  portion  may  partially  undergo  purulent  destruc. 
tion.  The  surrounding  parts  may  suppurate  in  such  a  manner 
that  a  sequestration  of  the  necrotic  tissue  occurs,  and  the  gan- 
grenous portion  is  later  thrown  off. 

In  the  more  acute  forms  of  gangrenous  mammitis,  the  course 
of  the  di-sease  is  entirely  too  rapid  and  virulent  for  a  sequestrum 
to  form  or  suppuration  to  take  place,  and  the  animal  dies  very 
quickly  from  acute  septicaemia  or  pyaemia.  Few  diseases  run  a 
more  stormy  course  than  the  more  acute  types  of  gangrene  of 
the  mammae.  In  one  instance,  which  we  observed,  a  cow  was  left 
apparently  well  at  milking  time  in  the  evening  ;  when  found  the 
next  morning  she  was  down  and  unable  to  rise  because  of  acute 
mammitis,  which  quickly  advanced  to  gangrene  of  the  organ  ; 
she  died  during  the  day.  Other  instances  have  been  observed 
where  the  di.sease  has  pursued  a  similarly  rapid  course. 

Pathology.  The  pathology  of  mammitis  includes  every  pos- 
sible morbid  change  in  an  acinous  gland,  important  changes  in 
the  milk  secretions,  and  such  systemic  disorders  as  pyaemia  and 


Acute  Maniniitis  953 

septicsemia,  which  may  emanate  from  the  disease  processes  in 
the  glands. 

An  incision  through  a  milk  gland  recently  attacked  by  mam- 
mitis,  reveals  engorgement,  injection  and  hemorrhages  in  the 
parenchyma.  The  milk  canals  contain  abnormal  secretions,  usu- 
ally flocculent  in  character,  due  to  clots  of  casein.  The  groups 
of  acini  upon  the  cut  surface  appear  as  small  yellow  clumps. 
Serous  or  sero-sanguineous  fluid  may  be  pressed  from  the  cut 
surface. 

If  the  disease  assumes  the  catarrhal  type,  and  limits  its  rav- 
ages chiefly  to  the  epithelium  of  the  gland,  the  milk  cistern  and 
milk  ducts  usually  contain  muco-purulent  or  purulent  secre- 
tions. The  accumulated  secretions  may  be  thin  and  watery  v\nth 
caseous  clots  floating  in  them,  stringy  and  tenacious,  or  purulent 
and  fetid. 

Sometimes  the  disea.se  may  be  limited  to  the  milk  cistern,  and  a 
catarrhal  inflammation  ensue  with  discharge  of  the  pus  through 
the  teat  orifice  ;  or  the  teat  orifice  may  become  blocked,  con- 
verting the  cistern  temporaril}^  into  an  abscess  cavity,  which 
eventually  ruptures  by  re-opening  of  the  milk  orifice,  and  the  dis- 
charge of  the  accumulated  pus  follows.  Such  an  abscess  tends  to 
cause  permanent  atresia  of  the  larger  milk  ducts  and,  preventing 
the  escape  of  milk  into  the  cistern,  produces  engorgement  of 
that  portion  of  the  gland  from  which  the  affected  duct  normally 
serves  as  an  outlet.  Later  the  engorgement  destroys  the  secre- 
tory power  of  the  part,  and  there  may  remain  for  a  time  an  im- 
prisoned volume  of  milk — a  "  milk  cj'st."  Catarrhal  inflamma- 
tion of  the  milk  cistern  may  lead  to  atresia  or  adhesions  in  any 
part  of  the  cavity.  Sometimes  the  entire  milk  cistern  becomes 
occluded,  the  cistern  walls  adhere  from  the  base  to  the  apex  of 
the  teat,  and  even  though  the  gland  itself  may  escape  destruc- 
tive inflammation,  it  is  later  doomed  to  pressure  atrophy  from 
the  compression  of  the  imprisoned  milk.  Such  adhesions  occur 
most  readily  in  the  dry  cow  or  heifer,  when  the  changes  named 
are  not  interrupted  by  a  constant  flow  of  milk  into  the  cistern. 

When  the  catarrhal  inflammation  extends  to  the  smaller  milk 
ducts  and  acini,  the  secretory  epithelium  is  more  or  less  injured 
or  wholly  destroyed,  while  the  cavities  of  the  acini  become  oc- 
cluded with  exudate.      Later  the  glandular  tissue  may   undergo 


954  Veterinary  Obstetrics 

atrophy.  The  atrophy  may  be  intensified  and  increased  by 
hyperplasia  of  the  inter-lobular   connective   tissue   septa. 

Treatment.  The  treatment  of  mammitis  is  nece.ssarily  unsat- 
isfactory. 

The  anatomy  of  the  gland  is  such  that  when  the  tissues  be- 
come infected  there  is  no  known  method  of  reliable  disinfection. 
Acute  inflammation  of  the  parenchyma  at  once  causes  the  milk 
ducts  and  acini  to  become  filled  with  exudate.  Into  these 
blocked  passages  we  are  powerless  to  introduce  remedies,  and 
from  them  we  are  alike  powerless  to  extract  the  exudate.  The 
gland  is  firmly  bound  down  by  its  very  tense  fibro-elastic  cap- 
sule, derived  from  the  abdominal  tunic.  When  the  imprisoned 
gland  becomes  inflamed  and  swollen,  great  pressure  is  at  once 
exerted  upon  its  substance  by  the  unyielding  capsule,  its  circula- 
tion is  impeded  or  suspended,  and  the  infecting  agent  is  afforded 
an  excellent  opportunity  for  rapid  multiplication  and  destructive 
activity  in  the  weakened  tissues.  Further  complications  arise 
from  the  dependent  position  of  the  gland,  which  interferes  seri- 
ously with  the  return  of  the  venous  blood. 

As  in  all  diseases  where  no  specific  method  of  handling  has 
been  devised,  so  in  mammitis,  an  almost  endless  variety  of  means 
have  been  suggested,  tried,  approved  or  condemned.  It  is  im- 
practicable to  relate  each  method  of  handling,  nor  would  it  be 
profitable. 

The  various  forms  of  handling  may  be  more  or  less  definitely 
classified. 

I.  Disinfection.  Since  acute  mammitis  is  referable  to  infec- 
tion, the  most  rational  course  for  treatment,  the  one  which 
technically  appeals  most  directly  to  reason,  is  disinfection.  Un- 
fortunately, as  already  stated,  we  have  no  efficient  plan  for  bring- 
ing this  about.  Three  plans  for  disiufectiou'.have  been  tried, 
and  each  has  had  its  champions,  possibly  because  each  possesses 
some  degree  of  efficiency. 

a.  Intra-mammary  injections  of  disinfectants  have  long 
been  practiced  and  advised  by  .some  veterinarians,  but  the  plan 
has  never  acquired  general  adoption.  Nocard,  Franck  and 
other  authorities  have  reported  favorably.  Vennerholm,  Zschokke 
and  other  equal  authorities  have  failed  to  secure  benefit  from 
this  method  of  handling.  In  our  hands,  a  2  @  5%  boric  acid 
solution,    injected    into    the   udder    by   gravity,    has    not    only 


Acute  Mammitis  955 

failed  to  reduce  the  infection  and  inflammation  but  has  appar- 
ently intensified  the  disease. 

In  the  healthy  udder,  only  a  small  amount  of  fluid  can  be 
introduced  under  a  gravity  pressure  of  three  or  four  feet.  We 
have  succeeded  in  this  manner  in  injecting  little  more  than  a 
pint  into  a  quarter  from  which  five  to  eight  times  that  volume  of 
milk  had  been  withdrawn.  This  signifies  that,  in  the  health}- 
udder,  fluids  injected  through  the  teat  pass  into  the  cistern  and 
larger  milk  canals,  but  not  into  the  smaller  milk  ducts  and  the 
acini. 

In  the  vast  majority  of  cases  of  mammitis,  the  small  ducts 
and  acini,  not  the  milk  cisterns  and  larger  canals,  constitute 
the  chief  center  of  disease.  Fluids  injected  into  the  udder 
usually  reach  the  least  important  part  of  the  gland  only — the 
cistern  and  large  canals.  As  a  consequence,  not  much  can  be 
expected  from  this  plan  of  handling.  If  the  disease  is  largely 
centered  in  the  cistern  and  large  sinuses,  disinfection  b}'  intra- 
mammary  injections  may  prove  highly  efficient,  but  such  cases 
are  in  the  minority. 

The  selection  of  a  disinfectant  for  such  purpose  is  not  highly 
important,  though  certain  principles  may  have  clinical  import- 
ance. Boric  and  other  acids  tend  to  coagulate  any  casein  or 
albumen  present.  The  same  holds  true  of  mercuric  chloride, 
and  the  salts  of  the  heavy  metals  generally.  Carbolic  acid, 
creolin  and  allied  drugs  are  highly  irritant.  Probably  lysol, 
bacillol  and  other  drugs  of  this  group  are  most  useful  for 
injection. 

Whatever  disinfectant  is  employed,  it  must  be  in  very  weak 
solution.  Of  lysol  or  bacillol,  not  to  exceed  0.5%  should  be 
used.  The  chief  reliance  should  be  placed  upon  the  irrigation 
of  the  cistern  and  sinuses  with  the  warm  water,  rather  than 
upon  the  efficiency  of  the  antiseptic  contained.  The  various 
soluble  silver  salts  have  been  propo.sed  for  this  purpose,  but  have 
failed  to  secure  a  prominent  place. 

b.  Disinfection  by  external  applications  is  an  old  plan  of 
handling.  Probably  in  many  cases,  the  practitioner  has  not  had 
disinfection  in  mind  when  applying  it.  Camphor,  iodine  and 
mercury,  in  combination  with  various  substances,  have  long  been 
used  in  the  form  of  ointments  thoroughly  anointed  over  the 
affected  area.     Their  value  has  been  stoutly  asserted   by  practi- 


956  Veteri7iary  Obstetrics 

tioners  like  Johne,  Bang  and  Franck.  They  probably  exert  some 
favorable  influence  as  disinfectants.  It  is  possible,  however, 
that  the  massage  used  in  applying  the  ointment  constitutes  as 
great,  or  even  a  greater,  factor  than  the  absorbed  portion  of  the 
ointment.  The  drugs  named  are  also  rubefacients,  and  may 
favorably  affect  the  di.seased  gland  by  exciting  increa.sed  vas- 
cularity   with   exalted  leucocytosis. 

c.  Systemic  disinfection  in  mammitis  has  not  yet  received 
much  attention.  How  effectively  it  may  be  employed  remains  to 
be  determined.  We  know  that  potassium  iodide  exerts  a  some- 
what specific  effect,  when  given  internally,  upon  lesions  of  acti- 
nomycosis and  botryomycosis — chronic  infections  which  are  not 
wholly  unlike  the  acute  infections  of  ordinary  mammitis. 

Aromatics  and  gum  resins,  when  given  to  healthy,  lactating 
animals,  are  recognizable  in  the  milk  by  the  sense  of  odor  and 
taste.  Most  of  these  drugs,  like  camphor,  turpentine  and  the 
aromatic  oils,  are  efficient  disinfectants,  and  given  in  full  doses 
tend  somewhat  to  lessen  infection  in  the  mammary  gland. 

2.  Modifications  *in  the  blood-flow  to  the  udder  have  been 
claimed  to  affect  the  course  of  mammitis.  In  former  times  practi- 
tioners aimed  to  reduce  the  intra-mammary  blood  pressure  by 
means  of  venesection.  Local  applications  of  camphor,  belladonna 
and  other  drugs  have  been  made,  in  the  belief  that  they  decreased 
the  amount  of  blood  sent  to  the  udder,  though  the  truth  of  this 
has  not  been  clearly  shown.  On  the  other  hand  it  is  not  impos- 
sible that  they  increase  the  blood  supply  and  also  the  leucocy- 
tosis, through  which  the  treatment  may  act  favorably  upon  the 
diseased  organ. 

Just  as  in  the  application  of  anti.septics,  so  here  the  massage 
incident  to  application  ma}^  exert  the  chief  favorable  influence. 

Cold  has  been  used  and  advocated  by  some,  either  cold  water 
or  ice  being  applied  to  the  inflamed  gland.  It  has  not  proven  of 
any  marked  value.  Its  tendency  is  to  cause  decreased  vascu- 
larity during  the  continuance,  to  be  followed  by  increa.sed  blood 
flow  and  vascular  engorgement  as  soon  as  the  cold  is  withdrawn. 

Fomentations  with  hot  water,  to  which  vinegar  and  various 
other  drugs  are  added,  have  long  been  recommended,  and  with 
the  accompanying  massage,  appear  to  exert  a  favorable  influence. 
For  this  purpose,  a  sufficiently  capacious  vessel  should  be  filled 
with  as  hot  water  as  the  patient  can  bear,  and  the  vessel  placed 


Acute  Mammitis  957 

directly  beneath  the  udder.  The  fomentation  and  massage 
are  then  applied,  the  bath  being  kept  hot  by  repeated  additions 
of  hot  water. 

It  has  been  recommended  also  to  modify  the  blood  flow  in  the 
mammae  by  suspension  or  compres.sion  of  the  glands.  Some 
recommend  that  a  three-cornered  piece  of  cloth,  of  sufficient  size 
to  encompass  the  udder,  be  fitted  with  long  straps,  those 
from  one  corner  passing  up  behind  on  either  side  of  the  tail, 
those  from  the  other  corners  upwards  along  the  flanks,  and  all 
tied  securely  over  the  loins.  This  may  support  the  weight  of 
the  pendulous  udder,  exert  some  pressure  upon  it,  and  de- 
crease the  engorgement  of  the  gland.  Some  would  cut  holes  in 
the  suspensorium,  through  which  the  teats  may  project,  so  that 
the  cow  may  be  milked  ;  others  advise  that  the  teats  be  included 
in  the  bandage,  and  one  corner  detached  while  the  cow  is  being 
milked. 

It  has  also  been  proposed  to  strap  the  udder  tightly  with  strips 
of  adhesive  plaster,  and  to  thereby  exert  compression  upon  the 
gland,  but  the  plan  has  not  come  into  general  use,  presumably 
because  it  has  failed  to  produce  the  expected  results. 

The  form,  direction  and  location  of  the  udder  of  the  cow  render 
suspension  and  adhesive  strapping  exceedingly  difficult,  and  the 
efficiency  of  neither  has  been  demonstrated.  It  may  well  be 
questioned  whether  the  inevitable  partial  displacement  of  such 
appliances,  when  the  animal  lies  down,  does  not  induce  injuries 
which  more  than  counterbalance  any  possible  good  it  is  hoped 
to  derive  from  the  strapping  or  suspension. 

With  the  aid  of  the  suspensory  bandage,  poultices  were  for- 
merly applied  to  the  inflamed  udder.  They  were  highly  com- 
mended by  many,  but  their  use  has  been  largely  discontinued. 
They  are  difficult  of  application  and  retention,  and  their  value 
is  very  problematic. 

Instead  of  attempting  to  decrease  the  blood  flow  to  the  in- 
flamed gland,  some  would  increase  it.  This  is  probably  in  a 
measure  brought  about  by  nia.ssage  and  by  the  application  of 
stimulating  liniments.  Cupping  has  also  been  tried.  A  cup- 
ping glass  of  sufficient  size  is  fitted  over  the  teat  of  the  affected 
quarter,  and  the  air  exhausted.  This  may  cause  the  discharge  of 
quantities  of  secretions  which  could  not  be  withdrawn  by  milking, 
and  stimulates  increased  nutrition  in  the  diseased  tissues. 


958  Veteri7iary  Obstetrics 

Modern  therapeutics  recognizes  the  value  of  increased  numbers 
and  activity  of  leucocytes  in  a  diseased  area.  Cupping,  massage, 
repeated  milking,  fomentations,  and  the  application  of  stimulating 
liniments  or  ointments,  all  probably  favor  leucocytosis.  It  may 
be  that  the  chief  value  of  each  of  these  applications  lies  in  this 
influence  upon  the  abundance  of  leucocytes  in  the  part. 

3.  It  has  been  proposed  to  exert  a  favorable  influence  upon  the 
course  of  mammitis  by  decreasing  the  flow  of  milk.  In  a  way, 
this  plan  is  closely  allied  to  the  decrea.sing  of  the  blood  supply  to 
the  gland.  In  considering  the  symptoms  of  the  malady,  we  had 
occasion  to  note  the  inevitable  decrease  of  milk  secretion,  or  even 
its  total  suspension,  as  soon  as  mammitis  becomes  established. 
The  artificial  checking  of  the  secretion  of  milk  is  usually  quite 
unnecessary  ;  it  becomes  checked  or  suspended  as  an  inevitable 
con.sequence  of  the  disease.  Not  only  is  the  secretion  of  milk 
decreased  or  suspended  in  the  affected  quarter,  but  also  in  the 
sound  areas  of  the  gland. 

Nevertheless  many  practitioners  would  have  us  decrease  the 
milk  secretion  by  the  application  of  belladona  or  camphor  to  the 
exterior  of  the  affected  gland.  Others  recommend  reduction  of 
lactation  by  a  reduced  diet  or  by  laxatives  or  purgatives. 
Whether  or  not  these  be  of  direct  value  in  precisely  the  way  in- 
tended, is  possibly  of  no  great  consequence.  Two  essential  thera- 
peutic principles  are  involved  :  I.  The  maintainance  of  the  vigor 
of  the  animal  system — as  a  whole  ;  and,  2.  The  placing  of  the 
diseased  organ  at  rest.  We  cannot  maintain  the  highest  systemic 
vigor  upon  a  too  restricted  diet,  and  it  is  equally  injurious  to 
overfeed.  The  forced  feeding  of  dairy  cows  is  highly  inimical  to 
the  progress  of  mammitis,  just  as  it  is  of  any  other  serious  organic 
malady.  It  is  consequently  important  that,  in  mammitis,  the 
food  rations  be  adjusted  to  the  needs  of  a  sick  animal,  and  this  in 
itself  will  reduce  the  tendency  to  active  lactation.  For  this  pur- 
pose it  is  well  to  allow  a  restricted  ration  of  bran,  roots  or  grass, 
freely  salted,  to  emphasize  the  laxative  tendency. 

4.  Elimination  of  disease  products  frcwn  the  system. 
Acute  mannnitis  is  inevitably  accompanied  by  the  entrance  into 
the  system  of  important  disease  products  which  more  or  less  se- 
riou.sly  affect  the  general  health  of  the  patient.  These  disturb- 
ances are  reflected  back  to  the  affected  organ,  there  to  intensify 
the  local  disease.     Not  only  is  it  important,  for  the  progress  of 


Acute  Mani7nitis  959 

mammitis,  that  the  animal  S3'stem  be  kept  in  the  most  vigorous 
condition  possible,  but  it  is  equally  important  that  the  disease 
products  shall  be  promptly  eliminated. 

Whenever  these  fail  to  be  promptly  eliminated,  they  at  once  act 
unfavorably  upon  the  system,  inducing  fever,  with  its  important 
train  of  symptoms.  With  the  advent  of  fever,  the  kidneys, 
bowels  and  other  eliminating  organs  fail  to  perform  their  normal 
functions. 

Mastitis  in  ruminants  is  especially  marked  by  great  torpidity 
of  the  digestive  system  :  rumination  ceases,  the  bowels  are  tor- 
pid, digestion  is  at  a  standstill,  the  aliment  within  the  canal 
tends  to  undergo  decomposition,  and  waste  products  which  are 
normally  eliminated  through  this  channel  are  retained  within  the 
system. 

It  has  accordingly  long  been  the  custom  of  veterinary  practi- 
tioners to  favor  elimination  by  stimulating  the  alimentary  tract 
to  increased  activity.  This  is  partly  accomplished  by  a  laxative 
diet,  which  in  mild  cases  frequently  suffices.  In  the  more  .serious 
cases,  the  patient  does  not  eat,  or  for  other  reasons  a  laxative  diet 
fails  to  produce  the  desired  results  and  the  practitioner  needs  ap- 
peal to  more  radical  measures. 

The  administration  of  purgatives  in  acute  mammitis  has  ac- 
cordingly become  recognized  by  many  practitioners  as  highly 
valuable.  Most  practitioners  rely  upon  the  admini.stration  of 
magnesium,  or  sodium  sulphate  with  various  adjuncts.  Thej- 
have  the  common  defect  of  inducing  a  degree  of  nausea,  de- 
creased thirst  and  inappetence,  which  combine  to  retard  or 
prevent  catharsis.  At  best  they  are  slow  of  action.  Oils  are 
little,  if  any,  more  effective. 

In  our  experience,  the  hypodermic  cathartics — eserine,  areco- 
line  and^pilocarpine,  combined  where  advisable  with  strychnine — 
constitute  the  most  reliable,  prompt  and  efficient  means  for  un- 
loading the  alimentary  tract.  They  save  12  to  20  hours  in  time, 
hours  which  may  be  of  critical  importance  in  the  control  of  the 
maladj'  ;  they  are  safe  and  bear  quick  repetition  when  the  dose 
proves  too  small  ;  and  they  pos.sess  very  high  efficiency. 

In  one  case  occurring  in  our  clinic,  acute  mammitis  of  a  verj- 
virulent  type,  in  all  four  quarters,  followed  the  iodide  of  potas- 
sium infusion  in  handling  parturient  paresis.  The  temperature 
was  106°  F.,  the 'pulse  very  rapid,  the   muzzle  dry,  the  animal 


960  Veterinary  Obstetrics 

extremely  dull  and  weak  and  paying  no  attention  whatever  to 
her  calf.  The  udder  was  immensely  enlarged,  hard  and  unyield- 
ing, and  but  a  few  drops  of  a  thin,  serous  fluid  could  be  pressed 
out  of  the  teats.  The  general  appearance  of  the  animal  indi- 
cated that  the  di.sease  was  progressing  rapidly  to  a  fatal  termina- 
tion, and  in  our  judgment  the  patient  would  not  have  survived 
many  hours  under  the  usual  methods  of  treatment. 

We  ignored  the  local  handling  of  the  organ,  and  instead  in- 
jected a  full  dose  of  eserine  sulphate  and  pilocarpine  hydro- 
chlorate  hypodermically.  The  purgation  and  salivation  were 
very  prompt  and  decided.  The  improvement  in  the  condition  of 
the  animal  was  also  prompt  and  remarkable.  The  temperature 
fell  at  once,  and  continued  to  drop  at  the  rate  of  more  than  i°F. 
per  hour,  until  it  reached  normal.  The  muzzle  soon  became 
moist,  and  the  cow  renewed  her  attentions  to  her  calf. 

The  engorgement  of  the  udder  diminished  rapidly  ;  the  gland 
quickly  became  less  tense  and  hard,  and  milk  soon  reappeared 
in  the  gland.  The  recovery  was  as  prompt  as  had  been  the  onset 
of  the  di.sease,  which  had  shown  unusual  virulence  from  the 
beginning. 

Vennerholm  regards  the  repeated  withdrawal  of  the  milk  or 
excretions  representing  it,  and  thereby  the  removal  of  so  much 
infectious  material,  as  one  of  the  most  important  elements  in  the 
handling  of  acute  mammitis  in  the  earlier  stages.  He  recom- 
mends that  the  milk  which  accumulates  in  the  cisterns  should 
be  withdrawn  at  least  hourly  so  long  as  there  is  a  hope  of  bring- 
ing about  the  resolution  of  the  gland.  He  very  properly  re- 
marks that  the  infectious  fluid  should  on  no  account  be  depo.sited 
upon  the  stable  floor,  but  should  be  milked  directly  into  a  con- 
tainer partly  filled  with  a  reliable  disinfectant.  Too  much  reli- 
ance should  not  be  placed  upon  the  withdrawal  of  the  small 
amount  of  fluid  which  has  accumulated  in  the  milk  cistern.  In 
most  cases  of  acute  mammitis,  the  amount  of  this  is  not  large, 
although  we  know  full  well  that  it  is  highly  infected,  and  may 
consequently  look  upon  its  retention  in  the  cistern  and  sinuses 
as  very  undesirable.  The  important  pathologic  changes  are  tak- 
ing place  chiefly  in  the  acini,  and  not  in  the  milk  canals  or  cis- 
tern, and  such  influence  as  we  may  be  able  to  exert  upon  the 
large  milk  canals  and  their  reservoirs  is  not  of  fundamental 
importance.     Our  anxiety  is  centered  upon  the*  acini  themselves. 


Acute  Mammitis  961 

While  the  infection  has  admittedly  entered  through  the  milk 
cistern  and  the  milk  canals,  nevertheless  after  the  infection  has 
traversed  these  parts  and  reached  the  parenchyma,  the  import- 
ance of  these  canals  in  the  course  of  the  disease  has  been  largely 
eliminated. 

When  considering  the  symptoms  of  acute  mammitis  we  have 
referred  to  the  advent  of  coma  in  rare  cases,  and  have  stated  that 
in  at  least  one  instance  the  inflation  of  the  udder  with  oxygen  over- 
came the  coma,  and  apparenth-  at  the  same  time  eliminated  the 
infection.  In  ordinary  mammitis  it  would  appear  that  inflation 
with  air  or  oxygen  would  prove  valueless. 

As  in  other  infections,  so  in  mammitis,  it  has  been  hoped  that 
curative  sera  may  be  devised  which  may  be  turned  to  practical 
account.  The  uncertain  and  usually  mixed  character  of  the  in- 
fection constitutes  a  serious  obstacle  to  serum  therapeutics. 

Cows  which  are  suffering  from  mammitis  should  be  milked  by 
a  person  who  does  not  come  in  contact  with  the  other  cows,  or 
should  be  milked  last,  so  that  the  milker  may  not  pass  from 
the  diseased  cow  immediately  to  a  healthy  one,  with  the  possible 
danger  of  transmitting  the  disease.  The  same  rule  should  be 
applied  to  the  healthy  portions  of  the  gland  of  an  animal  suf- 
fering from  the  disease  ;  the  healthy  quarters  should  be  milked 
first,  followed  by  the  milking  of  the  diseased  ones. 

Disinfection  of  the  udder  externally  is  of  very  great  impor- 
tance in  the  control  of  the  disease.  Before  beginning  to  milk  an 
affected  gland,  the  entire  udder  should  be  thoroughly  disinfected, 
and  after  the  milking  of  the  diseased  gland  has  been  completed 
it  should  again  receive  thorough  disinfection.  The  milker  should 
also  very  thoroughly  disinfect  his  hands  before  and  after  the 
milking,  and  especially  should  always  most  thoroughly  disinfect 
his  hands  after  having  nvilked  a  diseased  gland  before  he  milks 
or  otherwise  handles  the  udder  of  a  healthy  cow.  The  best  dis- 
infectant for  this  purpose  is  i-iooo  corrosive  .sublimate  solu- 
tion, becau.se  of  its  high  efficiency  and  freedom  from  odor,  so  that 
if  used  in  a  stable  where  milking  is  going  on,  there  is  no  danger 
of  causing  the  milk  to  become  tainted. 

In  stalls  where  mammitis  exists,  great  care  should  be  taken  to 
thoroughly  cleanse  and  disinfect  the  floors  and  gutters,  in  order 
to  prevent  the  spread  of  the  infection  from  animal  to  animal.  It 
61 


962  Veterinary  Obstetrics 

is  important  also,  as  has  been  suggested  in  dealing  with  the 
causes  of  the  disease,  that  the  tails  of  neighboring  cows  should  be 
kept  disinfected,  or,  preferably,  that  a  cow  suffering  from  mam- 
mitis  should  not  be  kept  so  near  to  a  healthy  cow  that  a  transfer 
of  the  infection  from  one  to  another,  through  the  medium  of  the 
tail  or  otherwise,  is  probable. 

In  wounds  of  the  teats  or  udder,  it  is  highly  important  that 
the  disinfection  of  these  should  be  as  complete  as  it  is  in  the 
power  of  the  practitioner  to  command,  in  order  to  avoid  the  en- 
trance of  infection  through  the  teat  orifice  into  the  gland.  In 
dealing  with  metritis,  or  other  disease  accompanied  by  infective 
discharges  from  the  vulva,  which  may  flow  down  over  and  soil 
the  udder  and  teats,  the  practitioner  should  exercise  care  in  order 
to  prevent  the  infection  from  gaining  entrance  into  the  teats. 

The  surgical  handling  of  mammitis  consists  in  the  opening  of 
abscesses,  the  detachment  of  necrotic  areas,  or  the  amputation  of 
the  gland. 

The  handling  of  abscesses  of  the  mammae  offers  few  special 
problems  as  compared  with  the  handling  of  abscesses  of  other 
portions  of  the  body.  Following  the  general  rule  of  procedure, 
they  should  be  opened  as  early  as  fluctuation  is  clearly  present  ; 
the  opening  should  be  free  and  dependent  as  in  other  abscesses  ; 
the  abscess  cavity  should  be  thoroughly  disinfected  and  any  ne- 
crotic tissue  lying  within  the  cavity  should  be  removed. 

In  some  instances  of  suppuration,  the  pus  collects  very  largely 
in  the  milk  cistern  and  is  discharged  through  the  orifice  of  the 
teat.  In  some  cases  this  discharge  of  pus  is  not  as  free  as  should 
be,  and  it  is  occasionally  advisable  to  amputate  the  end  of  the 
teat  in  order  to  secure  a  perfectly  free  opening.  The  question  of 
the  preservation  of  the  teat  is  usually  of  no  significance,  because 
the  quarter  has  lost  its  power  of  again  secreting  milk  and  is 
consequently  useless. 

In  some  insta^ices  of  severe  mammitis,  with  great  enlargement 
of  the  udder  and  extreme  tension  of  the  capsule  of  the  gland, 
the  virulence  of  the  disease  may  be  largely  overcome  by  long 
and  deep  scarifications,  by  which  the  capsule  is  incised  at  a 
number  of  places  in  such  a  manner  as  to  relieve  the  compression 
of  the  gland.  This  may  be  followed  by  liberal  bathing  with 
warm  antiseptic  solutions.  In  this  way  gangrene  of  the  gland 
may  be  avoided,  and  the  inflammation  largely  overcome;  but  after 


Acute  Mammitis  963 

all  no  ver}'-  useful  purpose  has  been  served,  except  possibly  that 
the  danger  to  the  life  of  the  animal  has  been  lessened.  The 
affected  gland  is  destroyed,  and  consequently  useless.  Amputa- 
tion would  generally  be  preferable. 

Whenever  gangrene  threatens  the  life  of  the  animal ;  when  the 
udder  is  the  seat  of  enormous  abscesses  which  must  eventually 
destroy  the  integrity  of  the  gland  and  cause  prolonged  disease 
and  loss  of  condition  ;  when  tumors  of  large  size  or  chronic  in. 
flammatory  processes  with  great  enlargement  and  pendulousness 
of  the  udder  exist  ;  or  when  the  gland  is  the  seat  of  actino- 
mycosis or  botryomycosis,  the  udder  should  be  amputated.  It  is 
impractible  to  amputate  one  of  the  quarters  of  the  cow,  since  the 
two  quarters  of  one  half  are  too  intimately  blended  for  separation. 

The  cow  is  to  be  cast,  and  preferably  secured  in  lateral  re- 
cumbency. Vennerholm  recommends  dorsal  recumbency,  but 
this  is  constantly  objectionable  in  ruminants  because  such  posi- 
tion tends  to  induce  tympany,  and  consequently  should  be  avoided 
as  far  as  practicable.  The  patient  should  be  secured  by  means 
of  two  stout  ropes,  one  of  which  is  to  be  attached  to  the  anterior, 
and  the  other  to  the  posterior  feet.  The  patient  is  then  to  be 
extended  by  attaching  each  rope  to  a  post  or  other  secure  fasten- 
ing, sufficiently  far  apart  to  allow  the  animal  to  be  fully  stretched 
between  the  two  points. 

The  question  of  anaesthesia   is   one  upon  which  practitioners 
are  not  agreed.     Vennerholm  recommends   complete  general  an- 
aesthesia.   In  our  experience  general  anaesthesia  in  the  ruminant 
is  dangerous,  because  of  the  probability  of  food  being  regurgitated  ' 
from  the  rumen  and   inhaled,  to  cause  foreign  bod}'  pneumonia. 

In  one  case  of  amputation  of  the  udder  in  the  cow,  where  the 
entire  gland  was  removed,  as  it  was  completely  gangrenous,  the 
cow  was  in  a  comatose  condition  and  required  no  anaesthetic, 
because,  so  far  as  could  be  seen,  no  sense  of  pain  was  induced 
in  the  animal  during  the  entire  operation.  Neither  is  the  opera- 
tion a  very  painful  one  in  most  cases,  so  far  as  can  be  judged  by 
the  character  of  the  tissues  involved.  The  principal  pain  is  in- 
duced by  the  cutaneous  incisions,  and  the  ligation  of  the  chief 
mass  of  inguinal  vessels.  The  operator  may  consequently  choose 
between  general  anaesthesia  and  local  anaesthesia  to  the  skin, 
followed  by  local  anaesthesia  to  the  vessels  passing  through  the 
inguinal  canal. 


964 


Veteri7iarY  Obstetrics 


With  proper  care  in  application,  the  local  anaesthesia  is  efficient 
and  ample  from  both  humane  and  surgical  standpoints,  and  is  far 
safer  than  general  anaesthesia  in  ruminants. 

If  the  entire  udder  is  to  be  removed,  it  is  most  easily  accom- 
plished by  amputating  the  two  halves  separately.  If  the  skin  is 
healthy,  enough  of  it  should  be  retained  to  readily  cover  over 
the  denuded  tissues,  though  most  of  it  would  best  be  removed 
with  the  gland.  A  curved  incision  is  made  around  the  half  of 
the  udder  to  be  removed,  at  such  a  point  that  sufficient  skin  will 
remain  to  properly  close  the  wound.  The  incision  should  extend 
only  through  the  skin  into  the  subcutaneous  connective  tissue. 
The  skin  is  separated, by  means  of  the  fingers  or  the  .scalpel  handle, 


Fig.  142.    Udder  ok  Cow,  showing  Principai^  Bloodvessels.     (Fur.stenberg). 

a  Ext.  pudic  art.  ;  b  Ext.  pudic  vein  ;  c  Arterial  twig  to  the  lymph  gland  ; 
d  Posterior  mammary  gland  ;  e  Anastomotic  twig  of  external  pudic  artery; 
g  Larger  venous  trunk  ;  h  Posterior  mammary  vein  ;  /  Lymph  gland  ; 
nt  Milk  vein  ;  o  Ant.  mammary  vein  ;  r  Lymphatic  vessel  ;  /  Nerve  trunk 
( ilio-hypogastric  and  ext.  spermatic). 


Infectioiis  Mammitis  of  Cows  965 

from  the  fibro-elastic  capsule  of  the  gland.  As  this  division  ap- 
proaches the  base  of  the  gland,  the  operator  encounters  the  sub- 
cutaneous abdominal  vein  and  a  branch  of  the  external  pudic  ar- 
tery, which  should  be  ligated,  preferably  with  a  double  ligature, 
in  order  to  prevent  anastomatic  hemorrhage. 

Posteriorly  the  operator  encounters  branches  of  the  external 
pudic  vein  and  artery,  which  require  ligation.  As  the  operation 
extends  upward,  the  capsule  of  the  gland  needs  be  detached 
from  the  abdominal  tunic,  of  which  it  constitutes  a  part,  and 
when  the  region  of  the  external  inguinal  ring  is  reached  the 
operator  encounters  the  chief  vascular  supply  of  the  gland,  as 
the  vessels  emerge  from  the  inguinal  canal.  These  should  be 
carefully  and  securely  ligated  en  masse.  Any  failure  to  properly 
secure  these  vessels  may  lead  to  serious  or  fatal  hemorrhage,  as 
has  been  repeatedly  observed. 

By  properly  dividing  the  connective  tissue  from  these  vessels, 
they  may  be  readily  bared  for  some  distance,  and  a  ligature 
passed  around  the  group  of  vessels,  which  may  then  be  divided 
with  scalpel  or  scissors  some  distance  beyond,  leaving  a  sufficient 
stump  to  insure  against  displacement  of  the  ligature.  If  these 
ves.sels  are  properly  ligated,  there  can  scarcely  occur  a  serious 
hemorrhage  from  any  of  the  others. 

If  the  other  half  of  the  gland  is  to  be  removed,  the  animal,  if 
secured  in  lateral  recumbaucy,  should  now  be  turned  to  the  op- 
posite side,  and  the  operation  repeated. 

The  wound  should  then  be  thoroughly  cleansed  and  disinfected, 
all  blood  clots  washed  carefully  away,  and  all  vessels  which  can 
be  discovered  properly  secured,  after  which  the  margins  of  the 
wound  should  be  trimmed  in  such  a  manner  that  they  can  be 
brought  together  in  proper  apposition,  without  being  either 
stretched  or  flaccid.  In  the  wound  should  be  laid  some  anti- 
septic tampons,  such  as  strips  of  iodoform  gauze,  in  order  to  pro- 
vide drainage  and  secure  antisepsis. 

2.  Infectious  Mammitis  of  Cows.     Infectious 
Agalactia.     "  Gelber  Galt." 

Messrs.  Borgeaud,  Nocard  and  Mollereau,  Zschokke,  Bang, 
Kitt  and  others,  describe  an  epizootic  form  of  mastitis  in  cows 
which  sometimes  occasions  very  serious  losses.     Zschokke  asserts 


966  Veterinary  Obstetrics 

that  some  dairymen  dread  the  malad}'  more  than  foot  and  mouth 
disease,  so  extensive  are  the  losses  sometimes  occasioned  in 
affected  dairies. 

The  malady  has  been  observed  chiefly  in  Switzerland,  where  it 
has  been  extensively  studied.  We  have  seen  no  definite  account 
of  the  existence  of  the  malady  in  America,  but  its  chronic,  in- 
sidious character  renders  its  importation  easy.  It  probably 
already  exists  in  this  country,  and  merely  awaits  recognition  and 
report  of  its  presence. 

The  disease  consists  of  a  catarrhal  mastitis  accompanied  by 
slight  or  inconspicuous  tumefaction  of  the  affected  quarter  or 
quarters.  The  onset  is  somewhat  insidious.  The  gland  does 
not  swell  greatly,  if  noticeably.  There  is  little  or  no  tendency 
to  abscessation  or  gangrene,  and  no  marked  systemic  disturbances. 

The  milk  from  the  affected  gland  diminishes  in  quantity  and 
undergoes  gradual  changes  in  quality.  It  becomes  serous,  bluish, 
and  more  or  less  viscid  or  flocculent.  Later  the  color  of  the  milk 
may  be  reddish  or  brownish.  It  acquires  a  slight  acid  reaction, 
is  odorless  and  has  a  salty  taste. 

The  affected  gland,  which  at  first  was  but  little  altered  in  size, 
consistency  or  temperature,  begins  after  2  or  3  weeks  to  atrophy, 
and  the  milk  secretion  largely  or  completely  ceases.  After  2  or  3 
months  the  gland  becomes  extremely  atrophied  and  shriveled,  and 
the  gland  tissue  so  far  disappears  as  to  be  almost  unrecognizable 
by  palpation.  After  the  disease  has  run  its  course,  the  gland  re- 
mains functionless  at  least  until  the  cow  calves  again,  possibly 
permanently. 

Ibel  (Archiv.  Tierheilk,  vol.  30J  found  that  the  lacteal  vesicles 
largely  disappear,  so  that  instead  of  200-300  in  a  lobule,  but 
15-60  could  be  found.  The  diameters  of  the  lacteal  vesicles 
were  also  greatly  reduced.  The  acini  were  sometimes  empty, 
sometimes  contained  granular  leucocytes  or  albumen  coagula. 

The  interlobular  connective  tissue  was  found  somewhat  thick- 
ened and  sclerotic.  Ibel  concludes  that  "  gelber  gait  "  at  first 
consists  of  a  comparatively  mild  parenchymatous  mastitis,  with 
the  escape  of  leucocytes  and  albumen  into  the  alveoli. 

The  disease  is  highly  contagious,  and  is  readily  transmitted 
from  the  diseased  to  the  healthy  glands  of  the  same  udder  or 
from  cow  to  cow,  through  the  agency  of  the  milker's  hands. 

The  cause  is  a  form  of  streptococcus,  which  can  readily  be  ob- 


Infectious  Manijnitis  of  Cows  967 

tained  in  pure  cultures,  and  by  which  the  typical  affection  can  be 
experimentally  induced. 

Zschokke  recognizes  two  types  of  the  disease — the  curable  and 
the  incurable.  The  first  is  caused  by  a  short  streptococcus  ;  the 
latter  by  a  long  streptococcus.  Apparently  this  is  a  variation  in 
the  virulence  of  the  same  organism  ;  if  very  virulent  it  forms  in 
long  chains  if  milder  in  short  chains. 

Zschokke  insists  that  the  microscopical  diagno.sis  is  practical, 
and  fundamentally  important.  Not  only  would  he  differentiate 
microscopically  between  acute  mammitisand  infectious  mammitis, 
but  he  would  recognize,  by  the  length  of  the  cocci  chains,  the 
grade  of  virulence  in  individual  cases  of  infectious  mammitis. 
He  considers  the  early  bacterial  diagnosis  of  the  greatest  import- 
ance in  order  that  control  measures  may  be  properly  instituted 
early  in  an  outbreak. 

The  handling  of  infectious  mammitis  or  agalactia  has  proven 
unsuccessful.  No  method  of  treatment  has  been  found  which 
exerts  any  recognizable  influence  from  an  economic  standpoint. 
Zschokke  tried  intra-mammary  injections  of  potassium  iodide, 
i-iooo,  and  itrol  (silver  citrate),  1-4000,  but  without  result.  He 
also  tried,  in  vain,  subcutaneous  and  intra-mammary  injections 
of  anti-streptococcus  serum. 

Cantharides  and  other  stimulating  applications  to  the  udder 
reduced  the  infection  ;  but  the  milk  flow  was  suppressed,  the 
gland  continued  functionless,  and  the  betterment  was  without 
economic  value. 

The  experiments  of  Zschokke  convinced  him  that  it  is  best  to 
leave  a  milk  gland,  affected  with  infectious  mammitis,  wholly 
alone.  If  the  milk  is  drawn  from  the  gland,  the  free  leucocytes 
are  also  extracted.  If  left  alone,  the  leucocytes  destroy  the 
streptococci,  especially  those  in  short  chains.  If  the  milk,  or 
mammary  excretion  representing  it,  is  left  in  the  gland,  not  only 
do  the  leucocytes  tend  to  destroy  the  cocci,  but  the  spread  of  the 
infection  to  other  quarters  of  the  udder  or  to  other  cows  is  obvi- 
ated. So  long  as  the  infected  excretions  remain  in  the  udder, 
they  do  no  harm  to  the  gland,  but  the  affected  gland  tends  more 
to  recovery  than  if  the  excretions  were  removed. 

The  most  important  feature  of  handling  the  malady  is  the  pre- 
vention of  its  spread  from  diseased  to  healthy  glands.  Diseased 
cows  should   be  as  well  isolated   as  practicable,  and  should  be 


968  Veterinary  Obstetrics 

milked  b}'  separate  milkers,  or,  if  by  the  same  milker,  they 
should  be  milked  last.  When  the  disease  exists  in  a  dairy,  dis- 
infectants should  be  freely  used  on  the  milker's  hands  and  the 
cow's  udders,  both  before  and  after  the  milking  of  each  cow. 

3.    Ex.\NTHEMA  OF    THE  UdDER.       ThE  MaMMITIS  OF  CoW-POX 
AND    PoCK-LIKE    DiSEASEvS. 

Pox  of  the  udder  is  quite  common  in  milk  cows  in  some  re- 
gions. Some  hold  that  there  is  a  true  and  a  false  pox,  while 
others  claim  that  the  two  alleged  diseases  are  really  identical  and 
consist  of  the  genuine  cow-pox. 

Cow-pox  is  usually  of  a  benign  character,  though  at  times  it 
is  severe  and  tends  to  produce  mammitis.  At  the  beginning  of 
the  disease  there  may  be  present  the  general  symptoms  of  fever, 
including  chills  with  constipation  and  a  decreased  flow^  of  milk. 
This  is  followed  in  the  course  of  a  few  hours  by  characteristic 
lesions  of  the  teats  and  the  parts  immediately  surrounding  these, 
consisting  at  first  of  hypersemic  areas,  with  swelling  of  the  sur- 
rounding skin.  The  skin  is  tender  upon  handling,  and  the  cow 
resists  being  milked.  In  the  course  of  two  or  three  days  there 
appear  distinct  papules  in  the  inflamed  areas,  which  vary  some- 
what in  their  appearance  according  to  the  color  of  the  skin.  If 
the  integument  is  not  too  highly  pigmented,  the  papules  are 
surrounded  by  a  red  zone,  and  become  pitted  or  pocked  in  their 
center.  The  contents  of  the  papules  are  at  first  clear  and  lym- 
phoid in  character,  but  later  become  cloudy  and  more  or  less 
purulent,  and  finally  dry,  to  constitute  a  scab,  which  drops  away 
in  two  or  three  weeks,  leaving  a  reddish,  depressed  scar. 

Should  the  pustules  be  injured  by  careless  milking  or  other- 
wise, and  the  crusts  torn  away,  the  disease  processes  become 
intensified,  the  ulcers  extend,  and  perhaps  those  which  are  near 
together  become  confluent.  The  crusts  forming  over  the  surface 
are  verN^  extensive,  and  under  repeated  irritation  the  lesions  tend 
constantly  to  grow  worse.  The  eruptions  do  not  all  appear  sim- 
ultaneously, but  new  crops  arise  from  time  to  time,  so  that  there 
may  be  fresh  papules  alongside  the  old  crusts  or  ulcers. 

While  the  course  of  cow-pox  is  usually  benign,  in  severe  cases 
there  is  a  tendency  to  the  occurence  of  mastitis  of  a  severe  type. 
It  is  not  known  that  the  mastitis  is  due  to  the  entrance  of  the 
cow-pox  organism  into  the  udder.     It  is  probable  that  the  pox 


Exanthema  of  the  Udder  969 

lesions  upon  the  teat  and  udder  cause  a  purulent  infection,  which 
furnishes  a  supply  of  highly  virulent  pus,  ready  to  induce  infec- 
tion at  any  time  that  it  may  chance  to  find  entrance  through  the 
teat  canal  into  the  milk  cistern  and  thence  into  the  milk  canals. 

The  source  and  character  of  the  infection  of  the  cow  pox  is 
unknown.  In  some  cases,  however,  it  is  traceable  to  vaccination 
in  man.  The  milker  may  have  been  vaccinated,  or  maj-  have 
handled  the  vaccination  wounds  in  children  or  others  who  have 
been  vaccinated,  and  thus  ma^^bear  the  disease,  upon  his  hands, 
to  the  teats  of  the  cows  while  milking.  Once  the  affection  has 
gained  entrance  into  a  dairy  stable,  it  is  readily  transmitted  by 
the  hands  of  the  milkers  from  one  cow  to  another. 

The  handling  of  cow  pox  in  dairy  cows  is  chiefly  prophylactic, 
and  consists  of  the  application  of  the  fundamental  rules  of  disin- 
fection. So  far  as  is  practicable,  the  affected  cows  should  be 
isolated  from  the  sound  ones,  and  should  be  milked  last.  If  the 
disease  exists  in  a  dairy  stable,  the  hands  of  the  milkers  should 
be  thoroughly  disinfected  before  and  after  the  milking  of  each  cow. 
In  our  judgment  the  best  disinfectant  for  this  purpose  is  corrosive 
sublimate,  because  of  its  efficiency  and  absence  of  odor. 

We  meet  from  time  to  time,  in  various  localities,  with  other 
forms  of  exanthema  of  the  teats  and  udder. 

In  the  vicinity  of  Ithaca,  N.  Y.,  there  has  prevailed  from  time 
to  time  a  disease  having  the  general  clinical  characters  of  an  in- 
fection. So  far  as  we  have  been  able  to  observe,  the  disease  is 
unaccompanied  by  the  formation  of  vesicles,  pustules  or  other 
lesions  to  definitely  identify  it  with  cow-pox.  At  first  there 
appear  small  inflamed  areas  in  the  skin  of  the  teat  or  contiguous 
parts  of  the  udder.  Later  the  areas  become  hemorrhagic,  and 
finally  necrotic,  when  they  dessicate,  turn  black  and  constitute 
a  large  scab,  which  is  exceedingly  hard,  tough  and  adherent. 
The  number  of  these  necrotic  areas  is  usually  limited  to  from 
two  to  five  or  six  upon  the  entire  udder  and  teats.  They  vary 
in  size  from  oi-e-quarter  to  one-half  inch,  or  even  more,  in  diame- 
ter. Ordinarily  the  disease  pursues  a  comparatively  benign 
course  ;  but  the  diseased  areas  are  sensitive  and  painful,  so  that 
the  cow  resists  being  milked.  In  some  cases  the  disease  is  fol- 
lowed by  a  very  destructive  streptococcic  mammitis,  which  usu- 
ally leads  to  the  permanent  destruction  of  the  affected  quarter 


970  Vetermary  Obstetrics 

or  quarters.  The  danger  of  mammitis  increases  as  the  proximity 
of  the  lesion  to  the  teat  orifice  increases.  Sometimes  the  lesion 
occurs  in  the  teat  orifice  itself,  interfering  promptly  with  the  pas- 
sage of  milk  and  leading  quickly,  in  many  cases,  to  infection  of 
the  gland. 

Apparently  the  mammitis  is  not  the  direct,  but  rather  an  indi- 
rect result  of  the  presence  of  the  eruptions.  The  infection  of  the 
gland  takes  place  after  the  scabs  have  attained  large  size  and 
more  or  less  abundant  suppuration  has  occurred  around  their  bor- 
ders. It  seems  that  the  infection  is  attributable  to  the  pus 
which  thus  forms,  and  later  gains  access  to  the  milk  cistern 
through  the  teat  orifice.  Our  chief  interest  in  the  disease  is  the 
prevention  of  the  mammitis  by  thorough  disinfection.  Whether 
this  be  genuine  cow-pox  or  not,  the  disinfection  should  be  careful 
and  ample.  The  diseased  parts  should  be  thoroughly  disinfected 
before  and  after  milking,  and  the  hands  of  the  milkers  should  be 
well  disinfected  before  and  after  the  milking  of  each  cow, 
whether  diseased  or  sound.  We  recommend  in  this  disease  the 
washing  of  the  udder  of  the  cow  and  the  hands  of  the  milkers 
with  a  i-iooo  corrosive  sublimate  solution,  to  be  followed  by 
the  application  of  a  disinfectant  to  the  teats  and  adjacent  parts 
of  the  udder,  consisting  of  equal  parts  of  tincture  of  iodine,  tinct- 
ure of  arnica  and  glycerine.  If  the  crusts  become  detached,  leav- 
ing a  raw  sore,  this  may  be  carefully  touched  with  stick  silver 
nitrate,  or  with  tincture  of  iodine. 

When  the  lesion  is  located  directly  in  the  milk  orifice,  vigor- 
ous disinfection  should  be  instituted.  The  part  should  be  pen- 
cilled with  a  fine  cone  of  silver  nitrate,  or  a  drop  of  tincture  of 
iodine  inserted  by  means  of  a  medicine  dropper. 

4.  Tuberculosis  of  the  Udder.     Tubercular  Mammitis. 

Tuberculosis  of  the  udder  is  virtually  confined  to  the  cow. 
Although  tuberculosis  is  very  common  among  dairy  cows,  recog- 
nizable tubercular  disease  of  the  udder  is  comparatively  rare. 
When  it  does  occur  it  is  regarded  as  especially  important  because 
of  the  highly  infectious  character  of  the  milk. 

Symptoms.  The  symptoms  of  tuberculosis  of  the  mammary 
gland  consist  usually  of  a  tense  swelling  of  the  mammae,  gener- 
ally of  one  quarter  only,  and  most  frequently  one  of  the  hind 
quarters.     The  general  condition  of  the  animal  is  not  affected  by 


Tubercular  Mammitis  971 

the  tuberculosis  of  the  udder,  and  whatever  constitutional  symp- 
toms maj'  appear  are  referable  to  the  ravages  of  the  disease  in 
other  parts  of  the  body.  The  mammitis  is  chronic  in  character, 
and  increases  very  gradually  in  volume  and  hardness.  After  a 
time  the  affected  quarter  becomes  very  hard  and  extremely  large. 
Franck  records  cases  in  which  the  udder  has  attained  a  weight 
of  30  to  40  pounds. 

The  secretions  of  the  gland  depart  from  the  normal  very  gradu- 
ally, and  may  retain  the  general  appearance  of  milk  for  weeks 
or  months,  and  then  slowly  become  watery,  filled  with  clots  and 
perhaps  becomes  yellowish  in  color.  The  lymph  glands  on  the 
proximal  side  of  the  mammae,  the  supra-mammary  lymph  glands, 
become  swollen  to  such  a  degree  that  they  may  be  felt  or  seen. 

The  diagnosis  of  tubercular  mammitis  is  to  be  made  in  con- 
junction with  the  general  symptoms.  The  definite  diagnosis 
must  depend  largely  upon  the  tuberculin  test.  According  to 
Bang  the  disease  is  characterized  by  the  fact  that,  for  some  time 
after  the  advent  of  the  malady,  the  secretions  of  the  gland  remain 
apparently  normal  in  appearance  and  quantity,  although  in  some 
cases  the  disease  may  be  acute  from  the  beginning,  and  conse- 
quently the  amount  of  milk  very  much  decreased.  In  compari- 
son with  other  forms  of  mammitis,  it  is  important  to  note  that 
as  a  rule  there  is  little  or  no  pain  in  the  tubercular  portion  of  the 
udder. 

Tuberculosis  of  the  udder  occurs  chiefly  in  very  severe  cases 
of  tuberculosis.  The  course  is  comparatively  rapid,  and  the  animal 
may  succumb  to  general  tuberculosis  in  a  few  months. 

Upon  post-mortem  examination  the  swelling  of  the  affected 
glands  is  usually  diffuse,  though  in  some  cases  it  is  nodular. 
Upon  section,  the  swollen  parts  of  the  udder  are  found  very  firm, 
and  the  cut  surface  is  even,  while  the  affected  portions  are 
prominently  separated  from  the  sound  parts  by  a  clear  line  of  de- 
marcation. There  occur,  throughout  the  diseased  portion  of  the 
gland,  more  or  less  numerous  yellow  spots  or  tubercules,  while 
the  larger  milk  canals  may  contain  yellowish  caseous  masses 
and  the  walls  of  the  milk  cisterns  may  show  small  tubercular 
elevations. 

In  cases  of  long  standing,  the  tubercular  degeneration  of  the 
gland  becomes   more   evident,  and    the    tubercles   may  become 


972  Veterinary  Obstetrics 

widely  disseminated  through  the  glandular  tissue  without  causing 
a  very  dense  swelling. 

Microscopic  examination  of  the  caseous  masses,  the  miliary 
tubercles,  and  the  milk  from  the  tuberculous  udder,  reveals  an 
abundance  of  tubercle  bacili. 

The  feeding  of  such  milk  has  produced  tuberculosis  in  swine, 
rabbits,  cows,  cats,  goats  and  other  animals,  and  numerous  in- 
stances are  cited  where  fatal  tuberculosis  of  man  has  apparently 
resulted  from  the  ingestion  of  such  milk,  especially  by  children. 
Tuberculosis  of  the  udder  is  incurable. 

5.  Actinomycosis  of  the  Udder. 

Actinomycosis  of  the  udder  maj'-  occur  in  any  animal  which  is 
subject  to  actinomycotic  infection,  but  has  been  observed 
chiefly  or  wholly  in  the  cow  and  sow.  It  closely  resembles  in 
many  respects  tuberculosis  of  the  udder.  Prior  to  the  identifica- 
tion of  actinomycosis,  the  disease  was  usually  mistaken  for 
tuberculosis.  It  may  affect  one  or  all  quarters,  but  has  a 
great  tendency  to  remain  confined  to  one  quarter,  because  as  a 
general  rule,  the  source  of  the  infection  is  local  and  not  systemic  ; 
whereas  the  opposite  usually  holds  true  in  cases  of  tuberculosis. 

The  malady  usually  reveals  itself  in  the  form  of  a  chronic, 
slow-forming  nodular  disease  of  the  gland,  the  nodules  varying 
from  ^  to4  inches  or  more  in  size,  and  consisting  of  small  abscesses 
surrounded  by  thick  and  dense  connective  tissue.  These  small 
foci  behave  like  actinomycotic  abscesses  occurring  in  other  tissues 
of  the  bod}^ ;  they  tend  to  rupture  one  after  another,  and  leave 
small  fistulous  openings,  which  are  somewhat  retracted,  and  heal 
tardily. 

Upon  section,  the  actinomycotic  lesions  have  the  superfi- 
cial appearance  of  tuberculosis,  and  may  at  first  be  mistaken  for 
that  disease.  The  section  reveals  abscesses  of  various  sizes,  sur- 
rounded by  more  or  less  dense  connective  tissue  walls.  If  the 
abscess  is  large,  and  contains  much  pus,  the  wall  is  usually  very 
thick  and  dense.  If  the  abscesses  are  very  small,  or  consist 
of  very  small  suppurating  areas,  the  walls  are  not  so  conspicuous, 
and  the  tissues  invaded  by  the  disease  present  a  yellowish,  gran- 
ular appearance,  quite  characteristic  of  the  malady,  and  different 
from  that  of  tuberculosis.  In  actinomycosis,  caseation  and  calci- 
fication do  not  occur.     The  diagnosis  may  be  definitely  made  by 


Mastitis  i?i  the  Mare  973 

the  microscopical  examination  and  the  identification  of  the  acti- 
nomyces. 

The  handhng  of  the  disease  does  not  differ  from  the  treatment 
of  actinomycosis  in  other  parts  of  the  body.  It  depends  essen- 
tially upon  the  internal  administration  of  iodine,  or  the  direct 
surgical  removal  or  destruction  of  the  diseased  parts.  Internally 
potassium  iodide  may  be  administered  to  the  cow,  in  doses  of  i 
to  3  drams  per  day,  while  tincture  of  iodine  or  iodine  ointment 
may  be  locally  applied  to  the  udder.  In  other  cases  it  is  best  to 
extirpate  the  affected  part  completely  with  the  scalpel.  When 
large  abscesses  appear,  they  may  be  sloughed  out  b}'  opening  them 
and  then  filling  the  cavity  with  sulphate  of  copper  crystals,  and 
leaving  them  in  position  until  they  come  away  spontaneously. 

6.  Mastitis  in  the  Mare. 

Acute  mastitis  due  to  ordinary  infection  of  the  udder  is  rare  in 
the  mare.  It  is  occasionally  observed  at  about  the  time  of  foal- 
ing, or  within  a  few  days  thereafter,  and  may  run  a  similar  course 
to  the  disease  in  the  cow,  though  not  usually  so  violent. 

Abscesses  occur  somewhat  rarely,  but  are  largely  referable  to 
other  causes  than  ordinary  wound  infection,  chiefly  to  strangles 
and  botrj'omj'Cosis.  As  in  the  cow,  it  is  possible  for  the  inflam- 
mation to  pursue  a  chronic  course.  The  prognosis  in  mammitis 
of  the  mare  is  more  favorable  than  in  the  cow.  The  handling  of 
the  disease  in  the  mare  calls  for  nothing  different  from  that  in 
the  cow. 

7.  Mammary  Strangles  in  the  Mare. 

When  strangles  attacks  a  mare  which  is  nursing  a  young  foal, 
the  infection  is  very  liable  to  involve  the  milk  glands  and  cause 
abscesses  of  these  or  of  the  neighboring  lymph  glands.  The  ab- 
scesses are  frequently  very  large,  and  are  accompanied  by  exten- 
sive and  virulent  inflammation  of  the  gland.  The  abscess  may 
rupture  externally,  and  escape  over  the  side  of  the  udder,  or  it 
may  rupture  within  and  escape  through  the  teat  with  the  milk. 

An  abscess  of  the  mammary  gland,  due  to  strangles,  does  not 
vary  in  any  essential  particular  from  a  strangles  abscess  in  any 
other  portion  of  the  body,  but  may  at  first  be  mistaken  by  the 
practitioner  for  an  ordinary  case  of  mammitis.  Generally,  how- 
ever, the  abscess  of  the  udder  follows  the  formation  of  abscesses 


974  Veterinary  Obstetrics 

in  the  sub-maxillary  glands  or  elsewhere,  so  that  the  practitioner 
is  forewarned  as  to  the  character  of  the  disease. 

The  chief  significance  of  strangles  abscess  in  the  mammary 
gland  of  the  mare  is  in  relation  to  the  health  of  the  foal.  -In  our 
experience,  when  a  young  foal  takes  milk  from  a  mare  which,  is 
suffering  from  strangles,  and  especially  when  the  strangles  affects 
the  udder  itself  in  the  form  of  abscesses,  the  malady  has  an 
unusual  virulence  for  the  foal,  and  it  is  very  liable  to  perish. 

The  handling  of  strangles  of  the  mammary  gland  demands 
the  same  general  measures  as  in  other  cases  of  strangles,  in  so  far 
as  the  mare  is  concerned.  The  abscesses  should  be  opened  early, 
and  the  animal  should  receive  internally  reliable  antiseptics, 
especially  large  doses  of  potassium  iodide,  in  order  to 'overcome 
the  infection  as  early  as  possible. 

The  foal  should  be  removed  from  the  mare,  and  fed  upon  milk 
from  a  healthy  mare  or  from  a  cow,  and  should  receive  some 
preventive  treatment,  such  as  the  administration  of  potassium 
iodide  in  its  milk,  in  order  if  possible  to  decrease  the  severity  of 
the  attack,  which  must  almost  inevitably  occur. 

8.    BOTRYOMYCOSIS   OF   THE    UdDER. 

There  occurs  occasionally  in  the  mare  a  chronic,  indurative 
inflammation  of  the  milk  gland,  which  is  characterized  by  a  very 
tense  and  hard  enlargement  of  the  udder,  with  chronic  fistulae 
and  small  recurrent  abscesses.  It  is  claimed  to  be  due  to  a 
special  form  of  micro-organism,  known  as  the  botryomyces  equi 
or  micrococcus  ascoformans.  Some  pathologists  claim  that  this 
micro-organism  is  simply  one  of  the  pus-forming  organisms,  and 
that  the  peculiar  characters  of  disease  resulting  from  it,  the  new 
formation  of  sclerotic  connective  tissue,  the  formation  of  abscess 
and  fistula  are  due,  not  to  the  special  form  of  the  agent  causing 
it,  but  to  the  peculiarities  of  the  tissues  of  the  animal  itself. 
The  general  character  of  botryomycosis  of  the  udder  of  the  mare 
is  analogous  in  all  respects  to  that  of  botryomycosis  of  other  tis- 
sues and  organs  of  the  horse. 

Symptoms.  The  symptoms  of  botryomycosis  of  the  udder  in 
the  mare  are  generally  well  developed  before  they  attract  any  at- 
tention. The  disease  may  occur  in  an  animal  which  is  nursing  a 
foal,  or  in  one  which  has  been  dry  for  montlis  or  years,  or  possibly 
has  never  bred.    It  is  usually  first  observed  by  the  owner  when  the 


Botryoniycosis  of  the  Udder  975 

••  ■ 
gland  becomes  much  swollen  because  of  the  maturing  of  an  ab- 
scess  preparatory  to    its    rupture.     The  gland  maj'  become  so 
swollen,  tense,   and  sensitive  that   the  animal  shows  pain,  ex- 
pressed by  lameness  in  the  hind  limb  of  the  corresponding  side. 

There  is  usually  some  edema  in  the  subcutaneous  tissues  of  the 
udder  and  neighboring  parts.  As  a  rule,  but  one-half  of  the 
glami  is  involved.  After  a  few  days  the  matured  abscess  ruptures 
and  discharges  a  small  quantity  of  pus,  and  there  remains  for  a 
period  of  time  an  inconspicuous  fistulous  opening,  from  which  a 
very  small  quantity  of  pus  exudes.  The  mouth  of  the  fistula 
sinks  deeply  into  the  skin  by  retraction  of  its  scar  tissue.  If  a 
probe  be  inserted  into  the  fistula,  the  canal  is  found  tortuous,  but 
one  ma)^  be  able  to  follow  it  for  a  distance  of  two  to  six  or  more 
inches.  After  a  time  the  fistula  heals,  and  later  another  small 
abscess  forms  in  some  other  portion  of  the  gland,  and  ruptures, 
to  be  followed  by  another  fistulous  opening.  In  some  cases  there 
may  exist,  at  one  time,  two,  three  or  more  fistulous  openings, 
from  each  of  which  a  very  small  quantity  of  thick  pus  is  dis- 
charged. 

The  general  health  of  the  patient  is  not  apparently  affected. 
The  diseased  gland  continues  to  grow,  and  may  attain  a  very 
large  size. 

The  disease  is  chronic,  and  shows  no  tendency  toward  spon- 
taneous recoverj',  but  rather  continues  from  year  to  year. 
There  is  little  tendency  for  the  disease  to  pass  beyond  the  capsule 
of  the  gland  and  involve  neighboring  tissues.  Vennerholm  states 
that  it  may  extend  to  the  thigh  or  perineum,  and  may  thus  cause 
marasmus  and  the  death  of  the  animal. 

The  differential  diagnosis  sometimes  offers  difficulties.  A  gray 
mare,  entered  in  our  clinic,  presented  symptoms  which  made  it 
difficult  to  determine  whether  she  was  suffering  from  botryoniy- 
cosis, melanosis  or  a  malignant  new-growth.  The  affected  half 
of  the  gland  was  enormously  enlarged,  and  the  animal  showed  a 
distinct  cachexia  and  was  very  stiff  in  her  movements.  Explor- 
ing the  pelvic  cavity  and  posterior  portion  of  the  abdomen  per 
rectum,  we  found  that  the  growth  extended  up  through  the  in- 
guinal ring  into  the  peritoneal  cavity.  An  unfavorable  prognosis 
was  given,  and  the  animal  was  destroyed,  whereupon  it  was 
found  that  the  gland  was  invaded  by  a  malignant  melanom,  and 


976  Veterinary  Obstetrics 

the  liver  weighed  72  pounds,  it  being  likewise  the  seat  of 
malignant   melanosis. 

Generally  the  disease  is  easily  diagnosed  by  the  chronic  course, 
the  enlarged  sclerotic  gland,  and  the  small  abscesses  and  fistulae. 

The  handling  of  the  disease  consists  essentially  of  the  early 
amputation  of  the  gland,  by  the  method  which  we  have  already 
described  for  amputating  the  udder  of  the  cow.  Asinbotryomy- 
cosis  of  other  parts  of  the  body,  so  here  we  may  cause  improve- 
ment of  the  disease  by  the  internal  administration  of  iodide  of 
potash.  In  our  experience,  however,  we  have  never  succeeded 
in  bringing  about  the  cure  of  botryomycosis,  in  any  organ,  by 
means  of  this  drug. 

9.  Infectious  Gangrenous  Mammitis  of  Ewes. 

Pustular  Eruptions  of  the  Lips  of  Nursing  Lambs. 

We  observed  in  our  clinic  an  important  outbreak  of  gangrenous 
mammitis  in  ewes,  which  proved  uniformly  fatal.  The 
mammary  affection  began  very  suddenly,  with  intense  inflamma- 
tion, engorgement  and  redness  of  one-half  of  the  udder.  The 
patient  at  once  became  very  lame,  much  depressed,  with  loss  of 
appetite  and  cessation  of  rumination.  Within  24  to  48  hours 
after  the  advent  of  the  attack,  the  apex  of  the  nipple  of  the  af- 
fected gland  assumed  a  dark  uecrotic-black  color,  the  teat  was  cold 
and  its  epithelium  was  easily  detached  and  rubbed  off.  Paralysis 
and  death  rapidly  followed. 

Searching  for  the  source  of  the  infection,  we  discovered 
that  most  of  the  lambs  in  the  flock  were  affected  with  pustular 
eruptions  of  the  lips.  The  pustules  were  located  chiefly  upon 
the  labial  margins,  were  about  yi  in.  high,  sharply  conical  and 
filled  with  yellow  pus.  Breaking,  they  left  behind  slow-healing 
ulcers. 

Apparently  the  disease  of  the  lips  of  the  lambs,  and  the  gan- 
grene of  the  mammae  of  the  ewes,  were  identical,  and  the  nursing 
served  to  transmit  the  infection  to  the  udders  of  the  ewes  and 
vice  versa.  Thorough  disinfection  of  the  lips  of  the  lambs,  with 
penciling  of  the  labial  ulcers  with  silver  nitrate,  was  followed  by 
a  cessation  of  the  mammitis  in  the  ewes. 


Infections  Agalactia  in  Goats  and  Sheep  977 

10.  Infectious  Agalactia  in  Goats  and  Sheep. 

There  has  been  observed  from  time  to  time,  in  Italy,  Switzer- 
land and  France,  an  infectious  disease  of  the  mammary  glands 
of  sheep  and  goats,  characterized  chiefly  by  a  gradual  decrease 
in  the  volume  of  milk  and  an  extreme  atrophy  of  the  glands. 

Clinically  the  disease  presents  all  the  characteristics  of  an  in- 
fection which  is  readily  transmitted  from  animal  to  animal,  and 
involves  not  only  the  infection  of  the  mammary  glands,  but  also 
the  articulations,  the  tendon  sheaths  and  the  eyes.  Vennerholm 
mentions  one  herd  of  28  animals,  in  which,  during  the  course  of 
six  weeks,  24,  including  one  buck  and  one  kid,  showed  symptoms 
of  the  disease.  The  male  animals  suffered  from  the  disease  of 
the  eyes  and  articulations. 

The  malady  does  not  seriously  affect  the  general  well-being  of 
the  animal.  The  milk  becomes  greatly  changed,  is  grayish- white 
and  flocculent,  and  after  standing  there  appears  a  precipitate  of 
pus,  which  is  separated  from  the  normal  milk  by  a  sharp  line  of 
red,  due  to  the  presence  of  red  blood  cells.  The  milk  acquires  a 
bitter,  saline  taste  ;  while  the  reaction  is  variable,  sometimes 
feebly  acid  and  sometimes  alkaline.  In  very  severe  ca.ses  the  milk 
may  be  firmly  coagulated  and  opaque.  The  quantity  of  milk 
may  be  decreased  rapidly,  to  the  extent  of  90  to  95%. 

As  in  the  agalactia  of  the  cow,  so  in  the  disease  of  the 
sheep  and  goat,  there  are  no  marked  evidences  of  acute  inflam- 
matory changes,  as  exhibited  by  swellings  or  tenderness  in  the 
gland.  The  gland  tends  rather  to  become  atrophied,  and  finally 
retracts  to  one-tenth  of  its  original  volume  and  becomes  very  in- 
conspicuous. Later  in  the  course  of  the  disease,  without  any 
evidence  of  pain,  there  may  appear  abscesses  of  a  chronic  or 
"  cold  "  character  in  the  udder,  as  well  as  in  the  parotid  salivary 
glands  and  in  the  region  of  the  stifle.  These  abscesses  contain 
a  thick  yellow  pus.  In  a  manner  somewhat  similar  to  the  forma- 
tion of  metastatic  abscesses,  .there  also  appear  inflammations  of 
the  fetlock,  stifle,  hip,  carpus  and  elbow,  which  in  some  instances 
constitute  the  only  evidence  of  the  disease,  especially  in  males  or 
in  females  which  are  not  in  milk.  Tendo-vaginitis  may  also 
appear. 

In  a  large  proportion  of  cases  there  appears  a  well-marked 
62 


978  Veteri7iary  Obstetrics 

keratitis,  in  which  there  is  either  a  local  or  a  diffuse  cloudiness 
and  ulceration  of  the  cornea,  with  increased  vascularity^  and 
hemorrhages.  In  some  cases  staphyloma,  followed  by  rupture  of 
the  cornea  and  hernia  of  the  iris,  has  occurred.  The  disease  of 
the  eyes  continues  for  a  prolonged  period,  and  generally  ends  in 
recovery  in  from  six  to  eight  weeks,  though  white  or  pigmented 
spots  sometimes  remain  upon  the  cornea.  These  changes  in  the 
cornea  are  accompanied  by  conjunctivitis. 

As  a  general  rule  the  animals  recover,  and  finally  their  power 
of  milk  production  becomes  restored.  The  cau.se  of  the  disease 
has  not  been  determined,  and  attempts  to  transmit  it  from  one 
animal  to  another  have  failed.  Isolation  and  disinfection  are 
apparently  indicated. 

II.   Mammitis  in  Swine. 

Inflammation  of  the  mammae  in  swine  is  an  exceedingly  rare 
disease.  It  may  involve  one  or  several  of  the  glands,  and  present 
the  ordinary  symptoms  of  mastitis,  with  swelling,  pain  and  a 
general  depression  of  the  system.  The  inflammation  may  end  in 
resolution,  induration  or  gangrene,  and  in  the  latter  case  may 
result  in  the  death  of  the  animal.  The  sow  is  so  immune  to 
ordinar}'  wound  infection  that  it  is  only  under  very  great  provo- 
cation that  the  glands  become  inflamed.  The  handling  is  accord- 
ing to  the  general  rules  already  related  for  mastitis  in  the  cow. 
12.   Mammitis  in  the  Bitch. 

According  to  Vennerholm,  mammitis  is  very  common  in  the 
bitch,  when  her  puppies  have  been  prematurely  taken  away. 
As  in  the  sow,  so  in  the  bitch,  there  is  a  high  degree  of  immunity 
again.st  invasion  by  the  ordinary  organisms  of  wound  infection, 
except  under  peculiarly  favorable  conditions.  In  the  bitch,  as 
in  other  muciparous  animals,  inflammation  of  those  glands  which 
are  not  used  is  not  usually  observed.  Ordinarily  the  number  of 
glands  exceeds  that  of  the  young,  each  of  which  has  its  own  teat, 
from  which  it  obtains  its  milk  supply.  Any  extra  glands  which 
the  mother  may  have  are  allowed  to  atrophy,  and  cease  to  func- 
tion from  the  first,  without  apparently  causing  any  marked  de- 
gree of  discomfort  or  danger  ;  but,  after  a  gland  has  been  fully 
aroused  to  its  function  because  of  its  use  by  the  new-born  animal, 
if  the  young  is  removed  before  the  normal  decline  in  lactation, 
mastitis  is  probable. 


Edema  of  the   Udder  979 

The  symptoms  of  mastitis  in  the  bitch  are  peculiar  chiefly  in 
the  fact  that  the  milk  canals  are  swollen  and  distended,  so  that 
they  feel  like  stretched  cords.  As  no  milk  cistern  is  present, 
the  mammitis  tends  to  become  lobular,  being  confined  to  the 
lobule  of  the  milk  canal  into  which  the  infection  has  penetrated. 
Otherwise  the  swelling  does  not  differ  materially  from  mastitis 
observed  in  other  animals.  The  character  of  the  milk  is  changed, 
becoming  serous  or  purulent,  and  mixed  with  blood.  The  in- 
flamed gland  is  not  especially  painful.  More  or  less  edema  may 
be  present,  in  the  early  stages.  The  course  of  the  disease  is  not 
so  acute  as  that  observed  in  ruminants,  but  tends  rather  to  be- 
come chronic  and  to  result  in  induration  and  atresia  of  the  milk 
canals.  These  changes  in  general  take  the  character  of  adeno- 
fibroma. 

In  some  rare  instances  the  glands  become  rapidly  gangrenous, 
but  as  a  general  rule  this  does  not  cause  the  death  of  the  animal. 

The  handling  of  the  disease  is  essentially  the  same  as  in  other 
animals,  and  consists  of  repeated  massage  and  milking  out,  with 
the  application  of  an  antiseptic  poultice.  Later,  if  the  disease 
becomes  chronic,  or  should  gangrene  occur,  the  affected  gland  or 
glands  may  be  amputated. 

13.  Edema  of  the  Udder.     Mammary  Engorgement. 

Clinically  there  not  infrequently  occurs  edema  of  the  udder, 
which  may  be  of  a  more  or  less  physiologic  character  and  may 
consist  largely  of  engorgement  of  the  gland  without  the  advent 
of  inflammation. 

It  may  appear  either  during  pregnancy  or  early  after  parturi- 
tion. In  some  instances,  during  pregnancy,  the  occurrence  of 
engorgement  and  edema  of  the  mammary  glands  may  suggest 
the  death,  or  some  disease  or  disturbance  of  the  fetus.  Very  fre- 
quently the  symptoms  are  followed  by  abortion.  Toward  the 
culmination  of  pregnancy,  the  mammary  glands  become  more  or 
less  congested,  depending  somewhat  upon  the  species  and  indi- 
vidual. As  a  general  rule,  the  congestion  and  edema  are  most 
marked  in  animals  which  have  not  previously  given  birth  to 
young. 

The  symptoms  in  such  cases  apparently  rest  upon  a  physio- 
logic basis,  depending  upon  the  harmonious  functioning  of  the 
uterus  and  the  mammar)'  glands.     In  some  animals,  especially  in 


980  Veterinary  Obstetrics 

the  bitch,  edema  of  the  mammae  may  occur  at  about  the  normal 
time  for  parturition,  after  the  disappearance  of  estrum  without 
impregnation.  In  these  instances  it  seems  that  the  functional 
activity  of  the  glands  becomes  aroused  without  pregnancy  having 
taken  place  at  all,  as  the  result  of  some  organic  sympathy  be- 
tween the  two  parts  of  the  generative  system. 

We  have  also  observed  such  edema  of  the  udder,  in  the  non- 
pregnant mare  mule,  accompanied  later  by  the  active  secretion 
of  milk.  In  these  cases  the  edema  was  related  to  the  functional 
activity  of  the  uterus  and  ovaries,  and  occurred  during  the  breed- 
ing season  onl3^ 

In  the  cow,  when  for  any  reason  the  milk  canals  or  the  teats 
become  blocked  so  that  the  milk  cannot  escape,  there  occurs  a 
great  distension  of  the  gland,  by  the  accumulation  of  milk  within 
its  canals,  until  the  pressure  within  its  cavity  attains  such  a  de- 
gree that  the  further  secretion  of  milk  is  stopped.  This  condi- 
tion of  over-distension  brings  about  an  edema  of  the  gland, 
accompanied  by  retrograde  changes  in  the  milk  and  its  final 
resorption,  followed  by  atrophy  of  the  gland. 

When  the  young  is  removed  from  the  mother  while  lactation 
is  still  active,  a  similar  edema  results  because  of  the  over-disten- 
sion of  the  gland.  This  very  frequently  leads  to  infection,  be- 
cause the  orifice  to  the  teat  is  open,  which  permits  the  invasion 
of  micro-organisms.  Should  the  gland  escape  infection,  the 
changes  taking  place  pursue  the  same  course  as  in  those  instances 
where  the  teat  orifice  is  blocked  and  infection  prevented. 

The  symptoms  consist  essentially  of  a  gradually  increasing 
tension  of  the  gland,  which  may  be  more  or  less  painful  and  maj' 
involve  a  quarter  or  half  or  the  entire  gland,  while  the  edema 
may  extend  forward  anterior  to  the  mammse,  or  upward  and 
backward  to  the  region  of  the  perineum. 

The  temperature  is  little  or  not  at  all  elevated,  and  the  .secre- 
tions from  the  gland  are  not  materially  altered  from  the  normal. 

The  anatomical  conditions,  in  cases  of  edema  or  congestion  of 
the  udder,  consist  essentially  of  vascular  engorgement  and  con- 
gestion of  the  inter-glandular  connective  tissue.  Unless  the 
edema  leads  to  infection,  the  disease  pursues  a  favorable  course 
and  ends  in  spontaneous  recovery  after  a  few  days.  Especially 
is  this  true  of  the  engorgement  of  the  gland  just  prior  to 
parturition. 


Tumors  of  the  Mamma'  981 

It  is  not  essential,  usually,  that  any  active  handling  occur. 
As  soon  as  lactation  has  become  well  established  and  the  young 
sucks  regularly,  or  the  gland  is  well  milked  out,  the  edema  spon- 
taneously disappears.  If,  however,  the  young  dies  or  has  been 
removed,  and  it  is  not  desired  to  keep  up  the  lactation  for  the 
production  of  milk,  it  is  advisable  and  frequently  essential  that 
a  portion  of  the  milk  should  be  withdrawn  two  or  three  times  a 
day,  until  the  activity  of  the  gland  becomes  diminished.  If 
less  and  less  of  the  milk  is  withdrawn  each  day,  the  lactation 
gradually  ceases,  and  the  milking  may  be  discontinued  gener- 
ally within  five  or  six  days.  Most  domestic  animals  are  thus 
easily  dried  up,  though  in  some  instances  there  is  considerable 
difficulty,  especially  in  the  milk  cow.  In  some  of  the  best  dairy 
animals  it  is  almost  impossible  to  stop  the  secretion  of  milk  with- 
out endangering  the  integrity  of  the  gland.  This  difficulty  is 
also  observed  at  times  in  ewes,  when  weaning  lambs,  espe- 
cially if  they  are  weaned  somewhat  early,  before  the  milk  glands 
have  largely  ceased  their  functions.  In  some  of  the  larger  breeds 
of  sheep,  which  are  very  heav}^  milkers,  it  is  well  to  carefully 
watch  the  ewes  while  the  lambs  are  being  weaned,  and  withdraw 
part  of  the  milk  from  those  which  show  very  great  distension 
of  the  gland  with  the  consequent  edema. 

14.    Tumors  of  the  Mamm.^. 

Tumors  of  the  mammary  glands  are  very  rare  in  domestic 
animals,  with  the  exception  of  the  bitch,  in  which  they  are  com- 
mon. Ruminants  are  almost  wholly  free  from  any  form  of  mam- 
mary tumor.  In  the  mare  we  observe  chiefly  the  botryomycotic 
udder,  which  has  already  been  described  upon  page  974,  and 
belongs  distinctly  to  infections,  not  to  tumors  proper.  The 
bitch  suffers  occasionally  from  a  form  of  granulation  tumor  or 
adeno-fibrom,  in  which  the  general  characters  of  adenoma  and 
fibroma  are  combined.  Such  adeno-fibroma  are  usually  the 
sequel  of  infection. 

The  adeno-fibrom  consists  chiefly  of  an  increase  of  the  con- 
nective tissue  between  the  lobules  of  the  gland,  which  new-formed 
tissues  press  upon  the  acini  and  gradually  bring  about  their  de- 
struction, until  there  remains  simply  the  epithelial  debris  sur- 
rounded bv  firm  connective  tissue. 


982  Veteritiary  Obstetrics 

Malignant  neoplasms  of  the  mammae  are  very  common  in  the 
bitch,  and  exceedingly  rare  in  other  domestic  animals.  In  aged 
bitches  mammary  carcinoma  are  very  common.  They  assume 
various  types,  most  frequently  scirrhous,  more  rarely  myxoma- 
tous, and  in  some  rare  cases  are  accompanied  by  calcification  or 
ossification.  The  cancer  may  break  down  and  result  in  ulcera- 
tion, or  the  blood  vessels  may  become  eroded  and  cause  a  hematom. 
The  carcinoma  usually  originate  in  the  substance  of  the  gland, 
although  more  rarely  they  may  have  their  beginning  in  the  skin 
covering  it.  As  a  general  rule  the  development  of  the  tumor  is 
slow,  although  it  may  at  times  be  rapid.  In  some  instances  the 
tumors  remain  quiescent  for  a  long  period  of  time,  especially  if 
not  interfered  with  ;  while  in  other  cases,  especially  if  the  glands 
have  been  removed,  metastatic  tumors  occur  in  the  surrounding 
tissues,  which  pursue  a  very  rapid  and  virulent  course. 

In  carcinoma  of  the  mammae  of  the  bitch,  the  affected  gland 
or  glands  are  enlarged  and  hardened.  The  swelling  is  distinctly 
lobular,  and  usually  commences  near  the  base  of  the  teat,  extend- 
ing thence  upward  to  involve  the  entire  gland.  Sometimes  the 
disease  is  confined  to  a  single  gland,  but  frequently  it  involves 
several,  and  in  some  cases  virtually  all  of  the  glands,  one  after 
another.  The  extension  from  one  gland  to  another  may  be  very 
rapid. 

Sarcoma  of  the  milk  glands  occur  chiefly  in  the  bitch  and 
mare,  as  nodular  and  more  or  less  soft  swellings,  which  may  reach 
very  large  proportions.  In  the  mare  the  tumor  may  extend  up- 
ward from  the  gland  through  the  inguinal  canal  into  the  peritoneal 
cavity. 

As  in  the  adeno-fibrom  and  the  carcinom,  so  in  sarcoma,  there 
may  be  a  tendency  to  o.ssification,  or  cysts  may  form  containing 
a  variable  quantity  of  fluid,  which  ma}-  resemble  mucus,  and  con- 
tain detritis  of  cells,  along  with  fat  and  crystals   of  cholesterine. 

Other  tumors  of  the  mammary  glands,  such  as  chondroma, 
lipoma  and  osteoma,  occur  in  domestic  animals,  especially  in  the 
bitch.  Very  rarely  large  cystic  tumors  form  in  the  mammae, 
filled  with  a  mucoid  substance,  while  their  boundaries  may  be  cal- 
cified and  .sharply  limited  so  that  they  can  be  easily  enucleated. 

Rehmet  relates  the  occurrence  of  echinococcus  polymorphus  in 
the  udder  of  a  cow.  Numerous  large  firm  nodules  were  observed, 
which   were  su.spected   of   being  tubercular   in   character  ;  but. 


He^norrhages  i7i  the  Udder  983 

when  examined  after  slaughter,  were  found  to  consist  of  very 
tense  cysts,  varying  in  size  from  a  hazelnut  to  a  hen's  egg,  and 
containing  a  clear  fluid  and  echinococci. 

There  are  also  observed,  in  the  udder,  retention  cysts.  A  milk 
canal  leading  from  a  portion  of  the  gland  becomes  occluded,  and 
consequently  a  quantity  of  milk  is  imprisoned  until  it  causes  a 
sufficient  distension  that  it  is  readily  seen  and  felt.  It  presents 
the  characters  of  a  fluctuating  tumor,  and,  when  opened,  dis* 
charges  ordinary  milk. 

The  handling  of  tumors  of  the  udder  consists  essentially  of 
their  early  enucleation,  or  the  amputation  of  the  entire  gland. 
It  is  especially  important,  when  malignancy  is  suspected,  that 
the  entire  gland  should  be  removed  early,  and  along  with  it 
should  be  included  any  neighboring  lymph  glands  which  are  prob- 
ably or  possibly  involved.  If  the  malignant  tumor  has  existed 
for  a  long  period  of  time,  the  probabilities  are  that  its  removal 
will  but  excite  other  disease  foci  in  neighboring  glands  to  in- 
creased activity,  and  that  the  disease  will  run  a  more  virulent 
course  than  if  left  untouched. 

15.   Hemorrhages  in  the  Udder. 

Hemorrhages  may  occur  in  any  part  of  the  udder,  either  be- 
cause of  trauma  or  exalted  blood  pressure,  and  may  result  in  the 
formation  of  hematoma  ;  or  the  blood  may  flow  into  the  larger 
milk  canals  or  milk  cistern  and  be  milked  out. 

The  symptoms  necessarily  vary  greatly  according  to  the  loca- 
tion of  the  injury  and  volume  of  blood  escaping  from  the  vessels. 
A  large  volume  of  blood  causes  a  distinct  .swelling  of  the  udder. 
This  is  especially  notable  if  a  hematom  occurs  in  the  subcutaneous 
connective  tissue.  In  pendulous  udders  the  gland  is  constantly 
turned  to  and  fro  upon  its  long  axis,  during  the  progression  of 
the  animal,  because  at  each  step  it  strikes  against  the  advancing 
hind  limb,  or  it  comes  in  violent  contact  with  obstacles  in  the 
path  of  the  animal,  from  either  of  which  causes  the  udder  may 
receive  more  or  less  serious  injuries.  In  the  normal  gland,  in- 
jury may  result  from  rough  milking,  from  treads  or  other- 
wi.se. 

The  milk  from  an  animal  suffering  from  mammary  hemor- 
rhage may  be  mixed  with  blood,  or  pure  blood  may  be  drawn 
from  the  teat.     If  the  hemorrhage  is  very  extensive,  the  udder 


984  Veterinary  Obstetrics 

may  hang  very  low  because  of  the  great  weight  of  the  large 
heniatom  which  it  contains.  If  an  injury  has  caused  hemorrhage 
into  the  udder,  and  the  blood  becomes  mixed  with  the  milk,  the 
mixture  is  usually  somewhat  clotted.  When  mammary  hemor- 
rhage is  due  to  the  passage  of  red  corpuscles  through  the  walls 
of  the  capillaries  into  the  milk  vessels,  the  blood  is  uniformly 
mixed  with  the  milk,  and  may  give  it  a  reddish  tinge,  or  may 
pass  unobserved  until  the  milk  has  stood  for  a  time,  when  the 
blood,  on  account  of  its  weight,  sinks  to  the  bottom  and  is  very 
readily  .seen. 

The  advent  of  blood  in  milk  not  infrequently  indicates  the 
commencement  of  a  clironic  catarrhal  mammitis,  affecting  chiefly 
the  milk  cistern  and  large  canals.  The  bloody  character  of  the 
milk  may  presently  abate,  but  the  catarrh  persists,  leading  grad- 
ually to  atresia  of  the  teat.  The  atresia  may  mature  dur- 
ing the  milking  period,  or  its  completion  be  delayed  until  the 
dry  period,  and  when  the  cow  again  comes  into  milk  the  atresia 
may  be  found  complete. 

Special  forms  of  infection  sometimes  cause  a  reddish  tint  of  the 
milk,  in  the  absence  of  blood  or  blood-coloring  matter. 

Termination.  In  those  cases  of  bloody  milk  due  to  exalted 
blood  pressure  in  the  gland,  the  duration  of  the  condition  is 
usually  prolonged,  so  that  it  is  a  long  time  before  the  milk  again 
becomes  normal.  As  a  general  rule  the  result  is  very  unfa- 
vorable, becau.se  the  same  condition  tends  to  recur  at  each 
calving.  If  hematoma  form,  they  are  slowly  resorbed,  to  leave 
cysts  behind,  or  induration  of  the  gland  occurs,  or  the  wall  of  the 
hematom  gives  way  and  its  contents  escape  externally.  Should 
the  hematom  become  infected,  mastitis  results,  usually  followed 
by  abscess. 

When  a  limited  amount  of  hemorrhage  occurs  in  the  milk,  the 
most  that  can  be  done  is  the  careful  milking  out.  This  does  not 
prove  very  satisfactory,  as  the  milk  is  unfit  for  use,  and  the 
animal  tends  to  give  bloody  milk  again  and  again  at  the  begin- 
ning of  each  milking.  When  hematoma  form,  an  attempt  may 
be  made  to  check  the  hemorrhage,  if  still  existing,  b}'^  the  appli- 
cation of  cold,  especially  of  ice  by  means  of  a  suspensory  bandage, 
or  by  hemostatics  given  internally.  Generally  this  is  not  neces- 
sary. The  hematom  should  be  left  alone  for  two  or  three  days, 
until  assured  that  the  hemorrhage  will  not  be  renewed  and  that 


Milk  FistulcB  985 

a  somewhat  resistant  wall  is  formed  around  the  escaped  blood. 
The  hematom  may  then  be  opened  and  the  blood  removed,  after 
which  the  lesion  is  to  be  handled  as  an  ordinary  wound. 

16.   Milk  Fistul-*:. 

A  milk  fistula  consists  of  a  communication  of  the  milk  cistern  or 
one  of  the  large  milk  canals  with  the  exterior,  through  a  canal 
other  than  the  normal  one.  While  such  fistulse  are  possible  in 
any  animal,  they  occur,  or  are  observed,  practically  in  the  cow 
alone.  Their  very  rare  occurrence  in  other  animals  is  of  little  or 
no  significance.  The  fistulse  may  be  congenital,  but  generally 
they  are  caused  by  penetrating  wounds  of  the  milk  cistern  during 
the  period  of  lactation.  They  arise  from  trauma  of  various 
kinds,  and  in  some  instances  result  from  operative  wounds,  or 
from  abscesses  forming  in  the  milk  cistern  or  large  milk  sinuses 
and  rupturing  outward  through  the  wall  of  the  teat  or  udder. 

Symptoms.  Milk  fistulse  may  open  at  any  part  of  the  teat, 
or  of  the  udder  near  the  teat  base.  They  are  most  common  in 
the  teat  near  its  base,  though  sometimes  observed  at  the  apex  of 
the  teat,  within  a  very  short  distance  of  the  normal  opening.  If 
the  fistulous  opening  is  very  small,  the  milk  may  not  flow  from 
it  except  when  the  teat  is  being  milked  and  greater  pressure  is 
consequently  placed  upon  the  fluid  within  the  cistern.  If  the 
fistulous  opening  is  large,  the  milk  drops  away  continually  when- 
ever the  pressure  of  the  milk  in  the  cistern  is  sufficiently  high. 

Fistulse  of  the  milk  canals  tend  to  heal  spontaneously  in  a  com- 
paratively short  time,  while  those  of  the  milk  cistern,  and  espe- 
cially those  of  large  size,  do  not  readily  heal  of  themselves,  and 
are  liable  to  become  permanent  unless  active  intervention  occurs. 
If  the  fistula  forms  somewhat  early,  during  active  lactation,  its 
walls  tend  to  become  healed  and  covered  over  by  a  protective 
epithelium,  so  that  they  will  not  readily  adhere.  If  the  perfo- 
rating wound  occurs  while  the  cow  is  dry,  or  if  she  ceases  to  milk 
before  the  walls  of  the  fistula  become  covered  over  with  epithe- 
lium, adhesion  of  the  wound  margins,  with  spontaneous  oblitera- 
tion of  the  fistula,  is  probable. 

Treatment.  Perforating  wounds  of  the  milk  cistern  or  canal 
should  be  handled  as  .soon  as  possible  after  their  occurrence.  The 
handling  should  consist  essentially  of  the  thorough  and  careful 
disinfection  of  the  wound,  after  which  it  maybe  neatly  sutured 


9^6  Veteriyiary  Obstetrics 

and  measures  taken  to  protect  the  sutures  during  milking.  It 
is  highly  important  that  strict  antiseptic  rules  should  be  followed 
in  order  to  prevent  infection  of  the  gland.  It  has  been  sugges- 
ted that  the  danger  of  disturbing  the  sutures  should  be  overcome 
by  the  use  of  the  milk  tube,  under  very  strict  antiseptic  precautions. 
Vennerholni  advises  that  a  rubber  band  may  be  placed  over  the 
suture  to  afford  pressure,  being  careful  not  to  apply  it  so  tightly 
as  to  cause  a  disturbance  of  the  circulation.  One  may  do  much 
also  to  prevent  the  tearing  out  of  sutures,  or  even  to  overcome 
the  necessity  for  their  insertion,  by  applying  a  strip  of  adhesive 
plaster  carefully  to  the  part.  The  strip  should  be  long  and  nar- 
row, and  applied  by  encircling  the  teat  several  times,  each  course 
overlapping  the  preceding  one,  the  whole  forming  a  solid  encase- 
ment, insuring  the  accurate  and  secure  closure  of  the  wound. 

In  chronic  fistula,  in  which  the  walls  are  covered  over  with  ep- 
ithelium, it  is  essential  that  the  protective  epithelial  layer  be 
destroyed  before  adhesion  can  take  place.  The  epithelium  of 
the  fistula  may  be  most  readily  destroyed  with  a  fine  thermocau- 
tery point,  by  inserting  it  well  into  the  fistulous  tract  and  con- 
tinuing the  cautery  until  the  epithelium  has  been  completely 
destroyed.  In  place  of  the  thermocautery  one  may  use  a  caustic, 
especially  the  nitrate  of  silver.  If  the  fistula  is  at  the  apex  of 
the  teat  and  near  by  the  normal  opening,  it  may  sometimes  be 
best  handled  by  the  amputation  of  the  teat  just  above  the  fistula. 

It  is  usually  desirable  that  any  interference  with  chronic  milk 
fistula  should  be  deferred  until  the  cow  is  dry,  in  order  to  avoid 
as  far  as  possible  the  danger  of  infection  of  the  gland  as  a  result 
of  the  injuries  to  the  tissues  during  the  operation. 

Supernumerary  teats  sometimes  exist  in  a  manner  to  con- 
stitute an  annoyance  in  milking,  because  they  are  constantly  in 
the  way  of  the  milker.  Sometimes  they  act  as  fistulse,  through 
which  milk  escapes  while  the  milking  proce.ss  is  going  on  with 
the  normal  teats.  Should  they  prove  annoying,  it  is  best  to 
amputate  them  during  the  dry  period,  when  the  healing  of  the 
wound  will  usually  cause  an  obliteration  of  the  duct  or  cistern  of 
the  supernumerary  nipple. 

When  heifer  calves  are  born  with  supernumerary  teats,  which 
may  later  prove  annoying  or  unsightly,  they  may  readily  be  re- 
moved by  clipping  them  off  with  scissors.  The  teat  should  be 
well  drawn  out,  and  excised  close  against  the  gland.     In  healing. 


Milk  Stones  or  Milk  Calculi  987 

any  milk  orifice  traversing  it  will  be  closed  and,  if  clipped  closely, 
will  not  show  when  the  animal  is  grown.  When  the  heifer 
calves,  the  rudimentary  gland  may  function  temporarily,  but 
soon  ceases  to  secrete  because  of  the  pressure  of  the  confined 
milk.     Later  the  gland  atrophies. 

There  is  a  want  of  power  in  the  teats  of  some  cows  to  retain 
the  milk  within  the  udder,  so  that  as  soon  as  the  gland  becomes 
distended,  the  milk  begins  to  escape  involuntarily  through  the 
teat  canal.  This  causes  great  waste  by  allowing  a  large  propor- 
tion of  the  milk  secreted  to  escape  from  the  teats  during  the  in- 
terval between  milkings.  Various  plans  for  overcoming  the 
difficulty  have  been  suggested  and  tried,  but  none  of  them  are 
very  satisfactory.  The  cow  may  be  milked  very  frequently,  so 
as  to  prevent  any  great  pressure  of  the  fluid  within  the  gland  ; 
or  the  lumen  of  the  teat  canal  may  be  closed  by  the  application 
of  a  rubber  band  or  a  metal  ring. 

Vennerholm  suggests  the  possibility  of  bringing  about  a  nar- 
rowing of  the  teat  canal  by  the  excision  of  a  wedge-shaped  piece 
of  the  teat  wall,  in  the  hope  that,  in  healing,  the  teat  orifice  may 
contract  sufficiently  to  hold  the  milk.  He  admits,  however,  that 
it  is  exceedingly  difficult  to  determine  the  proper  amount  of  tissue 
to  remove.  If  too  much  is  included,  the  teat  canal  maj^  become 
obliterated  or  excessiveh"  narrowed  ;  if  too  little  is  taken,  the 
object  is  unaccomplished.  Amputation  of  the  apex  of  the  teat 
may  also  cause  narrowing,  but  the  degree  can  not  be  foretold. 

17,  Milk  Stones  or  Milk  Calculi. 

There  are  occasionally  found,  in  the  udder  of  the  cow,  con- 
cretions of  the  carbonate  of  lime,  mixed  with  small  proportions 
of  fat  or  casein,  and  varying  in  size  from  that  of  a  mustard  seed 
to  a  large  bean.    They  may  occur  singly  or  in  large  numbers. 

When  very  large  they  may  readily  be  felt  through  the  walls  of 
the  large  milk  canals  or  of  the  cistern,  and  may  become  lodged  in 
the  teat  canal  in  such  a  manner  as  to  interfere  with  the  flow  of 
milk,  and  cause  pain  to  the  animal  during  milking.  When 
occurring  in  large  numbers,  they  may  cause  a  general  sen.sitive- 
ness  of  the  gland,  accompanied  by  .some  stiffness  and  a 
straddling  gait. 

They  are  to  be  differentiated  from  nodular  enlargements  in  the 
teats.     The  latter  are  immoveable  and   grow  slowly,  while  the 


988  Veterinary  Obstetrics 

calculi  are  generally  movable,  at  least  during  their  early  stages 
or  until  they  accidently  become  incarcerated  in  the  teat  canal. 

Sometimes  milk  stones  may  be  forced  out  through  the  teat 
canal  without  injury,  but  if  too  large  for  this  to  be  accomplished, 
it  is  advisable  to  remove  them  by  means  of  an  incision  through 
the  walls  of  the  gland,  after  which  the  wound  should  be 
carefully  closed  immediately. 

1 8.  Pendulous  Udder. 

The  mamnice  of  the  cow,  ewe  and  goat  frequently  become  very 
pendulous,  and  hang  down  almost  or  quite  to  the  ground.  Such 
an  udder  is  in  constant  danger  of  injury  from  being  struck  by 
the  hind  legs  during  locomotion,  especially  when  the  animal  is 
forced  to  run.  It  may  also  come  in  violent  contact  with  ob- 
stacles of  various  kinds  in  a  manner  to  cause  wounds,  to  be 
followed  by  infection. 

Sometimes  a  pendulous  udder  apparently  results  from  a  gradual 
yielding  of  the  suspensory  apparatus  of  a  comparatively  normal 
gland.  Once  the  gland  drops  away  from  the  abdomen  for  a  short 
distance,  its  weight  tends  to  cause  it  to  drop  lower  until  the 
pendulousness  becomes  extreme.  In  other  cases  the  pendulous- 
ness  is  attributable  to  mammitis,  followed  by  induration  and 
enlargement,  the  increased  weight  overcoming  the  power  of  the 
suspensory  apparatus  and  causing  the  gland  to  drop  down 
away  from  the  abdomen. 

We  have  no  successful  method  for  overcoming  the  pendulous 
udder.  An  ordinary  animal  so  affected  should  be  fitted  for  the 
butcher.  In  a  pedigreed  cow  having  a  very  high  value  as  a  breeder, 
if  the  udder  is  much  enlarged  and  indurated,  is  so  pendulous  as 
to  constitute  a  constant  and  serious  impediment  to  locomotion,  or 
menace  the  health  or  life  of  the  animal  on  account  of  repeated 
infections  from  injuries,  the  pendulous  organ  should  be 
amputated  according  to  the  technic  already  suggested  on  page  963. 

19.  Dermatitis  of  the  Udder. 

Inflammation  of  the  skin  of  the  udder  is  said  to  be  caused  at 
times  from  exposure  to  the  rays  of  the  sun  in  hot  weather.  The 
effect  is  referable,  according  to  Vidmark,  to  the  action  of  the 
ultra-violet  rays  upon  the  non-pigmented  skin,  which  leads  to 
dermatitis  and  mummification. 


Dermatitis  of  the  Udder  989 

When  cows  are  exposed  to  cold  and  damp  winds,  the  skin  of 
the  teats  and  udder  is  liable  to  become  inflamed  and  cracked.  If 
the  teats  of  the  cow  are  bathed  or  moistened,  preparatory  to 
milking,  and  then  left  to  dry  in  a  cold  draft,  the  skin  is  liable  to 
crack  and  become  very  sore,  so  that  in  milking  it  bleeds  and 
causes  quite  severe  pain  to  the  animal,  which  not  infrequently 
leads  to  uneasiness  and  kicking. 

Dry  gangrene  of  the  skin  of  the  teats  is  said  to  result  in  some 
cases  from  the  feeding  of  cows  upon  potato  refuse  or  ergotized 
fodder.  Wounds  or  other  injuries  to  the  teat  or  glands  may 
likewise  cause  dry  gangrene. 

The  symptoms  of  dermatitis  of  the  udder  are  as  variable  as 
the  causes  which  may  induce  it.  There  may  be  redness  accom- 
panied by  sensitiveness  in  the  part,  or  there  may  be  small  fissures 
or  excoriations  from  which  blood  exudes.  When  gangrene  occurs 
there  is  swelling  of  the  parts,  a  black  or  blue-black  color,  with 
usually  a  well  defined  line  of  demarcation.  The  sequestration  of 
the  mummified  portion  is  usually  very  slow. 

In  the  Mississippi  Valley  and  some  other  portions  of  the  United 
States,  there  appears  from  time  to  time,  usually  in  the  late  sum- 
mer or  autumn,  a  disease  affecting  the  feet,  mouths  and  udders 
of  cattle,  which  was  at  first  mistaken  by  some  for  the  contagious 
foot  and  mouth  disease.  It  occurs  almost,  if  not  entirely,  among 
animals  which  are  upon  the  pasture.  The  disease  first  expresses 
itself  by  a  stiffness  in  the  gait,  as  a  result  of  the  sore  feet  :  and 
a  dribbling  of  saliva  from  the  mouth,  as  a  consequence  of  the 
necrosis  of  the  buccal  mucous  membrane.  Hemorrhagic  areas 
occur  in  the  skin  of  the  feet,  especially  between  the  claws  ;  upon 
the  teats  and  udder  of  milk  cows  ;  and  in  the  mucous  membrane 
of  the  mouth,  especially  upon  the  bars  and  pad  of  the  upper  jaw. 
Later  the  areas  become  necrotic  and  slough  away,  leaving  painful 
ulcers,  which  heal  in  the  course  of  a  few  days.  Upon  post- 
mortem examination,  in  fatal  ca.ses,  hemorrhagic  areas  are  found 
throughout  the  length  of  the  alimentary  canal. 

The  character  of  the  disease  is  not  well  known,  though  it  has 
been  described  by  Mohler  as  mycotic  stomatitis.  So  far  as  we 
know,  the  disease  of  the  udder  has  not  proven  annoying  in  any 
case,  and  simply  constitutes  an  interesting  symptom  in  the  course 
of  the  more  widely  diffused  disease.  It  calls  for  no  special  treat- 
ment, .so  far  as  observed. 


990  Veterinary  Obstetrics 

The  prognosis  is  favorable,  except  for  the  danger  of  infection 
of  the  glandular  tissue  itself,  leading  to  mastitis  and  a  disturbance 
of  the  milk-secreting  functions. 

The  handling  of  dermatitis  of  the  udder  should  be  specially  de- 
termined for  each  case,  according  to  the  cause.  Generallj'  the 
treatment  should  consist  of  the  application  of  antiseptics  and 
protectives  to  the  injured  skin.  When  the  teats  are  fissured 
and  excoriated  as  a  result  of  exposure  to  damp  winds,  or  of 
wetting  the  teats  during  milking  and  not  properly  drying  them, 
great  care  should  be  taken  to  thoroughly  cleanse  them  with  a 
warm  antiseptic  solution.  Immediately  afterward  a  protective 
antiseptic  dressing  should  be  applied.  One  will  usually  obtain 
excellent  results  by  first  cleansing  the  parts  with  warm  antiseptic 
solution  and  then  applj'ing,  after  the  completion  of  the  milking, 
a  mixture  of  one  part  each  of  tincture  of  iodine,  glycerine,  and 
tincture  of  arnica.  Such  a  mixture  should  be  sparingly  applied, 
so  as  to  constitute  a  thin  coating  over  the  part.  Care  should 
be  taken  to  not  apply  so  much  as  to  make  the  parts  sticky,  and 
thereby  cause  dirt  to  adhere.  Vennerholm  suggests  the  applica- 
tion of  a  salve,  consisting  of  tannic  acid  and  oxide  of  lead,  or 
other  similar  substances,  but  such  applications  cause  dirt  to 
adhere  and  keep  the  teat  soiled,  unless  applied    very  sparingly. 

If  gangrene  of  the  skin  is  threatened,  antiseptics  should  be 
applied  more  liberall)^,  and  it  is  suggested  by  some  writers  that 
the  skin  should  be  scarified,  antiseptic  poultices  applied,  and  the 
udder  supported  by  a  bandage. 

If  the  gangrene  extends  into  the  deeper  parts  of  the  teat,  it 
may  be  advisable  to  amputate  it  in  order  to  hasten  recovery.  If 
the  gangrene  extends  into  the  cistern,  the  glandular  tissue  is 
almost  inevitably  involved  in  mammitis,  and  the  amputation  of 
the  teat  affords  excellent  drainage  for  the  gland  and  permits  all 
excretions  to  drop  away  almost  immediately. 

20.    FURUNCULOSIS    OF    THE    UdDER. 

Johne  has  recorded  a  special  form  of  disease  of  the  udder  of 
the  cow,  under  the  name  of  furunculosis.  In  the  cases  thus  re- 
corded, there  occurred  swellings,  which  were  one-quarter  to  two 
inches  in  diameter,  chiefly  above  the  base  of  the  teat.  The 
swellings  were  quite  hard  and  painful  for  a  time,  but  after  some 
weeks  fluctuated   and   finally  ruptured,  discharging  pus,  mixed 


Wounds  of  the  Udder  and  Teats  991 

with  fragments  of  necrotic  tissue.     Later  the  abscesses  healed, 
without  serious  interference  with  the  secretion  of  milk. 

Johne  did  not  determine  the  cause  of  the  disease.  Clinically 
it  assumed  an  enzootic  character,  and  appeared  chiefly  in  stables 
where  potato  tops  and  mouldy  straw  were  used  for  bedding.  In 
the  handling  of  the  disease,  the  abscesses  were  opened  and  dis- 
infected according  to  general  surgical  principles. 

21.   Wounds  of  the  Udder  and  Teats. 

Wounds  of  the  udder  and  teats  present  every  possible  variety 
in  cause  and  degree.  Cows  which  are  kept  in  crowded  stanchions 
frequently  suffer  from  wounds  to  the  teats  caused  by  neighboring 
animals  treading  upon  them.  In  many  parts  of  the  United 
States  a  very  common  cause  of  wounds  to  the  teats  of  cows  is 
barbed  wire,  especially  where  a  fence  has  been  badly  built  and 
cows  have  crowded  through  it  or  attempted  to  jump  over  it.  If 
the  cow  is  in  full  milk,  so  that  the  udder  is  ten.se  and  distended, 
the  wounds  from  the  barbs  of  the  wire  may  be  ver}'  .severe  and 
extensive. 

Wounds  or  contusions  may  also  occur  from  rough  milking.  If 
a  milker  is  careless  in  regard  to  his  finger  nails,  the  teats  may 
be  badly  abraded  by  the.se.  We  have  observed  wounds,  of  a 
more  or  less  .serious  character,  inflicted  by  pigs  or  other  animals 
in  sucking.  When  pigs  are  allowed  in  the  same  enclosure  with 
milk  cows,  and  there  chances  to  be  a  cow  from  which  the  milk 
flows  involuntarily  when  she  is  lying  down  with  the  udder  well 
filled,  pigs,  coming  about,  detect  the  milk  and  eat  it.  Following 
up  the  stream  to  its  source,  the  pig  finally  acquires  the  habit  of 
sucking  the  cow,  incidentally  wounding  the  teats  with  the  teeth. 
In  one  case  we  observed  a  heifer,  pregnant  for  the  first  time,  ac- 
quire maternal  attachment  for  a  half-grown  pig,  which  she 
persistently  suckled.  The  sucking  by  the  pig  caused  unimportant 
teat  wounds. 

From  wounds  of  such  diver.se  characters,  equally  variable  lesions 
follow,  such  as  milk  fistula,  suppuration,  ulceration  and  mammi- 
tis.  Wounds  of  a  quiescent  udder  usually  heal  well,  but  if  the 
cow  is  in  milk  and  the  lesions  involve  the  teats  it  may  be  exceed- 
ingly difficult  to  milk  the  cow  without  irritating  the  wound  and 
delaying  the  healing  process. 


992  Veterinary  Obstetrics 

As  we  have  already  stated  in  discussing  the  subject  of  maui- 
mitis,  suppurating  wounds  of  the  active  udder  or  teats  possess 
great  danger  for  the  integrity  of  the  gland  because  of  their  ten- 
dency to  produce  manimitis.  Penetrant  wounds  of  the  milk 
cistern  or  deep  wounds  near  the  apex  of  the  teat  in  milk  cows  are 
especially  dangerous. 

In  the  absence  of  a  penetrant  wound,  the  pus  flows  down  over 
the  teat  to  the  teat  orifice,  and  thence  the  infection  passes  up  into 
the  cistern;  or  the  careless  dairyman,  finding  the  cow  nervous 
or  unruly  because  of  the  sensitive  and  painful  teat,  resorts  to 
the  milk  tube  for  withdrawing  the  milk.  The  milk  tube, 
probably  already  filthy  from  prior  use,  becomes  contaminated 
further  as  it  is  being  inserted,  and  carries  infection  up  into  the 
cistern. 

Such  contamination  is  preventable  only  by  the  strictest  possible 
precautions,  consisting  of  the  thorough  disinfection  of  the  teat- 
wound,  the  entire  teat,  and  the  hands  of  the  operator  ;  and  the 
sterilization  of  the  milk  tube.  Even  then  the  teat  orifice  may 
contain  virulent  organisms  to  be  pushed  up  into  the  cistern  on 
the  end  of  the  milk  tube. 

It  would  be  far  better  to  aspirate  the  milk  from  the  wounded 
teat  by  means  of  a  cupping  glass.  It  would  cause  much  less  pain 
to  the  cow,  and  would  permit  far  better  asepsis. 

Vennerholm  suggests  that,  when  wounds  of  the  teats  are  very 
sensitive,  there  should  be  applied  to  them  a  5  %  solution  of  cocaine 
at  milking  time,  in  order  that  the  process  may  be  carried  out 
without  causing  pain.  The  pain  of  milking  can  always  be  re- 
duced greatly  by  first  bathing  the  part  with  warm  water,  to  which 
has  been  added  a  small  amount  of  carbolic  acid.  After  milking, 
the  wound  should  always  be  carefully^dressed  with  the  most  re- 
liable antiseptics,  for  which  purpose  we  recommend  equal  parts 
of  tincture  of  iodide,  tincture  of  arnica  and  glycerine. 

22.  Warts  on  the  Teats. 

Warts  on  the  teats  are  very  common  in  milk  cows,  and  differ 
greatly  in  form  and  size.  As  a  general  rule  they  are  more  or 
less  polypoid  or  pedunculate  in  character,  and  have  a  very  small 
neck,  though  they  are  sometimes  conical  or  sessile.  They  are 
especially  common  on  the  teats  of  young  cows.  There  may  be  15 
or  20  or  even  more  on  one   teat,  scattered   over  the   organ    from 


Stricture  or  Atresia  of  the  Teats  993 

the  apex  to  the  base,  and  spreading  somewhat  over  the  contiguous 
udder.  Generally  they  are  not  particularly  sensitive,  but  some  of 
them  are  markedly  so,  and  under  certain  conditions  and  situations, 
because  of  being  pinched  in  the  process  of  milking,  they  may  be 
quite  painful,  and  cause  the  animal  to  become  uneasy,  and  resist 
milking  by  stamping  or  kicking. 

If  the  warts  are  causing  no  annoyance  to  the  cow  and  are  not 
in  the  way  in  milking,  they  should  be  left  alone.  If  they  are 
causing  annoyance  they  may  be  very  safely  chpped  off  with 
shears,  under  local  anaesthesia,  or  cauterized  with  silver  nitrate  or 
with  the  thermocautery,  during  the  dry  period.  One  of  the  most 
efficient  and  convenient  remedies  for  warts  is  the  application  of 
strong  nitric  acid.  The  end  of  a  small  glass  rod  is  dipped 
in  the  acid,  and  with  this  the  surface  of  the  wart  is  cautiously 
moistened.  This  may  be  repeated  every  two  or  three  days,  until 
the  wart  contracts  and  the  small,  hard  eschar  drops  away.  If 
carefully  done,  not  too  much  of  the  acid  applied,  and  none  al- 
lowed to  touch  the  normal  skin,  no  pain  will  be  caused  what- 
ever. This  is  of  importance  as  affecting  the  temper  of  the 
cow.  In  young  animals  they  tend  after  a  time  to  disappear 
spontaneously.  They  may  also  be  caused  to  disappear  in  some 
cases  by  the  internal  administration  of  arsenic. 

23.   Stricture  or  Atresia  of  the  Teats. 

In  cows  there  not  infrequently  occurs  stricture  or  atresia  of  the 
milk  orifice,  the  cistern,  or  the  milk  canals,  which  may  either 
render  milking  very  tedious  and  difficult  or  completely  prevent  the 
withdrawal  of  the  milk  from  the  gland.  While  it  is  possible  for 
similar  lesions  to  occur  in  other  animals,  such  as  the  ewe  and 
goat,  from  an  economic  standpoint  the  condition  is  confined  to 
the  cow,  where  it  exerts  a  very  great  influence  upon  the  produc- 
tion of  milk  and  offers  an  exceedingly  complicated  and  difficult 
problem  to  the  veterinarian,  because  in  the  present  state  of  our 
knowledge  the  handling  of  this  group  of  affections  is  exceedingly 
unsatisfactory. 

The  teats  of   cows   show    as  great   variety   in  thefr  internal 

structure  and  arrangement  as  they  do  in  their  external  form  and 

size.     They  may  shew  upon  the  internal  wall  of  the  cistern  small 

gland-like  prominences  of  a  spherical  form,  but  having  no  special 

63 


994  Veterijiary  Obstetrics 

influence  upon  the  process  of  milking.  The  teat  walls  maj'  be 
very  thick,  leading  to  a  small  lumen  of  the  teat  canal,  accom- 
panied by  difficult  milking,  but  this  condition  cannot  be  regarded 
as  pathologic.  In  addition  to  these  there  may  be  transverse  folds 
of  the  mucous  membrane  projecting  out  into  the  milk  cistern, 
which  may  possibly  be  normal,  and  yet  may  offer  some  obstruc- 
tion to  the  passage  of  the  milk. 

Jensen  records  the  occasional  occurrence  of  perpendicular  par- 
titions in  the  cistern  of  the  teat,  constituting  essentially  double 
teats.  There  may  be  supernumerary  cisterns,  with  small  teat 
canals  opening  near  the  base  of  the  teat,  so  that  they  behave  as 
milk  fistulse.  Vennerholm  states  that  there  frequently  occur, 
in  the  cistern,  small  papilloma,  which  interfere  with  the  pas- 
sage of  the  milk  by  partially  filling  the  cistern.  Such 
papilloma  may  also  become  displaced  and,  dropping  into  the 
teat  canal,  partially  block  it.  The  cause  of  these  papilloma  is 
presumably  the  previous  occurrence  of  trauma. 

The  stricture  or  atresia  may  occur  at  any  point  in  the  teat, 
from  its  apex  to  its  base.  Most  of  the  lesions  are  found 
at  the  base  of  the  teat  or  in  the  teat  canal  at  its  apex,  while 
the  capacious  cistern  remains  comparatively  free. 

The  symptoms  of  stricture  or  atresia  will  depend  priniarilj^ 
upon  the  location  of  the  lesion  and  its  extent.  If  the  stricture 
or  atresia  occurs  in  the  teat  canal,  the  teat  promptly  and  read- 
ily becomes  distended  with  milk,  but  it  is  exceedingly  difficult 
or  impossible  to  press  it  out  through  the  teat  orifice.  When  the 
milk  is  forced  out,  it  comes  away  in  a  fine  stream. 

This  condition  should  not  be  confounded  with  those  instances 
in  the  cow  where  the  teat  canal  is  normally  very  narrow  and  the 
sphincter  muscle  surrounding  it  is  very  powerful,  rendering  milk- 
ing exceedingly  difficult.  In  such  cases,  ordinarily,  all  four  teats 
of  the  cow  are  alike,  and  merely  require  extra  pressure  in  order 
to  force  the  milk  through  the  narrow  canal.  Such  teats  are 
normal  upon  digital  palpation,  and  in  other  respects. 

By  palp^ation  of  teats  affected  with  stricture  or  atresia,  one  can 
usually  recognize  a  hard,  dense,  cord-like  thickening  along  the 
position  of  the  teat  canal,  which  indicates  that  the  mucous  mem- 
brane and  sub-mucous  connective  tissue  are  thickened  and 
indurated. 

In  most  cases  in  which  the  obstruction  exists  at  the  ba.se  of  the 


Stricture  or  Atresia  of  the  Teats  995 

teat,  it  is  found  that  the  milk  descends  slowly  or  not  at  all  into 
the  teat,  but,  if  it  once  descends  into  the  milk  cistern, 
is  easily  pressed  out.  When  the  cistern  is  emptied,  however,  it 
is  slow  in  refilling,  and  consequently  the  milking  process  is  ex- 
ceedingly tedious.  In  those  cases  of  stricture  where  the  upper  part 
of  the  cistern  is  completely  closed,  the  milk  may  readily  be  felt 
in  the  milk  canals  above,  pressing  down  upon  the  obstruction, 
while  the  teat  remains  empty.  Examining  closely  the  base  of 
the  teat,  one  usually  finds  in  the  central  portion  of  the  teat  base 
a  hard,  firm  nodule,  irregularly  spherical  in  form  and  varying  in 
size  from  Vz  to  yi  inch  in  diameter 

The  pathologic  processes  which  lead  to  a  narrowing  of  the  teat 
canal  are  usually  referred  to  some  traumatism,  involving  the  epi- 
thelium, the  mucous  membrane,  or  the  sub-mucosa  of  the  teat 
canal.  Lesions  of  this  character  are  assumed  to  follow  such  in- 
juries as  treads,  blows  or  rough  milking.  Following  these 
injuries,  hemorrhages  may  occur  into  the  sub-mucosa.  ac- 
companied by  exudation  into  the  surrounding  tissues.  After  the 
wounded  parts  have  become  infected  and  inflamed,  and  have  later 
healed,  there  remains  a  cicatricial  thickening  and  induration  of 
the  epithelium  and  sub-mucous  tissue.  In  some  cases  the  thick- 
ening involves  almost  the  entire  length  of  the  teat  canal,  and  ex- 
tends completely  around  it. 

In  our  observation,  most  of  the  cases  of  stricture  and  atresia 
of  the  teat  occur  at  the  base,  without  any  history  whatever  of 
traumatism  or  preceding  mammitis.  We  frequently  observe  the 
slow  formation  of  a  nodular  enlargement  of  a  very  firm  character 
at  the  base  of  the  teat,  usually  almost  directly  in  its  center,  at 
the  point  of  entrance  of  the  milk  canals  into  the  cistern. 

As  the  nodule  begins  to  form,  the  milker  first  observes  that 
the  milking  process  is  retarded.  The  milk  is  readily  pressed  out 
from  the  well-filled  cistern  through  the  teat  orifice,  but  the  cistern 
does  not  promptly  refill.  After  waiting  for  a  time,  the  cistern 
again  fills  and  the  teat  becomes  distended. 

Slowly  and  insidiously  the  difficulty  in  milking  increases,  and 
careful  palpation  reveals  a  firm  hard  nodule  centrally  located  in 
the  base  of  the  teat.  At  first  it  appears  about  }i  inch  or  less  in 
diameter,  very  firm,  painless.   It  grows  some,  but  does  not  attain 

inch. 


996  Veterhiary  Obstetrics 

The  teat  remains  empty,  the  nodule  in  the  teat  is  very  evi- 
dent, and  above  it  are  the  milk  canals,  widely  distended  by 
the  imprisoned  milk.  A  chronic  catarrh  of  the  epithelium  ap- 
parently exists  with  the  new  formation  of  dense  sclerotic  con- 
nective tissue  in  the  form  of  a  nodule.  If  left  alone  it  has 
little  tendency  to  cause  marked  mastitis.  In  a  large  propor- 
tion of  cases,  however,  the  use  of  the  milk  tube,  sound,  or 
other  implement,  creates  a  wound  and  deposits  virulent  infection 
in  it,  resulting  finally  in  mammitis.  If  left  alone  the  nodule  finally 
causes  complete  atresia,  and  the  milk  is  imprisoned  until  the  intra- 
mammary  pressure  reaches  the  point  at  which  milk  secretion  can- 
not be  continued,  after  which  the  quarter  commences  to  atrophy. 

The  process  is  a  chronic  one,  may  continue  to  develop  and  in- 
crease week  by  week,  but  usually  does  not  advance  far  enough 
to  bring  about  complete  atresia  during  the  milking  period  when 
its  appearance  is  first  observed.  After  the  cow  is  turned  dry, 
however,  the  process  continues,  and  leads  usually  to  complete 
atresia,  .so  that  at  the  next  calving,  it  is  found  that  the  affected 
teat  is  completely  closed  at  its  base,  making  it  impossible  for  the 
milk  to  enter  the  cistern  from  the  larger  canals. 

The  disease  may  affect  but  one  teat,  or  may  involve  two,  three, 
or  all  of  them.  It  behaves  clinically  as  a  chronic  infection,  and 
appears  to  spread  from  one  quarter  of  the  cow  to  another,  until 
each  is  involved  and  ruined.  We  have  observed  each  of  the  four 
quarters  of  the  udder  ruined  consecutively  because  of  such  nodu- 
lar growth  at  the  base  of  the  teat.  After  the  cistern  has  been 
completely  closed  at  the  ba.se,  the  disease  extends  down,  and  in 
many  cases  brings  about  a  complete  obliteration  of  the  cistern 
and  the  teat  canal. 

In  many  other  instances  the  atresia  has  its  beginning  in  an 
ulcer  involving  the  milk  orifice.  First  there  arises  difficulty  in 
withdrawing  the  milk  from  the  cistern.  If  the  nipple  is  carefully 
examined,  it  will  be  found  to  have  a  small,  hard,  sclerotic  ma.ssat 
the  teat  orifice,  usually  not  painful.  If  the  milk  orifice  is  care- 
fully inspected,  there  is  frequently  observed  a  red,  angry  ulcer, 
involving  the  milk  meatus  at  the  apex  of  the  teat.  Like  the 
preceding  disease,  the  course  is  chronic  and  insidious. 

There  is,  however,  no  limitation  of  the  area  in  which  the  sclerotic 
enlargement  may  occur.     While  most  of  these  changes  are  ob- 


Stricture  or  Atresia  of  the  Teats 


997 


served  either  at  the  apex  or  the  base  of  the  teat,  the  intervening 
portion  of  the  teat  is  nowhere  exempt. 

The  prognosis  of  atresia  or  stricture  of  the  teat  depends 
largely  upon  the  position  of  the  lesion.  The  outlook  is  the  more 
favorable  as  the  lesion  is  situated  nearer  to  the  end  of  the  teat, 
and  becomes  more  serious  as  it  is  nearer  the  base,  or  when  it 
involves  an  extensive  area  in  the  cistern  or  teat  canal. 

There  is  little  danger  to  the  life  of  the  animal  if  the  disease  is 
left  to  itself,  especially  if  the  atresia  is  complete.  If  surgical  in- 
terference is  undertaken,  except  under  the  most  rigid  precau- 
tions, there  is  great  danger  of  mastitis,  because  the  veterinarian 
cannot  certainly  prevent  the  invasion  of  bacteria. 

Handling.  In  many  cases  it  is  advisable,  especially  when 
there  is  complete  atresia  at  the  base  of  the  teat,  to  allow  the 
gland  to  atrophy  rather  than  assume  the  risk  of  causing  infection 
by  an  operation,  thereby  completely  destroying  the  affected 
quarter,  greatly  diminishing  the  milk  secretion  from  all  the  other 


Fig.  143. 


a,  Pomayer's  teat  dilator. 

b.  Aluminum  dilating  sounds, 

5,  6  and  7  mm. 

c.  Teat  sounds  of  Giovanoli. 

d.  Concealed  teat  knife. 

e,  Lance-shaped  teat  knife,  with 

probe  point.     American. 

f,  French  teat  dilator. 


g,  Holland  teat  knife  and  dilator 

combined, 
h,  Wessel's  concealed  knife  for 

dilating  teat  canal, 
i,    Fraun's  perforator, 
j,   Teat  reamer  of  Hug. 
k,  Teat  lancet  of  Hug. 
1,  Teat  dilator  of  Parmans.  (  Hauptner. ) 


998  Veterinary  Obstetrics 

quarters,  and  bringing  into  jeopardy  the  life  of  the  animal.  This 
is  especially  true  of  such  operations,  when  2,  3  or  all  the  teats  are 
affected  and  the  number  of  operations  required  renders  serious 
mammitis  well  nigh  inevitable.  After  all  the  danger  to  the 
animal,  the  outlook  for  any  definite  improvement  is  virtuall}' 
hopeless. 

Should  the  veterinarian  decide  to  operate,  the  essential  object 
to  be  attained  consists  of  a  dilation  of  the  teat  canal,  or  of  the 
communication  between  the  teat  cistern  below  and  the  milk 
canals  above.  Any  and  all  operations  having  such  an  end  in 
view  require  the  strictest  possible  asepsis.  The  hands  of  the 
operator,  the  teat  and  the  instruments  must  be  scrupulously  clean, 
and  the  operations  must  be  carried  out  without  introducing  into 
the  teat  any  form  of  infection  or  irritant.  Even  after  an  opera- 
tion has  been  successfully  performed,  from  the  standpoint  of 
asepsis,  it  is  still  a  difficult  problem  to  so  instruct  a  caretaker  that 
he  will  use  the  necessary  precautions  to  maintain  an  aseptic 
condition  in  the  part  during  the  process  of  healing.  Various 
methods  for  overcoming  the  stricture  or  atresia  have  been  sug- 
gested, differing  in  detail,  and  belonging  essentially  to  two  classes 
— the  bloodless  and  the  bloody  dilations. 

The  dilation  of  the  narrowed  canal,  without  the  division  of  the 
tissues,  is  attempted  by  means  of  bougies  or  sounds.  This 
method  can  only  be  applied  in  those  cases  where  the  lumen  of 
the  canal  is  narrowed,  but  not  completely  closed.  Some  advise 
the  introduction  of  a  piece  of  catgut  about  two  to  three  cm.  in 
length,  bearing  a  head  at  the  distal  end,  which  will  prevent  it 
from  slipping  entirely  into  the  teat.  When  this  is  introduced 
through  the  constricted  portion,  it  swells  by  absorbing  surround- 
ing moisture,  and  gradually  dilates  the  constricted  part.  It  may 
be  inserted  just  after  one  milking,  and  remain  in  position  until 
the  next.  Others  advise  the  repeated  insertion  or  prolonged  re- 
tention of  metallic  teat  sounds  or  bougies  like  b.  c.  Fig.  143. 

Other  forms  of  bougies  have  been  suggested,  such  as  one  con- 
sisting of  pure  gum,  which  exerts  gradual  pressure  upon  the  part 
and  brings  about  dilation. 

These  palliative  measures  have  generally  proven  unsatisfactory, 
being  accompanied  by  very  decided  danger,  without  any  corre- 
sponding probability  of  permanent  benefit. 


Stricture  or  Atresia  of  the  Teats  999 

The  dilation  of  the  canal  or  cistern  by  incision  has  been  quite 
largely  practiced  for  many  years,  and  numerous  instruments  have 
been  devised  and  recommended  for  carrying  out  the  operation. 
The  stilette  of  an  ordinary  trocar  serves  the  purposes  of  dilating 
the  teat  canal  quite  effectively,  in  so  far  as  the  immediate  results 
are  concerned.  Various  instruments,  known  as  milk  needles, 
and  having  a  small  caliber  and  the  stilette  of  a  trocar,  have  been 
devised  for  this  purpose.  Some  operators  have  used  a  small 
lancet,  a  probe-pointed  bistoury,  or  a  bistoury  cache.  Various 
forms  of  the  latter  have  been  recommended,  such  as  a  and  d, 
Fig.  143,  and  many  other  forms  involving  similar  principles. 

The  perforator  of  Fraun,  Fig.  143  i,  has  been  highly  recom- 
mended by  some,  because  with  it  transverse  membranes  may  be 
perforated,  and  the  perforation  enlarged  by  means  of  the  four 
blades,  which  can  be  pressed  out  laterally  after  the  introduction 
of  the  instrument  into  the  constricted  portion. 

In  addition  to  these  cutting  instruments,  one  requires,  for 
handling  the  teat  after  the  operation,  one  of  the  ordinary  forms 
of  milk  tubes,  by  which  the  edges  of  the  wound  may  be  kept 
apart,  and  their  adhesion  prevented  during  the  process  of  heal- 
ing, and  with  which  the  milk  may  be  drawn  with  the  least 
possible  injury.  It  is  highly  important  that  milk  tubes,  or  other 
instruments  designed  to  remain  in  the  teat,  should  be  of  pure 
silver,  because  the  silver  is  antiseptic. 

The  operative  dilation  of  the  feat  may  be  undertaken  upon  the 
standing  animal.  The  foot  upon  the  affected  side  may  be  secured 
by  passing  a  side  line  around  it,  and  thence  around  the  limb  oppo- 
site, the  end  of  the  line  being  held  by  an  a.ssistant  ;  or  the  oper- 
ator may  place  himself  upon  the  opposite  side  to  the  affected 
teat,  under  the  assumption  that  the  cow  will  kick  with  the  foot 
upon  the  affected  side.  It  is  better,  however,  that  the  animal 
should  be  cast,  or  still  better,  confined  upon  an  operating  table, 
where  the  antiseptic  precautions  can  be  more  effectively  applied. 
The  instruments,  hands  and  teat  should  be  thoroughly  disin- 
fected, and  the  cistern  should  be  carefully  washed  out  with  sterile 
water.  Some  even  recommend  that  the  cistern  be  washed  out 
with  a  I -1000  corrosive  sublimate  solution,  by  means  of  a 
hypodermic  .syringe. 

The  operator  grassps  the  teat  with  one  hand,  above  the  point  of 
obstruction  if  possible,  presses  the  milk  down  against  the  obstruc- 


looo  Veteriyiary  Obstetrics 

tion,  and  then  introduces  the  instrument  through  the  teat  canal 
until  it  reaches  the  point  of  disease.  Bang  directs  that,  in 
case  a  knife  is  used,  the  incision  through  the  constricted 
portion  should  be  backward  in  an  anterior  teat  and  for- 
ward in  a  posterior  teat,  in  order  that  the  resulting 
stream  of  milk  may  be  favorably  directed.  This  applies 
only  to  those  cases  in  which  the  obstruction  is  in 
the  teat  canal  and  not  in  the  base  of  the  teat.  When  the  teat 
canal  is  sufficiently  dilated,  the  cow  loses  her  power  to  hold  the 
milk,  and  it  flows  away  involuntarily  ;  but  during  the  process  of 
healing  she  regains  the  power  of  retaining  it. 

The  after-handling  consists  in  frequent  milking  and  in  very 
careful  disinfection  and  cleanliness  of  the  parts.  While  healing 
is  going  on,  it  is  desirable  to  insert  a  milk  tube  daily,  and  retain 
it  in  position  for  several  hours  in  order  to  prevent  adhesion  during 
the  process  of  repair.  Even  with  this  precaution,  it  is  exceed- 
ingly difficult  to  prevent  a  recurrence  of  the  stricture  ;  and  finally, 
during  the  dry  period,  complete  atresia  is  liable  to  occur. 

Strebel  and  others  recommend  that  the  thickened  tissues  which 
cause  the  stricture  should  be  removed  by  curetting.  They  ad- 
vise, as  an  instrument,  a  stilette  with  a  sharp  shield  at  the  distal 
end,  which  may  be  pushed  through  the  thickened  part,  and  then 
forcibly  drawn  out,  cutting  away  a  portion  of  the  diseased  tissues. 
By  repeated  use,  this  instrument  finally  enlarges  the  canal  to  a 
sufficient  size,  after  which  the  treatment  is  of  the  same  general 
character  as  that  already  described  after  dilating  by  cutting. 
Others  use  a  small  curette  in  the  same  way,  or  even  a  very  nar- 
row-bladed  knife  or  scalpel. 

Others  have  suggested  incising  the  teat  from  the  side,  cutting 
down  upon  the  obstacle  and  removing  it  completely  with  the 
scalpel,  and,  under  strict  aseptic  precautions,  carefully  suturing 
the  wound.  lyater  great  care  should  be  used  in  milking,  so  as  to 
avoid  the  tearing  out  of  the  sutures  and  the  consequent  estab- 
lishment of  a  milk  fistula.  The  operation  has  not  come  into 
general  use,  because  it  is  almost  impossible  to  carry  out  the 
operation  and  the  after-treatment  with  sufficient  care  to  avoid 
mammitis. 

If  the  ob.struction  is  near  the  end  of  the  teat,  the  amputation 
of  the  obstructed  portion  immediately  above  the  seat  of  the 
disease  may  afford  .satisfactory  results.     The  operation  is  espec- 


Stricture  or  Atresia  of  the  Teats  looi 

ially  favorable  in  those  cases  where  the  obstruction  is  quite  near  to 
the  end  of  the  teat,  and  the  teat  is  so  long  that  it  will  have  ample 
length  after  amputation.  The  teat  is  grasped  with  the  fingers, 
and  is  amputated  immediately  above  the  point  of  obstruction, 
either  with  a  pair  of  scissors  or  with  a  scalpel.  As  the  teat  is  at 
the  moment  somewhat  stretched,  the  stump  assumes  the  form  of 
a  crater,  which  favors  healing.  Kiihn  has  constructed  special 
forceps,  Fig.  144,  for  holding  the  teat  in  such  a  manner  that  the 
excision  is  readily  performed  with  the  scalpel. 


Fig.  144.     Tkat-Amputating  Forceps  of  Kuhn. 
(  Bayer  and  Frohner. ) 

After  the  teat  is  amputated,  the  milk  flows  away  involuntarily, 
but  later,  as  the  healing  process  goes  on,  the  opening  narrows, 
and  finally  the  milk  -is  retained  as  before.  Following  the  ampu- 
tation, there  is  little  difficulty  from  hemorrhage,  and  if  any  occur 
it  may  be  checked  by  a  bandage  or  by  a  rubber  band,  placed 
around  the  teat,  but  not  too  tightly,  lest  it  interfere  with  the  life 
of  the  tissues.  It  may  be  well,  for  a  time,  to  protect  the  wound 
against  infection  by  means  of  antiseptics  applied  upon  a  cotton 
pack,  which  covers  the  wound  and  the  teat  generally  and  main- 
tains antisepsis  for  a  few  hours.  This  dressing  may  be  retained 
in  position  by  a  ligature  about  the  teat,  or  with  strips  of  adhe- 
sive plaster. 

If  it  is  desired  to  prevent  the  milk  from  escaping,  it  may  be 
retained  by  the  application  of  an  elastic,  or  other  ligature,  near 
the  end  of  the  teat,  sufficiently  tight  to  clo.se  the  milk  canal,  but 
not  tight  enough  to  interfere  .seriously  with  the  nutrition  of  the 
part. 

Amputation  of  the  teat  is  impracticable  when  the  obstruction 
is  located  near  its  base. 

\'ennerholm  recommends  that,  when  there  are  transverse  mem- 
branous folds  across  the  cistern,  the  teat  should  be  as  firmly 
grasped  as  pos.sible  above  the  obstruction,  and  then  so  vigorously 
pressed  that  the  milk  contained   brings  about    a  rupture  of  the 


I002  Veteririary  Obstetrics 

band,  after  which  the  affected  teat  is  to  be  very  frequently  emptied 
for  a  few  days.  Others  attempt  to  rupture  these  transverse  bands 
by  still  greater  pressure  than  can  be  applied  by  means  of  the  hands, 
but  the  recorded  results  from  the  operation  do  not  seem  to 
strongly  commend  it.  Wherever  these  operations  are  under- 
taken, mastitis  very  frequently  follows,  and  the  cow  eventually 
becomes  three- teated. 

In  a  somewhat  extensive  experience  in  the  operative  handling 
of  the  nodular  obstruction  at  the  base  of  the  teat,  we  have  had 
success  in  a  small  minority  of  cases  ;  whereas,  in  the  larger 
number,  mastitis  of  a  more  or  less  serious  form  has  been  induced, 
which  lias  usually  ended  in  the  loss  of  the  affected  quarter  or 
quarters.  Under  these  conditions  it  seems  more  judicious  in 
man}'  cases  to  allow  the  gland  to  atrophy  and  the  cow  to  become 
three-teated  rather  than  to  involve  the  risk  of  a  dangerous  infec- 
tion to  be  followed  later  by  the  destruction  of  the  gland. 


DISEASES  OF  THE  NEW-BORN  ANIMAL. 

I.  Infections  of  the  New- Born. 

At  the  time  of  birth  there  necessarily  occurs  a  wound  of  the 
new-born  consisting  of  a  division  of  the  umbilic  cord.  The 
division  of  the  cord  may  occur  just  prior  to  the  completion  of 
the  expulsion  of  the  fetus,  after  a  portion  of  the  fetal  body  has 
passed  beyond  the  vulva,  as  is  usually  the  case  in  those  animals 
having  a  very  short  umbilic  cord,  like  the  cow  and  other  rumi- 
nants. In  other  animals,  where  the  umbilic  cord  is  long,  as  in 
the  mare,  the  fetus  is  usually  wholly  expelled  before  rupture  of 
the  cord  takes  place.  In  any  animal,  though  extremely  im- 
probable in  ruminants,  the  entire  fetal  placenta  may  follow  the 
expulsion  of  the  fetus  immediately,  and  the  cord  remain  intact. 
As  a  general  rule  this  presages  the  death  of  the  fetus  in  the 
larger  animals,  because  the  separation  of  the  fetal  from  the  ma- 
ternal placenta  has  advanced  to  such  a  degree  before  the  expul- 
sion of  the  young  that  it  disturbs  the  aeration  of  its  blood  and 
leads  to  its  death  by  strangling.  In  multiparous  animals,  where 
.  the  fetal  placenta  must  necessarily  follow  each  fetus  before  a 
succeeding  one  can  be  expelled,  the  fetal  membranes  very  fre- 
quently remain  attached  to  the  fetus  by  the  umbilic  cord,  which 
is  divided  by  the  mother  with  the  teeth.  In  other  5'oung  which 
ma^'  be  born  with  the  navel  cord  unbroken,  its  rupture  very  fre- 
quently results  from  the  struggles  of  the  young  animal,  or  may 
be  brought  about  by  the  mother. 

The  point  at  which  the  navel  cord  divides  is  usually  very  close 
to  the  umbilicus — in  the  foal  and  calf  from  one  to  three  inches — 
in  which  region  the  cord  is  normally  smaller  and  weaker  than  at 
other  parts.  After  the  rupture,  the  normal  course  of  events 
consists  of  the  retraction  of  the  two  umbilic  arteries  and  of  the 
urachus,  upward  and  backward  into  the  peritoneal  cavity,  draw- 
ing with  them,  in  their  retreat,  portions  of  the  loose  connective 
tissue  which  immediately  surround  them.  In  this  retraction  the 
walls  of  the  vessels  become  thickened,  while  their  lumen  becomes 
correspondingly  decreased,  thus  preventing  the  escape  of  blood 
from  the  arteries  or  of  urine  from  the  urachus.  The  escape  of 
urine  or  of  blood  is  further  safeguarded  by  the  connective  tissue, 
1003 


I004  Veterinary  Obstetrics 

which  is  continuous  with  the  external  layer  of  the  vessel  walls, 
adheres  to  the  divided  ends  of  the  vessels,  and  becomes  retracted 
along  with  them,  serving  to  close  over  the  broken  ends  and  form 
a  fibrous  network  which  offers  an  impassible  barrier  for  the  blood 
or  urine. 

The  umbilic  vein,  having  very  thin  walls,  collapses  at  once 
after  rupture,  so  that  its  lumen  is  closed  and  what  blood  remains 
within,  being  free  from  any  cardiac  or  capillary  pressure,  soon 
coagulates  and  blocks  the  remaining  cavity.  The  Whartonian 
gelatine  included  within  the  cord  rapidly  loses  its  fluid  portion, 
which  oozes  away  from  the  broken  end  ;  within  a  few  hours 
the  navel  becomes  dessicated  to  a  hard,  dry  crust,  which  hermet- 
ically seals  the  surface  of  the  wound,  and  aseptic  healing  occurs 
beneath  the  scab. 

Prior  to  the  hermetic  sealing  of  the  wound  by  dessication,  it 
is  open  to  infections  of  an  extended  variety,  which  acquire  special 
significance  because  of  the  vulnerability  of  the  tissues  involved. 

The  tissues  of  the  umbilic  cord,  including  the  urachus,  veins 
and  arteries,  invested  with  connective  tissue  and  Whartonian 
gelatine,  become  dormant  when  the  cord  ruptures,  and  possess 
little  or  no  power  of  resistance  against  bacterial  invasion.  •  The 
conditions  prevailing  at  this  epoch  rather  invite  infection,  as  the 
tissues  provide  abundant  moisture,  nutrient  material  and  warmth 
for  bacterial  growth. 

Opportunities  for  infection  are  not  wanting.  Even  before  the 
fetus  has  escaped  from  the  vulva  or  the  cord  has  ruptured,  any 
infection  existing  in  the  vulvo- vaginal  canal  of  the  mother  may 
have  acquired  a  habitat  on  or  in  the  cord.  Nocard  and  others 
hold  that  the  appallingly  fatal  infectious  diarrhea  of  calves  is  due 
chiefly  to  navel  infection,  and  that  the  infection  is  already  lying 
in  wait  in  the  vulvo-vaginal  canal  of  the  cow  when  the  calf  is 
being  born.  Later,  when  the  cord  ruptures,  the  umbilic  stump 
is  readily  brought  in  contact  with  the  earth,  bedding,  dung, 
urine,  etc.,  whence  it  may  acquire  virulent  infections. 

The  anatomy  of  the  part  permits  the  infection  to  reach  the 
circulatory  system  by  a  short  route  through  the  inert,  open 
umbilic  vein,  and  to  be  carried  thence  to  remote  parts. 


Purulent  hifectioii  of  the  Navel  1005 

I.  Purulent  Infection  of  the  Navel.    Omphalitis. 
Omphalo-phlebitis.     Pyo-septhvEmia. 

Purulent  infection  of  the  navel  is  greatly  favored  bj'  many  of 
the  circumstances  attending  the  birth  of  the  young  animal. 
When  it  is  born  in  a  stable  or  barnyard,  or  in  surroundings  where 
filth  and  dirt  are  abundant  and  omnipresent,  there  is  constant 
exposure  to  infection  of  the  new-made  wound.  Whenever  the 
animal  lies  down,  especiall}^  in  sternal  recumbency,  the  new-made 
wound  comes  in  direct  contact  with  infected  bedding,  decompo- 
sing feces  or  urine,  or  with  other  filth  which  may  chance  to  ex- 
ist at  such  a  point . 

The  carnivorous,  and  to  a  lesser  degree  the  herbivorous  mother 
habitually  cleanses  the  broken  cord  by  licking,  and  thereby  with- 
draws from  it  a  large  part  of  the  Whartonian  gelatine,  thus 
favoring  the  early  dessication  of  the  stump.  It  appears  that,  in 
spite  of  the  fact  that  the  mouth  usually  abounds  in  pathogenic 
bacteria,  the  process  of  licking  the  navel  is,  according  to  clinical 
observations,  comparatively  safe  and  tends  to  protect  the  navel 
against  infection.  We  observe  infection  of  the  navel  most  fre- 
quently in  the  foal,  whose  mother  pays  less  attention  to  the 
navel  than  do  other  domestic  animals. 

Purulent  infection  of  the  navel  very  frequently  arises,  also,  as 
an  indirect  result  of  ligating  the  umbilic  cord.  The  danger  from 
ligating  the  cord  consists  usually  of  two  principal  elements — the 
infection  of  the  wound  by  careless  ligation,  and  the  providing  of 
a  breeding  ground  for  bacteria  by  the  inclusion  of  the  Whar- 
tonian gelatine. 

From  a  surgical  standpoint,  nothing  can  well  be  more  danger- 
ous to  the  new-born  animal  than  the  careless  or  filthy  ligation  of 
the  umbilic  cord  by  a  layman  or  a  veterinarian  with  dirty,  in- 
fected hands  and  an  unclean  ligature.  Most  ligatures  applied  to 
the  navel  are  placed  there  by  laymen,  who  are  ignorant  of  the 
fundamental  rules  and  practices  of  surgery,  and  consequently 
pick  up  almost  any  kind  of  ligature,  which  they  apply  without 
disinfection  or  sterilization,  and  usually  without  disinfecting  or 
even  washing  their  hands.  Thej'  thus  bear  directly  to  the  cord 
abundant  infection  of  a  dangerous  character. 

Even  when  a  ligature  is  applied  to  the  navel  under  some  of 
the  rules  of  modern  surgery,  other  important  ones  are  habitually 


ioo6  Veterinary  Obstetrics 

neglected,  and  the  ligature  is  nevertheless  wrongly  and  danger- 
ously placed.  The  exterior  of  the  cord  consists  of  the  imper- 
meable amniotic  sheath,  which  encloses  within  it  the  vessels  sur- 
rounded by  the  Whartonian  gelatine.  If  the  cord  is  tightly 
ligated*  the  gelatine  is  firmly  enclosed,  and  its  fluid  portions  can- 
not escape  readily  and  permit  proper  dessication  of  the  stump. 
Even  if  the  ligature  has  been  applied  under  other  antiseptic  pre- 
cautions, but  retains  the  Whartonian  gelatine,  the  procedure  is 
at  once  in  conflict  with  surgical  practice,  becau.se  this  substance 
constitutes  an  excellent  medium  for  the  growth  of  pathogenic 
bacteria  and  assumes  the  same  surgical  significance  as  extensive 
blood  clots  when  retained  in  a  wound.  The  danger  from  infec- 
tion is  further  emphasized  if  the  ligature  is  placed  at  a  point  too 
distant  from  the  umbilicus,  thus  increasing  the  amount  of  tissue 
in  the  cord  which  must  undergo  dessication  or  putrefaction.  The 
greater  the  amount  of  moist  tissue,  the  more  probable  is  putre- 
faction, and   the   less  likely  is  dessication  to  occur. 

Ligation  possesses  yet  another  danger,  in  the  possible  incarce- 
ration of  the  two  umbilic  arteries  and  the  urachus.  If  the 
ligature  is  applied  very  tightly  before  the  cord  is  severed,  the 
retraction  of  the  arteries  and  urachus  into  the  abdominal  cavity 
may  be  prevented.  Being  retained  in  the  navel,  the  open  ends 
of  the  arteries  and  urachus  are  freely  exposed,  and  rendered  more 
subject  to  infection  during  putrefaction  of  the  tissues. 

The  po.ssibility  of  either  preventing  or  decreasing  navel  infec- 
tion by  ligating  the  stump  is  by  no  means  clear  upon  surgical 
grounds.  When  a  living  tissue  is  ligated,  and  the  ligature  so 
tightly  applied  as  to  cause  necrosis  on  the  distal  side,  it  appears 
clinically  to  cause  a  prompt  protective  reaction  (leucocytosis)  on 
the  proximal  .side  of  the  ligature,  which  largely  serves  to  prevent 
important  infection.  But  when  a  ligature  is  applied  to  a  dormant 
or  dead  ti.ssue  like  the  umbilic  stump,  no  such  reaction  is  caused, 
and  the  stump  goes  on  to  putrefaction  or  dessication,  as  circum- 
stances may  favor.  The  application  of  a  ligature  about  a  mass 
of  dead  tissue  cannot  prevent  infection  of  the  necrotic  mass  on 
either  side  of  the  ligature,  but  may  greatly  favor  putrefaction  by 
confining  fluids  within  the  parts.  When  such  bacterial  infection 
and  decomposition  occur  in  the  necrotic  tissues  of  the  cord,  the 
more  or  less  dormant  vessels  incarcerated  in  the  decomposing 
tissues  are  .seriously  exposed  to  bacterial  inva.sion. 


Purulent  Infeciio7i  of  the  Navel  1007 

It  is  thus  a  common  clinical  observation  that  purulent  infec- 
tion of  the  navel  is  greatly  favored  by  the  process  of  ligation, 
and  the  more  improperly  ligated  the  greater  the  danger.  Ad- 
mittedly a  navel  cord  may  be  safely  ligated.  If  the  cord  is  di- 
vided at  the  proper  point,  the  Whartonian  gelatine  thoroughly 
pressed  out  and  the  stump  ligated  under  perfect  aseptic  precau- 
tions, followed  by  the  application  of  an  aseptic  covering,  and  its 
retention  in  position  and  in  an  aseptic  state  (a  very  difficult  task 
with  domestic  animals),  the  operation  is  safe. 

Another  method  by  which  infection  apparently  takes  place  is 
through  the  medium  of  flies,  which  are  attracted  to  the  cord 
while  it  is  yet  moist  after  birth.  These  filth  carriers,  having 
previously  been  in  contact  with  infected  wounds  or  putrid  organic 
matter,  carry  the  infection  to  the  navel.  Foals  born  during  fly 
time  very  frequently  suffer  from  navel  infection. 

Symptoms.  Navel  infection  occurs  within  a  few  hours  after 
birth,  and  the  danger  is  eliminated  as  soon  as  the  cord  is  thor- 
oughly dessicated.  Consequently,  the  danger  period  is  during 
the  first  12  to  24  hours  after  birth.  The  symptoms  usually  fol- 
low very  promptly  after  this  period,  although  in  the  initial 
stages  of  the  disease,  the  malady  may  be  overlooked  or  unrecog- 
nized by  the  owner  or  attendant.  First  there  usually  occur  the 
general  symptoms  of  local  infection,  modified  by  the  peculiar 
structure  of  the  navel.  In  the  foal.  Fig.  90  B,  page  559,  there 
is  an  extension  of  a  hairless  skin  from  the  umbilicus,  to  con- 
stitute the  cutaneous  portion  of  the  cord,  beyond  which  the 
cord  is  somewhat  smaller,  softer,  more  fragile,  and  covered  with 
the  amnion.  It  is  just  beyond  this  cutaneous  area  of  the  cord 
that  it  normally  ruptures. 

When  the  umbilicus  becomes  inflamed,  this  projection  of  hair- 
less skin  becomes  intensely  reddened,  tense  and  glistening. 
Further  examination  will  reveal  the  fact  that,  instead  of  the  part 
having  dessicated  normally,  there  exudes  from  near  the  center 
of  the  cord  a  dirty,  thin,  watery,  flocculent  serosity,  which  may 
be  grayish-w^hite  or  tinged  with  blood.  If  the  part  is  carefully 
examined  with  a  fine  probe,  it  will  usually  be  found  possible  to 
pass  the  instrument  upward  and  forward  for  a  variable  distance 
toward  the  liver  along  the  cour.se  of  the  umbilic  vein.  If  the 
infection  has  extended  along  the  vein  in  its  course  through  the 
peritoneal  cavity,  the  probe  can  probably  be  passed  for  a  distance 


ioo8  Veterinary  Obstetrics 

of  two,  three  or  four  inches,  or  even  more.  If  the  infection  has 
been  arrested  in  the  umbilic  ring,  the  probe  cannot  pass  be- 
yond it. 

The  behavior  of  the  case  will  depend  primarily  upon  the  degree 
of  extension  of  the  infection.  It  may  be  confined  chiefly  or 
wholly  to  the  umbilicus  itself,  to  constitute  simple  omphalitis  ; 
or  it  may  pass  beyond  the  umbilicus,  in  the  lumen  of  the  umbilic 
vessels,  and  the  infecting  agent  and  its  products  gain  entrance 
into  the  blood  stream,  by  which  they  may  be  carried  to  distant 
parts,  to  produce  septic  or  pysemic  disturbances  of  a  grave  char- 
acter, which  we  recognize  as  omphalo-phlebitis  or  pyosepthaemia 
of  the  neiv-born. 

It  is  an  important  clinical  fact  that  the  gravity  of  navel 
infection  is  usually  in  inverse  proportion  to  the  local  dis- 
turbances If  the  local  changes  are  great,  inducing  severe  local 
omphalitis,  the  systemic  disturbances  are  usually  unimportant ; 
if  the  infection  gains  admission  to  the  umbilic  veins,  and  thence 
enters  the  general  circulation,  the  local  disturbances  may  be  com- 
paratively insignificant,  while  the  sepsis  or  pyaemia  is  exceed- 
ingly grave. 

When  the  infection  remains  localized  in  the  umbilicus  itself, 
the  part  becomes  swollen,  somewhat  tender  to  the  touch,  and 
soon  suppurates.  Small  abscesses  form  in  and  about  the  um- 
bilicus, which  open  and  discharge  pus.  The  ab.sce.sses  may  be 
followed  by  fistulse  of  varying  lengths,  into  which  a  probe  may 
be  passed  for  a  distance  of  one,  two  or  more  inches.  Sometimes  the 
fistula  may  consist  of  the  suppurating  walls  of  the  umbilic  vein 
or  artery.  The  swelling  from  local  umbilic  infection  may  be 
very  great,  sometimes  offering  a  sharp,  hemi.spherical  swelling, 
4-6  inches  in  diameter. 

The  course  of  such  local  infection  is  usually  chronic,  continuing 
for  week  after  week.  A  somewhat  limited  amount  of  pus  is  dis- 
charged, which  is  generally  of  an  ordinary  consistency,  without 
odor.  Such  an  inflammation  does  not  involve  the  general  well- 
being  of  the  young  animal  ;  it  takes  its  food  in  the  normal  man- 
ner and  amount,  its  digestion  is  undisturbed,  it  is  playful,  and 
its  growth  is  usually  unaffected. 

When  the  infection,  instead  of  expending  its  virulence  upon 
the  tissues  of  the  umbilicus,  gains  admission  to  the  open  umbilic 
vein  and   extends  along    its  course  toward    the  heart,  and   the 


Purulent  lufedion  of  the  Navel  1009 

bacteria  and  their  products  enter  the  blood  stream,  the  symptoms 
are  wholly  different  from  those  of  the  local  disease.  The  coagu- 
lated blood  within  the  umbilic  vein  breaks  up  under  bacterial 
invasion,  liquifies,  and  may  be  partly  discharged  into  the  hepatic 
vein  from  the  central  end  of  the  umbilic  vein,  and  externally  from 
the  stump  of  the  cord  as  a  dirty,  flocculent,  reddish-gray  liquid, 
consisting  of  the  disintegrated  blood  clot  mingled  partly  with  pus. 
The  entire  lumen  of  the  umbilic  vein  has  become  a  suppu- 
rating cavity.  The  tissues  about  the  umbilicus  are  sHghtly,  if  at 
all  swollen,  but  the  umbilic  stump  is  swollen,  tense,  glistening, 
and  projects  out  from  the  umbilic  ring  as  an  elongated  cone, 
having  in  its  center  a  very  small  opening,  from  which  the  dis- 
charge appears.  This  discharge  may  occur  as  early  as  the  3rd  or 
4th  day  after  birth,  and  may  continue  for  a  period  of  one,  two, 
or  even  more  weeks,  should  the  animal  survive.  During  the 
continuation  of  the  discharge  from  the  umbilic  vein  through  the 
stump,  the  hairs  about  the  navel  are  kept  befouled  and  moist. 
Usually  the  adjacent  hairs  become  matted  together,  and  may 
more  or  less  hide  the  broken  end  of  the  stump.  Later  the  be- 
fouled, matted  hairs  drop  away,  leaving  a  depilated,  naked  surface. 

Soon  after  the  commencement  of  suppuration  in  the  umbilic 
vein,  there  frequently  occurs  also  a  corresponding  infection  in 
the  broken  end  of  the  urachus,  which  results  in  the  duct  becom- 
ing reopened,  with  a  consequent  dribbling  of  urine  from  the 
navel,  which  adds  to  the  moist  condition  of  the  diseased  part  and 
gives  to  it  the  odor  of  decomposed  urine.  Usually  this  condition 
is  attributed  to  "  persistent"  urachus,  but  according  to  our  ob- 
servations, this  designation  is  ordinarily  erroneous,  since  the 
open  condition  of  the  urachus  with  dribbling  of  the  urine  is  gen- 
erally secondary. 

In  the  more  serious  cases  of  navel  infection,  the  local  symptoms 
are  so  insignificant  in  a  general  way  that  they  may  wholly 
escape  the  observation  of  the  owner  or  caretaker.  The  first 
signs  of  disease  which  he  notes  are  the  more  serious  systemic  dis- 
turbances, because  of  the  entrance  of  the  infection  into  the 
general  circulation.  When  the  young  animal  has  reached  the 
age  of  two  to  four  daj-s  or  somewhat  more,  there  suddenly  appears 
in  many  cases  a  high  fever,  with  loss  of  appetite  and  extreme 
dullness.  The  udder  of  the  mother  becomes  over-distended  with 
64 


loio  Veterinary  Obstetrics 

milk  as  a  consequence  of  the  loss  of  appetite  of  the  young.  The 
coat  of  the  young  animal  is  staring  and  dull.  There  may  exist 
either  constipation  or  diarrhea.  In  many  cases  distinct  chills  are 
noticed  as  a  symptom  of  the  fever  which  is  present.  The  young 
animal  in  many  cases  shows  very  great  weakness,  and  may  perish 
from  the  infection  in  the  course  of  24  to  48  hours  after  the  first 
symptoms  of  disease  are  observed. 

The  symptoms  of  general  infection  vary  widely  in  intensity. 
Between  the  rapidly  fatal  septicaemia  which  we  have  outlined 
and  those  cases  which  for  a  time  do  not  attract  any  notice, 
there  is  every  gradation.  In  many  cases  the  symptoms  of  fever 
continue  for  a  day  or  two,  with  a  decreased  appetite  and  other 
general  febrile  symptoms,  disappear,  and  the  young  animal  ap- 
parently regains  its  usual  health,  although  it  may  not  .seem  quite 
as  vigorous  as  should  be  expected. 

In  some  of  the  very  mild  cases,  no  febrile  symptoms  appear  of 
such  a  character  as  to  attract  the  attention  of  the  owner,  and 
the  early  stages  of  the  general  infection  pass  unnoticed.  This 
very  frequently  occurs,  and  it  is  only  when  the  secondary  symp- 
toms of  the  infection  arise  that  the  attention  of  the  owner  is  at- 
tracted to  the  diseased  condition  of  the  patient. 

When  the  young  animal  has  reached  an  age  of  from  three  to 
five  or  even  ten  days,  and  sometimes  more,  there  suddenly  ap- 
pear, without  warning,  acute  septic  or  pyaemic  inflammations  of 
various  parts  or  organs  of  the  body.  Pre-eminently  there  occur 
septic  or  pyaemic  inflammations  of  the  articulations.  The  young 
animal  is  left  apparently  well  in  the  evening,  and  is  found  the 
following  morning  severely  lame  in  one  of  its  limbs — usually  so 
lame  that  it  will  not  bear  weight  upon  the  affected  member. 
Upon  examination  of  the  limb,  one  of  the  prominent  articulations 
is  found  swollen,  hot,  tense,  and  painful  upon  manipulation. 
The  inflammation  usually  affects  the  more  important  articula- 
tions, especially  the  hock  and  stifle,  and  less  frequently  the  elbow 
and  carpus  or  other  joints.  The  suddenness  and  intensity  of  the 
arthritis  usually  leads  the  owner  to  believe  that  the  dam  has  in- 
jured the  joint  of  the  young  by  treading  upon  it. 

The  course  of  the  inflammation  of  the  articulation  varies  ac- 
cording to  circumstances.  In  many  ca.ses  it  increases  in  intensity 
for  a  few  hours  in  the  articulation  first  involved,  and  then  very 
suddenly  abates,  while   another  articulation   becomes   violently 


Purulent  hifectio7i  of  the  Navel  lOi  i 

inflamed.  The  inflammation  may  thus  involve  one  after  another 
of  the  articulations,  disappearing  from  one  to  reappear  in  another. 
This  has  caused  the  disease  to  be  designated  by  some  as  rheu- 
matoid arthritis,  and  by  others  as  foal  lameness,  calf  lameness, 
etc.  As  the  disease  continues,  there  is  a  well-marked  tendency 
for  the  arthritis  to  become  fixed  and  permanent  in  a  given  articu- 
lation, and  at  the  same  time  additional  articulations  become  in- 
volved, so  that  in  many  instances  two,  three,  or  four  joints  are 
simultaneously  disea.sed. 

We  recognize  two  somewhat  distinct  forms  of  arthritis  ;  the 
one  a  serous  inflammation  without  the  formation  of  abscesses, 
the  other  characterized  by  the  presence  of  absces.ses,  the  con- 
tents of  which  are  usually  mixed  with  synovia.  The  apparently 
serous  arthritis,  in  which  ab.scesses  do  not  form,  constitutes  the 
most  common  type  of  articular  disease. 

The  inflamed  articulation  is  greatly  enlarged,  ten.se,  hot  and 
painful.  The  distended  synovial  sac  may  offer  some  symptoms 
of  fluctuation,  but  does  not  "point."  Later  the  articular  tissues 
hypertrophy,  the  subcutem,  synovial  membranes  and  other  parts 
thicken  and  become  more  or  less  sclerotic.  At  the  same  time 
the  contents  of  the  synovial  sac  may  become  increased,  caus- 
ing severe  distension,  which  may  remain  permanent.  When  in- 
volving the  femoro-patellar  articulation,  the  .synovial  disten- 
sion floats  the  patella  upwards  until  it  reaches  the  level  of  the 
top  of  the  external  femoral  condyle,  when  the  patella  slips  out 
laterally  to  constitute  "floating  luxation  of  the  patella"  which 
may  prove  temporary  or  permanent. 

Le.ss  frequently  the  arthritis  is  of  a  purulent  character,  and  the 
joint  soon  becomes  the  seat  of  an  extensive  suppuration,  the  pain 
is  very  severe,  and  the  accompanying  constitutional  symptoms  are 
exceedingly  grave.  After  the  lapse  of  a  few  days,  the  pus  in 
the  synovial  sac  becomes  so  abundant  that  distinct  fluctuation  is 
present.  Unless  opened  surgically,  the  abscess  ruptures  and 
discharges  a  flocculent  pus  mixed  with  abundant  synovia.  In 
most  cases,  however,  the  sepsis  is  so  acute  and  severe  that  the 
young  animal  perishes  before  the  abscess  ruptures  spontaneously  ; 
or,  if  the  abscess  is  opened,  the  animal  soon  succumbs  from 
septicaemia. 

The  absces.ses  are  not  confined  to  any  particular  articulations 
of  the  body.     They  are   observed  chiefly  about   the    principal 


IOI2  Veterinary  Obstetrics 

articulations  of  the  limbs,  such  as  the  tarsus,  carpus,  fetlock  and 
stifle,  but  usually  do  not  include  the  coxo-femoral  or  scapulo- 
humeral joints,  though  somewhat  rarely  these  are  involved. 
When  the  hip  joint  becomes  affected,  the  symptoms  are  not  so 
well  defined,  because  of  the  depth  of  the  abscess.  The  animal  is 
excessively  lame  in  the  affected  hip,  and  there  is  a  general  swell- 
ing of  the  gluteal  region.  The  imprisoned  pus  finally  approaches 
the  exterior  at  some  point,  causes  fluctuation  if  the  young 
animal  lives  for  a  sufficient  time,  and  may  then  rupture  or  be 
opened,  and  the  true  character  of  the  disease  becomes  revealed. 

The  severe  lameness  caused  by  the  arthritis  exerts  an  impor- 
tant influence  upon  the  course  of  the  disease,  aside  from  the 
septicaemia  with  which  it  is  so  closely  associated.  The  lameness 
interferes  with  the  young  animal  securing  proper  nourishment, 
because  in  many  instances  it  is  unable  to  rise  or  even  to  stand 
while  it  sucks,  and  thus  it  suffers  from  starvation.  In  chronic 
cases,  also,  the  young  animal  suffers  greatly  from  decubitis 
gangrene  upon  various  portions  of  the  surface  of  the  body,  so 
that  from  these  sores  alone  it  may  soon  become  a  very  repulsive 
and  pitiable  object. 

The  formation  of  pysemic  abscesses  does  not  confine  itself  to 
any  organs  or  tissues,  but  may  occur  at  almost  any  point 
within  the  entire  body.  Abscesses  may  form  within  the  lungs 
and,  rupturing  into  the  bronchial  tubes,  cause  death  from  an 
acute  septic  pneumonia.  In  other  instances  the  abscess  forms  in 
the  articulations  of  the  vertebral  column,  and  may  extend  in- 
ward to  press  upon  the  spinal  cord,  thereby  inducing  a  more  or 
less  sudden  and  complete  paralysis  ;  or  the  abscess  may  form  in 
the  spinal  canal  and  bring  about  similar  symptoms. 

Spinal  paralysis,  due  to  pysemic  abscess  as  a  result  of  navel 
infection,  may  cause  either  sudden  or  gradual  paralysis.  If  the 
abscess  forms  in  the  inter- vertebral  space,  and  suddenly  forces 
its  way  into  the  spinal  canal  to  cause  pressure  upon  the  cord, 
the  paralysis  may  be  very  sudden  and  unexpected,  as  we  noted 
in  one  instance  where  a  foal  had  been  apparently  well  and  very 
thrifty  and  vigorous  until  some  8  or  lo  weeks  old,  when  it  was 
found  one  morning  unable  to  rise.  It  could  not  stand  when 
helped  to  its  feet,  and  presented  all  the  appearances  of  a  broken 
back.     Upon  post-mortem  examination,  there  was  discovered  a 


Purulent  Infection  of  the  Navel  1013 

small  abscess  at  the  dorso-lumbar  articulation,  which,  rupturing 
into  the  spinal  canal,  had  caused  pressure  upon  the  spinal  cord. 

In  another  instance,  in  a  calf,  there  appeared  at  the  age  of  6 
or  8  weeks  a  gradually  increasing  paraplegia.  The  caretaker 
had  not  observed  any  disease  or  infection  of  the  navel,  but  a 
careful  inspection  of  the  part  revealed  the  presence  of  an  old 
suppuration,  the  evidence  consisting  chiefly  of  dried  pus  upon 
the  surrounding  hairs,  and  a  naked  point  at  the  navel,  indicating 
that  a  limited  infection  of  the  part  had  existed.  Being  unable 
to  account  otherwise  for  the  paralysis,  we  diagnosed  spinal 
abscess  as  a  result  of  navel  infection,  and  finally,  destroying  the 
animal,  we  discovered  upon  post-mortem  examination  a  large 
abscess  in  the  spinal  canal,  pressing  upon  the  cord,  as  shown  in 
Fig-  145- 


Fig.  145.     Omphalo-Phcebitis. 
Spinal  abscess,  in  a  four-weeks-old  calf. 
A,  Inspissated  pus  in  spinal  canal,  pressing  upon  the  spinal  cord,  SC, 
causing  paralysis  of  posterior  parts. 

Pathology.  The  disease  is  the  result  of  the  entrance,  into 
the  freshly  broken  navel,  of  pus-forming  micro-organisms.  So 
far  as  we  are  aware,  the  disease  is  not  limited  to  any  one  form  of 
infection.  In  one  instance,  where  a  foal  had  succumbed  to  the 
disease,  bacteriologic  examination  of  deep-seated  pyaemic 
abscesses  revealed  the  presence  of  a  pure  streptococcic  infection. 
The  local  infection  of  the  navel  is  a  mixed  one,  as  has  been 
shown  by  Bollinger   and    others.     Clinically    we    observe    that, 


IOI4  Veterinary  Obstetrics 

along  with  the  general  purulent  infection,  there  maj'  also  occur 
a  tetanus  infection,  inducing  a  virulent  form  of  that  malady. 
Nocard  and  others  have  shown  that,  in  calves,  along  with  other 
infections,  or  without  them,  there  may  enter  through  the  broken 
navel  cord  the  germs  of  infectious  diarrhea.  One  organism  or 
another  may  acquire  precedence,  and  consequently  modify  the 
symptoms  of  the  infection. 

The  force  of  the  infection  is  sometimes  expended  upon  the 
navel  and  its  immediate  neighborhood,  producing  a  type  of  dis- 
ease depending  somewhat  upon  its  virulence.  In  such  cases 
it  appears  that  a  sufficiently  resistant  embolus  forms  in  the  um- 
bilic  vein  to  constitute  an  efficient  barrier  against  the  centripetal 
progress  of  the  infection  and  limit  its  ravages  to  the  umbilic 
region.  The  infection  induces  a  more  or  less  severe  inflamma- 
tion, with  swelling,  suppuration,  and  the  formation  of  abscesses 
and  fistulse.  If  the  infection  possesses  a  still  higher  virulence, 
gangrene  or  necrosis  of  the  tissues  may  occur. 

If  the  infection  extends  beyond  the  immediate  area  of  the 
navel  through  the  lumen  of  the  umbilic  vein  or  other  umbilic 
vessels,  it  quickly  gains  entrance  to  the  general  sy.stem,  and 
induces  septicaemia  or  pyaemia.  Upon  post-mortem  examina- 
tion in  such  cases,  the  navel  vein  is  usually  found  filled  with 
decompo.sed  blood,  mixed  with  a  dirty-gray,  flocculent  pus. 

The  umbilic  vein  is  converted  into  a  vast  suppurating  tube, 
opening  at  one  end  into  the  hepatic  vein,  at  the  other  externally 
at  the  umbilicus.  The  purulent  contents  may  escape  outwards 
through  the  navel  or  inwards  into  the  hepatic  circulation.  Once 
the  infection  reaches  the  hepatic  circulation,  it  flows  freely  ta 
the  heart,  passes  through  the  pulmonary  system  and  gains  the 
systemic  circulation.  The  gravity  of  the  attack  is  dependent 
upon  the  amount  and  virulence  of  the  infection  entering  the 
hepatic  circulation,  and  the  power  of  resistance  (age  and  vigor) 
of  the  patient.  In  many  cases  the  septicaemia  is  so  acute  and 
intense  that  the  patient  succumbs  in  a  few  hours,  pre.senting 
essentially  only  the  symptoms  of  high  fever  with  very  slight 
navel  disease. 

In  other  instances  the  disease  assumes  the  character  of 
pyaemia,  and  the  clumps  of  bacteria,  passing  into  the  general 
circulation,  are  forced  through  the  pulmonary  vessels,  into  the 
lungs,  where  they  may  lodge  to  bring  about  pulmonary  abscesses. 


Piirideiit  hifectioii  of  the  Navel 


1015 


Passing  through  the  puhnouary  capillaries,  and  reaching  the 
systemic  circulation,  the  infection  may  become  arrested  at  any 
point,  and  induce  an  acute  septic  or  pyaemic  inflammation.  The 
infection  is  especially  liable  to  become  lodged  in  the  capillaries 
in  or  about  the  synovial  membranes  of  the  articulations  or  of 
the  sheaths  of  tendons,  and  to  induce  therein  either  an  acute 
serous  or  purulent  inflammation. 


Fig,  146.     .Abscesses  of  Umbilic  Vein  and  Arteries  in  Omphalo- 
PHi,EBiTis  OF  Foal. 

A  section  of  the  abdomiual  floor,  including  the  umbilicus,  seen  from  above. 
B,  Bladder, 
r,  Emergence  of  umbilic  vein  from  naval  cord  into  intra-peritoneal 

portion  of  that  vessel. 
UA,  Umbilic  arteries  retracted  to  the  fundus  of  the  urinary 

bladder,  B, 
1,1,  Pus  cavities  in  umbilic  vein. 

2,  Abscess  in  right  umbilic  artery. 

3,  Greatly  thickened  walls  of  left  umbilic  artery. 

4,  A  brief  segment  of  apparently  normal  artery. 

5,  Thrombus  in  posterior  aorta  and  iliac  arteries. 

No  tissue  or  organ  of  the  body  is  immune  against  the  ravages 
of  the  disease.  The  internal  organs  are  by  no  means  free  from 
the  dangers  of  pysemic  infection.  Abscesses  of  the  liver,  kid- 
neys and  spleen  are  frequently  found. 

We  have  frequently  observed  absces.ses  within  the  umbilic 
veins  and  arteries,  as  shown  in  Fig.  146,  especially  when  these 
vessels  have  been  caught  and  held  as  a  consequence  of  the 
ligation  of  the  umbilic  cord.  If  the  cord  has  not  been  ligated, 
and  the  arteries  thus*  held,  they  quickly  retract  into  the  abdomen 
and  are  comparatively  free  from  danger. 


ioi6 


Veterinary  Obstetrics 


Pyaemic  arthritis  is  usually  highly  destructive  to  the  affected 
articulation.  When  the  focus  of  infection  is  within  the  articu- 
lation, the  synovial  membranes  are  found  greatly  thickened, 
intensely  injected,  and  frequently  necrotic.  The  articular  cavity 
is  usually  distended  with  purulent  synovia,  as  indicated  at  A  A 
Fig.  147.  The  infection  spreads  rapidly  to  the  surrounding  tis- 
sues, causing  extensive  suppuration  in  the  neighboring  tendon 
sheaths,  like  at  C,  and  in  the  subcutaneous  tissues  at  B. 

,B        A  A 


>' 


Fig.  14: 


OMPH.\I,0-PHI.EBrn.^ 


Sagittal  section  from  carpus.     Same  case  as  Fig  146. 

A,  A,  Intra-articular  abscess  of  carpal  joint,  communicating 
with  an  extensive  subcutaneous  abscess,  B,  and  posteriorly 
with  an  empysemic  cavity,  C,  in  the  vaginal  .sheath  of  the 
flexor  tendons. 

The  articular  cartilage  undergoes  rapid  destruction,  as  shown 
at  A  and  B,  Fig.  148.  In  addition  to  the  lesions  already  men- 
tioned, there  may  occur  septic  inflammation  of  the  pleura,  inter- 
muscular abscesses,  opthalmia,  leptomeningitis,  catarrhal  enteri- 
tis, pneumonia,  myocarditis,  bronchitis,  etc. 


Fig.  148.     Omph.\lo-phlebitis. 

Cross  section  of  Fig.  147,  showing  lower  row 
of  carpal  bones,  seen  from  above. 
A,  B,  Purulent  destruction  of  articular  cartilage. 

At  the  upper  part  of  the  illustration  is  seen  the 
pus  cavity,  B,  of  Fig.  147,  in  cross  section. 


Purulent  Infectio7i  of  the  Navel  1017 

Prognosis.  The  prognosis  is  verj^  grave  in  all  cases  of 
omphalo-phlebitis,  that  is,  in  all  patients  suffering  from  umbilic 
infection  in  which  the  infection  gains  the  hepatic  and  general 
•circulation.  It  is  most  hopeless  in  the  foal,  in  which  animal  the 
mortality  exceeds  95%.  Of  the  few  which  ultimately  sur- 
vive, the  vast  majority  are  comparatively  valueless  because 
of  permanent  changes  in  the  articulations  or  in  other  parts  of 
the  body.  In  the  calf  the  prognosis  is  somewhat  more  favor- 
able, but  is  still  exceedingly  grave.  The  greater  the  age  of  the 
young  animal  when  the  symptoms  of  the  disease  appear,  the 
more  vigor  and  strength  it  has  acquired  ;  the  better  the  progno- 
sis. If  the  infection  is  so  mild  that  the  first  evidences  appear 
only  after  the  young  patient  is  2  or  3  weeks  old,  the  prognosis 
is  fair. 

When  simple  omphalitis  is  present  and  severe,  and  the  local 
swelling  and  inflammation  indicate  that  the  entrance  of  the  in- 
fection into  the  general  system  is  barred  by  a  resistant  embolus 
in  the  umbilic  vein,  the  prognosis  is  good. 

Handling.  The  handling  of  the  localized  infection  of  the 
navel  consists  es.sentially  of  local  disinfection.  The  navel  should 
"be  thoroughly  cleansed  ,and  if  a  portion  of  the  cord  is  still  present 
and  undergoing  decomposition  it  should  be  cautiously  removed, 
and  any  necrotic  tissues  should  be  excised  or  curetted  away  as 
far  as  is  practicable.  Abscesses  in  the  navel  should  be  opened 
promptly,  under  strict  antiseptic  precautions.  It  is  highly  essen- 
tial, also,  that,  before  attempting  to  operate,  one  should  care- 
fully differentiate  between  inflammation  of  the  navel  and 
umbilic  hernia.  In  some  cases  the  two  conditions  coexist,  and 
become  highly  confusing,  so  that  the  hernia  may  be  mistaken 
for  an  abscess,  or  vice  versa  ;  or  a  fistula  may  exist  along  with 
hernia.  When  attempting  to  lay  open  a  fistula,  the  surgeon 
may  open  the  peritoneal  cavity  and  invite  intra-peritoneal  infec- 
tion, or  a  protrusion  of  the  omentum  or  the  intestine.  Sup- 
purating fistulse  about  the  navel  should  usually  be  treated  by 
the  injection  of  antiseptics,  such  as  tincture  of  iodine,  rather 
than  b}^  opening,  unless  the  more  conservative  method  fails  to 
produce  the  desired  results. 

The  selection  of  a  disinfectant  is  not  so  important  as  the  thor- 
oughness of  its  application,  except  that  it  should  be  one  which 
will  penetrate  the  tissues  freely,     We  prefer  the  application  of 


-ioi8  Veterinary  Obstetrics 

the  tincture  of  iodine  or  of  other  antiseptics  in  alcoholic  solution. 
They  have  the  advantage  that  the  alcohol  quickly  evaporates  and 
leaves  the  antiseptic  behind  in  a  dry  state.  It  may  be  equally 
effective  to  apply  a  wet  dressing  to  the  part,  in  the  form  of  an 
antiseptic  pack,  to  be  retained  in  position  by  means  of  a  band- 
age. If  this  is  attempted,  the  pack  needs  be  kept  constantly 
saturated  with  the  antiseptic  and  frequently  renewed. 

When  the  infection  has  become  general,  and  septicaemia  or 
pyaemia  has  developed,  all  forms  of  handling  become  almost 
hopeless.  In  accordance  with  general  surgical  principles,  we 
would  promptly  open  abscesses,  and  disinfect  their  cavities 
whether  they  involve  the  muscles  or  the  articulations.  Inter- 
nally there  may  be  given  various  antiseptics,  and  we  especially 
recommend  large  and  repeated  doses  of  quinine,  or  in  the  foal 
we  may  add  to  the  quinine  large  doses  of  potassium  iodide,  or 
supplant  the  quinine  by  the  iodide. 

Recent  developments  in  opsonic  and  serum  therapy  have 
aroused  interest,  and  in  the  minds  of  some,  hope  has  been  estab- 
lished that  pyo-septicsemia  of  the  new-born  may  be  brought 
under  control.  As  yet,  the  problem  is  undecided.  Spencer 
(Proc.  Am.  Vet.  Med.  Ass'cn.,  1908,  p.  393)  claims  definite  re- 
sults in  severe  cases,  but  the  data  submitted  are  not  convincing. 
Most  of  his  cases  were  comparatively  old  foals,  in  a  fair  proportion 
of  which  .spontaneous  recovery  might  have  been  anticipated. 
He  gave  10  cc.  of  anti-streptococcic  serum  subcutaneously, 
daily.  No  evidence  is  submitted  that  the  foals  had  streptococcic 
infection.  If  the  infection  was  streptococcic,  we  have  no  evi- 
dence that  the  serum  was  from  the  same  organism.  In  about 
half  his  cases,  S.  used  influenza  serum  instead  of  the  antistrep- 
tococcic preparation.  In  one  case  he  combined  them.  Were 
we  to  accept  the  conclusion  that  the  sera  acted  specifically  in 
these  cases,  we  would  be  forced  into  the  position  that  the  charac- 
ter of  the  infection  is  unimportant,  and  all  that  is  nece.s.sary  is 
to  buy  some  kind  of  .serum  from  a  manufacturer,  admini.ster  it 
in  any  kind  of  infection,  and  get  a  .speedy  cure. 

It  is  to  be  sincerely  hoped  that  investigations  along  these  lines 
may  develop  a  safe  and  reliable  remedy  for  umbilic  infection  of 
the  new-born,  but  until  we  are  supplied  with  more  definite  data 
regarding  this  or  other  remedies,  the  practitioner  needs  rely  upon 
prophylaxis,  not  upon  therapeutics. 


Purident  Infection  of  the  Navel 


1019 


While  the  handling  of  pyo-septhaemia  of  the  new-born  is  ex- 
ceedingly unfavorable  and  well-nigh  hopeless,  prophylaxis  of 
navel  infection  is  highly  succ-essful,  and  should  be  regularly  ap- 
plied in  stock-breeding,  especially  in  horse-breeding.  Franck 
recommends  that,  after  the  navel  cord  has  been  ligated,  it  should 
be  penciled  over  with  concentrated  carbolic  acid,  but  Vennerholm 
contends  that  this  converts  the  covering  of  the  cord  into  a  parch- 


FiG.  149.    SoHNLE's  Navel  Bandage  for  Foals. 
a,  Elastic  girth  inserted  in  the  suspensorium.     (Bayer  &  Frohner). 

ment-like  membrane,  which  interferes  with  the  escape  of  the 
tissue-fluids,  and  consequently  with  the  mummification  of  the 
cord.  He  recommends  instead  the  plan  of  Sohnle  of  Wurtem- 
berg,  who  uses  a  special  navel  bandage,  as  shown  in  Fig.  149. 
Vennerholm  recommends  that  the  surrounding  parts  be  carefully 
shaved,  in  order  to  prevent  the  adhesion  of  dirt.  The  navel  is 
then  disinfected,  and  further  protected  by  the  application  of  the 
Sohnle  apparatus.  The  leather  surcingle,  and  other  parts  of  this 
apparatus,  are  well  padded,  to  prevent  galling  of  the  young  ani- 
mal, and  applied  as  shown  in  the  figure.  The  navel  rests  in  a 
depression  in  the  surcingle,  in  which  there  is  placed  sterilized 
cotton,  upon  which  the  disinfected  navel  rests.  The  parts  are 
disinfected  and  redressed  daily,  until  the  navel  stump  sloughs 
away  and  granulation  is  fully  established. 

The  plan  of  Vennerholm  and  Sohnle  is  admittedly  good  if 
thoroughly  applied,  but  it  requires  a  very  long  and  tedious  course 
of  procedure,  with  a  somewhat  expensive  apparatus  and  no 
little  annoyance  to  the  foal.     It  is  dangerous  to   entrust    such    a 


I020  Veterinary  Obstetrics 

method  of  handling  to  laymen,  but  the  remedy  demands  applica- 
tion by  the  veterinarian  himself.  Unless  properly  applied, 
closely  watched  and  carefully  reapplied,  the  pad  quickly  becomes 
befouled  and  at  once  acts  as  a  retainer  and  promoter  of  infection. 
In  our  judgment,  so  complicated  a  method  of  handling  is  alike 
needless  and  dangerous. 

In  our  experience  we  have  had  most  excellent  results  by  a  far 
simpler  method,  which  we  believe  safer  and  more  efficient.  We 
provide  the  breeder  with  a  dessicating  antiseptic  powder  for  ap- 
plication to  the  navel  cord  as  soon  as  the  foal  or  other  young 
animal  is  born.  This  powder  may  be  variously  compounded, 
according  to  the  taste  of  the  veterinarian,  but  should  consist  of 
reliable  antiseptics  having  a  distinct  dessicating  power.  We 
would  suggest,  for  such  a  powder,  equal  parts  of  iodoform,  tannin, 
oxide  of  zinc  and  starch,  all  finely  powdered  and  mixed.  The 
oxide  of  zinc  might  be  displaced  by  calomel,  or  the  latter  might 
be  added  to  the  compound  suggested.  Quite  as  good,  or  per- 
haps even  superior,  is  a  powder  consisting  of  equal  parts  of  dessi- 
cated  alum,  gum-camphor  and  starch,  finely  powdered  and  thor- 
oughly mixed.  The  latter  mixture  is  especially  efficient  in 
keeping  flies  away  from  the  moist  cord. 

For  the  application  of  such  a  powder,  the  owner  or  veterina- 
rian should  first  thoroughly  cleanse  and  disinfect  his  hands.  If 
the  navel  has  become  soiled,  it  also  should  be  cleansed  and  dis- 
infected. The  navel  cord  should  not  be  tied.  We  have  al- 
ready stated  our  objections  to  ligating  the  cord,  on  page  1005. 
If  it  is  unruptured,  the  caretaker,  after  disinfecting  his  hands, 
should  pull,  tear  or  scrape  the  cord  in  two,  under  antiseptic  pre- 
cautions, at  a  distance  of  about  two  or  three  inches  from  the 
navel,  after  which,  with  his  thumb  and  finger,  he  should  press 
out  from  the  stump  the  Whartonian  gelatine  and  fluids.  After 
this  has  been  well  done,  the  powder  should  be  dusted  over  the 
stump  of  the  navel  very  freely  and  repeatedly,  until  the  rem- 
nant of  the  cord  has  become  completely  dessicated  and  the  navel 
hermetically  sealed. 

If  the  application  is  repeated  three  or  four  times  at  intervals 
of  one-half  hour,  the  stump  of  the  cord  is  well  mummified  with- 
in two  to  four  hours  and  the  danger  from  infection  is  eliminated. 
The  horse-breeder  should  be  impressed  with  the  fact  that  the 
efficacy  of  the  remedy  depends    wholly    upon    the    early    and 


Tetanus  of  the  New-born  102  r 

thorough  application,  and  that  any  delay  or  carelessness  is  liable 
to  vitiate  the  result. 

Antistreptococcic  serum  has  been  heralded  as  a  valuable  prophy- 
lactic against  this  infection,  but  is  wholly  needless.  Local 
cleanliness  is  ample,  and  other  means  superfluous  or  worse.  Few 
diseases  of  animals  are  more  subject  to  safe,  convenient  and 
economic  prevention  than  navel  infection  of  the  new-born.  Its 
success  calls  for  fidelity  to  cleanliness  on  the  part  of  the  owner, 
preceded  by  timely  and  intelligent  advice  by  the    veterinarian. 

2.  Tetanus  Neonatorum. 

Tetanus  of  the  New-born. 

Tetanus  of  the  new-born  acquires  special  significance  because 
of  the  avenue  of  entrance  of  the  tetanus  bacilli.  While  tetanus 
may  appear  in  any  new-born  animal  from  the  same  causes  which 
induce  it  in  the  adult,  it  is  of  especial  interest  to  us  when  occur- 
ring "as  a  result  of  navel  infection.  Owing  to  the  method  of 
infection,  the  malady  acquires  a  distinctive  name,  though  differ- 
ing in  no  essential  respect  from  the  ordinary  disease,  except  per- 
haps that  it  is  more  virulent  because  the  toxic  substances  enter 
more  freely  and  directly  from  the  umbilic  vein  into  the  general 
circulation.  In  domestic  animals,  tetanus  of  the  new-born  is 
chiefly  confined  to  the  foal. 

The  symptoms  of  tetanus  of  the  new-born  are  identical  with 
those  observed  in  the  adult  animal,  except  that  in  our  observa- 
tion the  onset  is  more  sudden,  the  course  more  violent,  and 
death  more  certain.  We  have  not  observed  a  recovery,  but  in 
the  few  instances  which  we  have  seen  the  course  of  the  disease 
has  been  especially  brief  and  stormy.  As  a  general  rule  the  foal 
goes  down  and  is  unable  to  stand  within  24  hours  after  the  first 
symptoms  are  noted. 

If  the  navel  is  examined  in  these  cases,  so  far  as  we  have 
observed,  there  is  found  in  each  instance  a  well-marked  purulent 
discharge  emanating  from  the  navel  vein. 

The  disease  is  handled  the  same  as  other  cases  of  tetanus,  but, 
so  far  as  we  have  observed,  is  hopeless  from  the  outset. 

Tetanus  of  the  new-born  may  be  safely  and  readily  prevented 
by  the  same  precautions  which  we  have  suggested  in  the  fore- 
going article,  for  ordinary  purulent  infection  of  the  navel. 


1022  Veterinary  Obstetrics 

3.    DYSENTERIA    NEONATORUM.       DYSENTERY  OF  THE  NEW-BORN. 
WHITE    SCOURS. 

In  all  new-boru  animals  there  may  occur  disorders  of  the  di- 
gestive tract,  which  are  expressed  chiefly  in  the  form  of  dysen- 
tery, due  as  a  rule  to  the  entrance  into  the  aliment&ry  canal,  and 
multiplication  therein,  of  various  forms  of  bacteria  which  induce 
a  catarrhal  inflammation  of  the  alimentary  mucous  membrane, 
accompanied  by  an  acute  diarrhea.  While  the  disease  may  affect 
the  new-born  of  any  species  of  animal,  it  is  most  common  and 
fatal  among  calves.  In  this  animal  there  is  a  distinctively  infec- 
tious form,  in  which  the  disease  becomes  enzootic,  and  assumes 
the  proportion  of  a  very  destructive  plague  in  dairy  herds. 
The  calf  is  no  more  subject  to  digestive  disturbances,  aside  from 
the  infectious  diarrhea,  than  are  other  new-born  animals.  In 
fact  it  may  well  be  questioned  if  dysentery  of  the  new-born  ani- 
mal is  not  more  common  in  the  foal,  when  we  leave  out  of  <:on- 
sideration  the  specific  dysentery  of  the  calf. 

a.  Sporadic  Dysentery  of  the  New-Born. 
White  Scours. 

Dysentery  of  the  new-born  consists  of  a  diarrhea  which  at- 
tacks the  young  animal,  usually  during  the  first  few  days  of 
extra-uterine  life.  The  disease  appears  occasionally  among  all 
species,  especially  among  foals  and  calves. 

Symptoms.  When  the  young  animal  has  reached  the  age  of 
two  to  ten  days,  symptoms  of  general  illness  of  a  more  or  less 
severe  type  appear. 

The  feces  are  very  fluid,  and  usually  somewhat  mixed  with 
mucus.  They  are  generally  fetid,  and  vary  in  color,  frequently 
being  of  a  dirty  yellowish  or  whitish  tinge.  They  may  partake  of 
the  peculiar  coloring  of  the  foods  consumed,  so  that,  in  case  the 
young  animal  partakes  of  green  grass,  the  feces  assume  a  tinge 
of  green.  The  feces  are  usually  mixed  to  some  extent  with  gas 
bubbles,  because  of  gaseous  decomposition  taking  place  within 
the  alimentary  canal,  and  the  presence  of  these  bubbles  imparts 
to  the  feces  a  frothy  character.  The  liquid  feces  are  sticky,  and 
the  tail  and  buttocks  soon  become  soiled  by  the  adherent  dis- 
charges. This  constitutes  one  of  the  first  noticeable  symptoms 
of  the  disease. 


Sporadic  Dysentery  of  the  Nciv-born  1023 

The  evacuations  from  the  bowels  are  frequent,  and  the  feces 
are  usually  expelled  with  force.  When  the  disease  is  well  ad- 
vanced the  feces  are  highh'  irritant,  the  amount  of  feces  ex- 
pelled at  a  given  time  is  usually  very  small,  and  the  expulsion 
is  accompanied  by  straining  and  other  symptoms  of  pain.  The 
■disease  may  cause  symptoms  of  colic,  as  indicated  by  the  whisking 
of  the  tail,  kicking  at  the  abdomen  and  looking  at  the  flank. 
The  patient  becomes  weak  ;  if  the  disease  is  very  severe,  it  lies 
most  of  the  time,  and  when  it  gets  up,  it  staggers  about  in  a 
very  weak  manner.  The  eyes  beicome  sunken,  the  animal  ver\' 
listless,  and  saliva  may  flow  from  the  mouth.  Emaciation  is  very 
rapid  in  the  severe  cases,  and  the  coat  is  dry  and  rough.  The 
measurement  of  the  temperature  is  not  very  reliable,  because  in 
the  weakened  state  of  the  animal  the  anus  remains  somewhat 
open.  Moreover,  the  frequent  passage  of  liquid  feces  tends  to 
keep  the  rectal  temperature  somewhat  depressed. 

As  usually  observed,  the  principal  postmortem  change  is  an 
irritated  condition  of  the  gastro-intestinal  canal,  which  is  largely 
concentrated  in  the  colon  and  rectum.  In  these  parts  there  is 
ptesent  a  well-marked  catarrhal  inflammation  of  the  mucous 
membrane,  with  a  greatly  increased  secretion  of  fluids  and  mucus. 
There  is  usually  very  marked  anaemia  and  paleness  of  the  tissues. 

The  bacteriology  of  the  disease  has  not  been  well  determined. 
Usually  there  is  a  mixed  infection.  Various  forms  of  micro- 
organisms have  been  described  by  different  writers,  but  it  has 
not  been  definitely  shown  that  the  disease  is  due  to  any  one  alone. 

Causes.  Sporadic  diarrhea  of  the  new-born  depends  largely 
upon  the  abrupt  introduction  of  pathogenic  organisms  into  the 
alimentary  canal  of  an  animal  which  is  not  inured  to  their 
presence.  The  young  animal  has  undergone  a  sudden  transition 
from  the  uterus  of  the  mother  (which,  with  the  placenta,  has 
served  as  a  barrier  against  most  infections)  to  extra-uterine  life, 
where  it  is  subjected  to  the  dangers  incident  to  taking  into  the 
alimentary  tract,  food  which  is  almost  inevitably  contaminated 
t\'ith  microorganisms  capable  of  inducing  disease. 

Anything  which  may  depress  the  general  strength  of  the 
young  animal,  and  which  may  suppl}-  a  favorable  breeding 
ground  for  the  bacteria  introduced  into  the  digestive  tract,  serves 
indirectly  to  favor  the  multiplication  of  the  disease  organisms. 
If  too  much   food  is  taken,  it  over-taxes  the  digestive  powers, 


I024  Veterinary  Obstetrics 

and  thus  invites  the  occurrence  of  disease.  It  is  frequently- 
observed  that,  when  young  animals  are  over-fed,  and  especially 
when  they  receive  their  food  in  too  large  amounts  at  a  given 
period,  they  are  liable  to  suffer  from  dysentery.  Under  natural 
conditions,  where  the  young  animal  is  constantly  with  the 
mother  and  has  opportunity  to  suck  as  often  as  it  may  like,  the 
danger  from  over-feeding  is  not  very  marked.  However,  if  the 
young  animal  is  separated  from  its  mother  during  long  intervals, 
and  thus  becomes  very  hungry,  it  will  eat  voraciously  when  op- 
portunity is  afforded,  and  will  partake  of  more  milk  than  the 
state  of  its  digestive  organs  warrants,  thus  tending  to  induce 
digestive  disturbances.  In  mares  it  is  frequently  observed  that 
the  udder  is  greatly  distended  with  milk  at  the  time  that  the  foal 
is  born,  and  that  the  young  animal  shows  a  voracious  appetite, 
attempting  to  take  all  the  milk  present,  with  disastrous  results. 

An  improper  quality  of  milk  is  also  dangerous  for  the  diges- 
tive functions  of  the  new-born.  When  mares  or  other  mothers 
are  hard- worked,  and  especially  in  warm  weather,  their  milk  is 
very  liable  to  produce  digestive  disturbances  in  the  young  ani- 
mal, and  all  the  more  so  because  the  foal  is  usually  denied  the 
opportunity  to  suck  at  frequent  intervals,  and  becomes  very 
hungry.  Added  to  this  condition,  the  foal  of  a  work  mare  is 
occasionally  compelled  to  follow  her  upon  a  long  journey,  the 
fatigue  of  which  favors  the  occurrence  of  dysentery,  and  greatly 
aggravates  the  disease  when  it  already  exists. 

The  adaptability  of  the  food  to  the  new-born  is  highly  impor- 
tant. New-born  animals  sometimes  show  a  depraved  appetite, 
and  soon  after  birth  partake  of  food  which  they  are  not  compe- 
tent to  digest.  In  one  instance  we  found  upon  post  mortem  ex- 
amination, in  a  case  of  fatal  diarrhea  in  a  foal  three  or  four  days 
old,  a  tangled  mass  of  straw  in  the  stomach,  weighing  perhaps  half 
a  pound,  incapable  of  digestion  or  of  escaping  from  the  organ 
through  the  pylorus,  and  acting  as  an  irremovable  irritant.  It 
is  very  common  to  observe  foals  habitually  swallowing  bedding 
and  other  forms  of  rubbish  or  indigestible  substances.  It  is  a 
very  common  experience,  when  examining  the  feces  in  a  case  of 
scours,  to  find  mixed  with  the  intestinal  discharges,  undigested 
particles  of  straw  or  other  similar  substances.  The  eating  of 
hay  by  very  young  animals  frequently  acts  as  a  cause  of  persis- 
tent dysentery. 


sporadic  Dysentery  of  the  New-born  1025 

Decomposiug  foods  constitute  a  fertile  source  of  diarrhea,  and 
the  disease  is  consequently  very  largely  seen  among  young  ani- 
mals which  are  artificially  reared.  Milk  which  has  been  allowed 
to  partially  decompose,  which  has  begun  to  ferment  or  sour,  is 
always  dangerous  as  a  food  for  the  new-born  ;  but  even  more 
dangerous  is  food  which  is  contaminated  with  filth.  In  many 
instances  the  vessels,  from  which  artificially-reared  animals  are 
fed,  are  exceedingly  filthy  and  dirty,  and  contain  particles  of 
milk  which  have  been  allowed  to  remain  and  decompose  day  after 
day. 

Prognosis.  The  prognosis  of  sporadic  dysentery  in  new-born 
animals  is  usually  favorable.  In  those  animals  in  which  the 
disease  appears  very  early,  within  two  or  three  days  after  birth, 
the  prognosis  is  less  favorable  than  in  those  in  which  the  attack 
is  delayed  until  the  animal  has  acquired  some  age  and  strength. 
The  prognosis  necessarily  depends  somewhat  upon  the  cause  of 
the  disease,  and  the  power  of  the  veterinarian  to  overcome  it.  In 
such  a  case  as  that  to  which  we  have  above  referred,  in  which 
the  animal  had  swallowed  a  large  amount  of  straw  which  had 
become  molded  into  a  tangled  mass  in  the  stomach  and  vr.s 
neither  removable  nor  digestible,  the  termination  could  not  be 
other  than  fatal. 

Handling.  The  prevention  of  sporadic  dysentery  in  young 
animals  is  highly  important.  The  food  of  the  new-born  animal 
should  be  as  free  as  possible  from  pathogenic  organisms,  should 
be  allowed  in  proper  amounts  and  at  sufficiently  frequent  inter- 
vals, and  should  be  as  readily  digestible  as  circumstances  will 
permit.  If  the  young  animal  is  allowed  to  suck  the  mother,  it 
should  be  given  such  opportunity  quite  frequently  ;  at  first  the 
young  animal  should  be  allowed  to  be  with  its  mother  constantly. 
If  the  amount  of  milk  in  the  udder  is  excessive,  a  portion  of  it 
should  be  withdrawn,  so  that  the  young  animal  will  not  be 
tempted  to  over- feed.  This  is  especially  true  of  the  foal, 
since  the  mare  sometimes  has  an  enormous  quantity  of  milk 
when  the  foal  is  born,  and  the  latter  is  so  voracious  that  it  may 
greatly  overfeed,  if  not  prevented  by  the  timely  withdrawal  of 
a  portion  of  the  milk.  The  objection  has  been  interposed  that 
the  withdrawal  of  the  milk  removes  the  colostrum,  which  some 
have  alleged  is  essential  to  the  well-being  of  the  young  animal. 
65 


1026  Vetermary  Obstetrics 

How  true  this  may  be,  has  not  been  definitely  shown,  but  it  is 
certainly  true  that  many  animals  are  well  raised  without  having 
access  to  the  colostrum.  In  many  mares  the  milk  has  been 
flowing  freely  from  the  udder  for  days  or  weeks  before  the  foal 
is  born,  and  the  colostrum  has  already  escaped.  Yet,  so  far  as 
'we  have  clinically  observed,  the  foal  does  not  suffer  from  this 
cause. 

When  young  animals  are  to  be  artificially  reared,  the  task 
should  be  undertaken  with  a  practical  understanding  and  appli- 
cation of  the  rules  of  aseptic  feeding.  The  food  should  be  given 
frequently,  and  in  small  amounts,  in  harmony  with  the  undevel- 
oped state  of  the  alimentary  tract,  and  it  should  be  as  free  as 
practicable  from  decomposition  and  from  filth  bacteria.  The 
vessels  from  which  the  milk  is  fed  to  the  young  animal  should  be 
regularly  cleansed  and  sterilized  by  boiling  before  each  feeding. 
In  some  instances  it  may  be  desirable  to  Pasteurize  the  milk  be- 
fore it  is  fed  to  the  young  animal,  but  this  process  reduces  the 
digestibility  of  the  milk  to  a  degree,  and  is  undesirable  except 
in  those  cases  where  dangerous  pollution  cannot  otherwise  be 
avoided. 

The  composition  of  the  food  should  resemble  as  closely  as  pos- 
sible the  normal  milk  of  the  species  of  animal  to  which  it  is  being 
fed.  When  a  young  animal  is  being  reared  artificially,  the  milk 
should  preferably  be  derived  from  an  animal  of  its  own  species. 

The  surroundings  of  the  new-born  should  be  scrupuously  clean, 
and  there  should  be  a  careful  avoidance  of  any  dangerous  sub- 
stances which  are  likely  to  be  swallowed.  If  the  young  animal 
exhibits  a  morbid  appetite,  such  as  a  tendency  to  eat  bedding,  it 
is  highly  important  to  apply  effective  preventive  measures.  In 
some  instances  the  young  animal  shows  a  marked  tendency  to  eat 
fecal  matter  which  has  been  voided  by  itself  or  other  animals. 
The  eating  of  bedding  may  be  largely  overcome  by  removing  it 
and  keeping  the  animal  upon  a  bare  floor,  or  still  better,  when 
the  season  and  surroundings  will  permit,  by  placing  the  animal 
upon  clean  grass.  In  other  cases,  where  the  morbid  appetite  is 
marked  and  serious,  we  have  found  it  necessary  to  apply  a  muzzle 
to  the  young  animal  so  that  it  could  not  swallow  rubbish. 

When  the  disease  has  become  established,  the  precautions 
above  suggested  should  be  rigidly  enforced,  and  in  addi- 
tion, measures  should  be  taken  to  remove,  from  the    alimentary 


sporadic  Dyse?itery  of  the  New-born  1027 

canal,  indigestible  and  irritant  substances,  allay  the  irritation 
in  the  parts,  and  disinfect  such  contents  as  may  remain  in  the 
canal.  First  of  all  we  strongly  recommend  the  administration 
of  an  oleaginous  cathartic,  such  as  castor,  linseed,  or  cotton  seed 
oil.  To  the  foal  may  be  given  one  tablespoonful  of  castor  oil,  or 
two  to  three  ounces  of  linseed  or  cotton  seed  oil.  The  oil  is  ad- 
ministered to  gently  evacuate  the  intestinal  canal  of  its  irritating 
contents,  and  at  the  same  time  to  bring  about  a  soothing  of  the 
irritated  mucous  membrane. 

Many  practitioners  have  proceeded  in  an  opposite  direction, 
and  have  administered  opium,  tannin,  catechu,  alum  and  other 
astringent  substances,  which  tend  to  retain  within  the  canal  the 
irritant  substances  which  contain  or  bear  the  infecting  agents. 
We  have  not  been  able  to  observe  the  benefits  from  this  class  of 
drugs,  which  have  been  claimed  for  them  by  many  writers. 

The  disinfection  of  the  alimentary  canal,  after  the  removal  of 
the  infecting  discharges  .so  far  as  practicable,  should  receive  close 
attention  upon  the  part  of  the  practitioner.  Many  drugs  exert 
either  a  direct  or  an  indirect  influence  upon  micro-organisms  in 
the  digestive  canal.  Since  the  discharges  are  usually  acid  in  re- 
action, man}'  practitioners  have  strongly  advised  the  use  of  alka- 
line carbonates,  such  as  chalk  or  sodium  bicarbonate.  Others 
have  had  excellent  results  b}'  the  administration  of  powerful 
antiseptics,  like  corrosive  sublimate  or  carbolic  acid  in  appro- 
priate doses.  Indirectly,  excellent  results  have  been  obtained 
hy  the  adminiscratiou  of  small  doses  of  calomel,  which,  by  ex- 
citing the  functions  of  the  liver,  cause  an  increased  amount  of 
bile  to  be  poured  into  the  intestines,  which  acts  as  an  antiseptic, 
increases  the  peristalsis  of  the  bowels,  and  causes  the  expulsion 
as  well  as  the  destruction  of  the  micro-organisms.  Salol  and 
other  .similar  drugs  have  been  used  and  recommended   by  some. 

Stimulants  and  carminates  have  also  been  u.sed  and  highly 
commended  by  many  practitioners.  We  have  largely  used  the 
tincture  of  ginger,  with  apparently  good  results.  Any  of  the 
carminates  or  aromatics  may  perhaps  be  used  with  benefit. 
Some  of  them  have  a  direct  antiseptic  influence,  while  indirectly 
they  all  tend  to  disinfect  the  alimentary  canal  by  arousing  the 
normal  peristalsis  and  secretions  of  the  intestines,  which  in 
themselves  control  to  a  great  extent  the  question  of  infection. 
There  are  probably  few  disinfectants  which  are  superior   in   effi- 


I028  Veterinary  Obstetrics 

ciency  to  the  normal  peristalsis  of  the  intestines  and  the  corre- 
lated normal  secretions  of  the  alimentary  glands.  Stimulants 
strengthen  the  animal  and  help  tide  it  over  a  crisis  in  the  course 
of  the  disease.     Alcoholic  stimulants  act  also  as  antiseptics. 

Much  good  may  sometimes  be  had  from  the  administration  of 
gruels  or  other  substances  which  are  at  once  nutritive  and  sooth- 
ing to  the  irritated  mucosa.  For  this  purpose  one  may  use  a  thin 
gruel  of  elm  bark  or  of  starch,  or  may  administer  the  whites  of 
eggs,  but  care  should  be  taken  not  to  force  too  large  an  amount 
of  these  substances  upon  the  young  animal  unless  the  conditions 
warrant  us  to  believe  that  they  will  be  digested,  and  not  decom- 
pose to  further  complicate  the  disease. 

It  is  desirable  to  overcome  as  far  as  practicable  the  tenesmus 
due  to  the  irritation  by  the  intestinal  discharges  in  the  rectum, 
for  which  purpose  one  may  advantageously  administer  enemas 
of  a  soothing  and  aseptic  character,  such  as  a  o.s'/ir  solution  of 
carbolic  acid  in  starch  or  milk.  Enemas  of  elm  bark  gruel,  to 
which  has  been  added  salicylate  of  soda,  may  be  used  advan- 
tageously. 

The  surroundings  of  the  young  animal  should  be  clean  and 
comfortable,  and  any  exertion  upon  its  part  should  be  carefully 
avoided,  since  this  tends  to  greatly  aggravate  the  disease. 

b  Infectious  Diarrhea  of  Calves. 

There  occurs  frequently  in  calves  a  serious  dysentery  or  scours, 
which  is  regarded  as  a  specific  infectious  disease,  differing  mate- 
rially from  the  sporadic  dysentery  of  the  young  animal.  It  ap- 
pears usually  during  the  first  few  days  after  birth,  but  may  appear 
almost  immediately  after  birth,  and,  in  fact,  seemingly  exists  in 
some  instances  at  the  time  that  the  young  animal  is  born,  so  that 
it  quickly  perishes  from  the  disease  without  having  sucked  the 
mother.  The  disease  is  highly  fatal,  and  runs  a  very  acute 
course. 

Causes.  Franck  was  one  of  the  first  to  describe  diarrhea  as 
an  infectious  disease,  since  which  time  many  writers  have  verified 
his  conclusions,  that  it  is  a  highly  contagious  malady  due  to  a 
specific  cause. 

Nocard  asserted  the  identity  or  close  relationship  between  in- 
fectious abortion  and  dysentery  of  the  new-born,  but  there  seems 
to  be   no  very   good  clinical  grounds   for  such  an  assumption, 


Infediotis  Diarrhea  of  Calves  1029 

though  the  possibility  of  the  co-existence  of  the  two  maladies  in 
one  herd  cannot  be  denied.  Nocard  believed  that  the  infection 
usuall)'  enters  the  body  of  the  calf  through  the  umbilic  cord,  and 
consequently  may  occur  during  the  passage  of  the  fetus  through 
the  birth  canal.  It  has  been  shown  by  Walther  Schild  that  new- 
born animals  have  bacteria  in  the  alimentary  tract  prior  to  the 
ingestion  of  food. 

Jensen  does  not  accept  the  views  of  Nocard,  but  inclines  to  the 
belief  that  the  infection  is  usually  transmitted  directly  to  the 
alimentary  canal  through  the  mouth,  or  at  least  that  it  may  be 
so  transmitted.  Jensen  found  oval  bacteria  in  pairs  or  short 
chains,  in  the  mesenteric  glands,  spleen,  liver,  kidneys,  heart, 
lungs  and  elsewhere.  The  organism  is  apparently  closely  allied 
to  the  bacterium  coli  cotmmmis  and  bacillus  fctidi  lactis.  The 
findings  of  Jensen  have  in  the  main  been  verified  by  other 
investigators.  He  induced  the  disease  experimentally,  by  admin- 
istering a  culture  of  these  organisms,  with  milk,  to  calves  of  sus- 
ceptible age. 

Symptoms.  The  symptoms  of  the  disease  appear  usually  in 
from  one  to  two  days  after  birth,  but  in  some  instances  within  a 
very  few  hours.  The  first  symptom  observed  by  the  owner  is 
usually  tenesmus,  accompanied  by  fluid  evacuations  which  are 
at  first  of  a  yellowish  color  and  stinking.  At  first  the  liquid 
feces  are  expelled  with  considerable  force,  but  later  the  intestines 
largely  lose  their  power  and  the  evacuations  take  place  involun- 
tarily, while  the  color  changes  from  the  normal  j^ellow  to  a  gray 
or  whitish-gray,  and  becomes  very  thin.  The  young  animal 
ceases  to  take  food,  and  rapidly  becomes  weak  and  dull,  with 
cold  extremities.  The  course  of  the  di.sease  is  usually  very  rapid, 
and  death  follows  in  from  12  to  48  hours.  According  to  Fried- 
berger  and  Frohner,  the  mortality  ranges  from  80  to  100%. 

Sometimes  the  disease  is  accompanied  by  stretching,  and  at 
other  times  convulsions  are  present.  In  those  cases  where  the  calf 
sickens  within  a  very  few  hours  after  birth,  before  it  has  sucked, 
the  course  is  very  rapid  and  fatal.  This  fact  has  supported  the 
opinion  of  Franck  and  Nocard,  that  the  infection  occurs  during 
the  intra-uterine  life  of  the  calf  or  at  the  time  of  birth  while  the 
fetus  is  passing  through  the  vagina.  Upon  similar  grounds 
Friedberger  and  Frohner  are  of  the  opinion  that  infectious 
uterine  catarrh  (granular  venereal  disease?)  of  the  mother  may 


1030  Veterinary  Obstetrics 

become  transferred  to  the  alimentar}'  tract  of  the  fetus  and  induce 
the  diarrhea. 

Thus,  according  to  one  and  another  investigator,  a  relationship 
is  suggested  between  several  more  or  less  serious  maladies — abor- 
tion, diarrhea,  uterine  catarrh.  At  the  present  time  the  writer 
is  handling  a  herd  for  severe  granular  venereal  disease,  in  which 
abortion  and  diarrhea  co-exist,  but  the  relationship  of  the  diar- 
rhea to  the  granular  vaginitis  is  not  clear. 

Upon  post-mortem  examination  the  chief  changes  are  found  in 
the  alimentary  canal  and  in  the  heart.  The  digestive  mucous 
membrane  is  injected  and  hemorrhagic,  and  in  some  places  shows 
a  denudation  of  epithelium.  The  irritation  is  largely  concen- 
trated in  the  rectum,  where  the  mucous  folds  are  excessively 
hyperaemic.  The  mesenteric  glands  are  enlarged  and  infiltrated, 
as  are  also  the  liver  and  kidneys.  The  spleen  is  apparently 
normal  ;  the  heart  at  times  shows  ecchymoses.  In  addition  to 
these  changes,  there  are  present  at  times  small  areas  of  pneumonia. 

Handling.  The  therapeutics  of  this  disease  has  constantly 
proven  unsuccessful,  and  the  chief  attention  is  necessarily  turned 
to  preventive  measures.  More  than  a  quarter  of  a  century  ago, 
Franck  advi.sed  that  pregnant  cows  be  removed  from  infected 
stables  four  to  six  weeks  prior  to  parturition,  and  that  they  be 
placed  in  clean  and  disinfected  stalls.  Others  have  advised  that 
the  posterior  portions  of  the  pregnant  animal,  the  vulva,  peri- 
neum, tail  and  buttocks,  be  carefully  disinfected,  that  the  vagina 
be  irrigated  with  warm  antiseptics  shortly  prior  to  parturition, 
and  that  the  udder  be  washed  with  a  2%  carbolic  acid  solution 
before  permitting  the  calf  to  suck  or  before  drawing  milk  from 
the  udder  to  feed  the  calf.  Morkeberg  succeeded  in  reducing  the 
mortality  from  77  to  33%,  by  applying  careful  disinfection,  fol- 
lowed by  the  immediate  removal  of  the  calf  and  feeding  it  upon 
clean  milk.  The  udder  was  carefully  washed  with  corrosive  sub- 
limate solution  before  the  milk  was  drawn  for  feeding  the  calf.. 

Nocard  advises  that  the  navel  cord  should  be  ligated  and  ex- 
cised, and  the  stump  carefully  disinfected,  because  he  believes 
that  the  disease  is  largely  transmitted  through  the  wound  of  the 
ruptured  cord  while  the  calf  is  passing  through  the  vagina  or 
while  the  freshly  ruptured  cord  is  yet  in  contact  with,  or  moist- 
ened by,  the  vulvo-vaginal  fluids.  While  we  admit  the  proba- 
bility of  the  transmission  of  the  disease  through  the  navel  wound,. 


bifedioiis  Diarrhea  of  Calves  1031 

it  would  certainly  be  unfortunate  to  ignore  other  even  more 
probable  avenues  of  infection. 

If  the  infection  exists  in  the  genital  passages  of  the  mother,  it 
may  as  readily  gain  the  lungs  and  alimentary  tract  by  entering  the 
nostrils  and  mouth  as  it  may  enter  the  system  through  the  umbliic 
wound.  It  is  therefore  quite  as  important  to  guard  these  portals  of 
entry,  as  it  is  the  umbilic  stump.  Assuming  the  correctness  of  the 
view  that  the  infection  is  already  lying  in  wait  in  the  genital 
canal  when  birth  begins,  antiseptic  irrigations  of  the  vaginal 
canal  of  the  cow  just  prior  to  labor,  and  the  immediate  disinfec- 
tion of  the  nostrils  and  mouth  of  the  new-born  are  indicated.  As 
we  have  already  indicated  on  page  561,  we  very  greatly  prefer, 
and  strongly  recommend,  the  application  of  dessicant  antiseptic 
powders  to  the  freshly  ruptured  navel,  and  would  omit  the 
ligature.  We  regard  the  dessication  of  the  navel  stump  as  more 
efficient,  convenient  and  economic.  Apparently  those  who  advise 
ligation  of  the  cord  desire  that  it  shall  be  done  prior  to  rupture, 
but  the  cord  of  the  calf  is  so  short  that  it  usually  ruptures  at  the 
moment  of  expulsion,  and  immediately  encounters  the  most  crit- 
ical exposure  in  its  history,  if  we  accept  the  theory  of  intra- 
vaginal  infection.  A  ligature,  encircling  the  now  dormant  cord 
and  presumably  infected  stump,  cannot  act  as  a  barrier  to  the 
spread  of  the  infection,  but  it  may  readily  favor  the  extension  of 
the  infection  in  the  necrotic  stump  by  retaining  the  included 
Whartonian  gelatin. 

The  calf  should  at  once  be  removed  from  the  cow  and  from  the 
infected  stable.  The  removal  is  to  be  followed  by  the  rigid  appli- 
cation of  the  general  rules  of  asepsis  and  antisepsis.  These  must 
include  clean  and  comfortable  quarters  for  the  new-born,  and 
strictly  clean  milk  in  proper  quantity  and  at  proper  intervals.  In 
applying  these  rules,  the  milk  must  be  withdrawn  from  the  cow 
under  the  strictest  possible  precautions  to  avoid  its  contamina- 
tion. Before  the  milk  is  drawn,  the  milker  should  carefully  dis- 
infect his  hands  and  the  udder  of  the  cow.  The  milk  should  be 
drawn  in  a  sterile  vessel.  Ample  precautions  are  to  be  taken 
against  contamination  of  the  milk  between  its  withdrawal  and 
feeding  to  the  calf.  The  feeding  vessels  must  be  handled  under 
strict  aseptic  precautions,  being  sterilized  before  each  feeding. 
Care  must  be  taken  also  that  the  infection  shall  not  be  borne  to  the 
susceptible  young  by  intermediary  bearers,  such  as  caretakers,. 


1032  Veterinary  Obstetrics 

animals,  bedding  or  food.  When  the  disease  exists  in  a  stable, 
it  is  of  great  importance  that  all  fecal  and  other  excreta  from 
the  diseased  calves  shall  be  promptly  disinfected.  The  buttocks 
and  other  soiled  parts  should  be  cleansed  with  a  reliable  disin- 
fectant, and  the  soiled  bedding  and  floor  should  be  given  close 
attention. 

When  the  young  animal  has  once  become  infected,  the  case  is 
almost  hopeless.  Various  antiseptics  have  been  used  and  recom- 
mended, such  as  the  tri-chloride  of  iodine,  creolin,  carbolic  acid, 
salicylate  of  soda  and  others.  Opium  has  also  been  used  and 
recommended,  in  conjunction  with  powdered  rhei  radix.  Opsonic 
and  serum  prevention  and  cure  have  been  proposed,  but  at 
present  do  not  warrant  any  relaxation  in  disinfection. 

c.  Septic  Pleuro-pneumonia  of  calves. 

Under  the  name  of  septic  pleuro-pneumonia,  Poels  has  des- 
cribed a  fatal  disease  of  calves,  complicated  by  inflammation  of 
the  pleura  and  lungs,  and  caused  by  specific  bacteria  which  be- 
long to  the  colon  group.  Poels  secured  pure  cultures  of  the 
bacteria,  which  caused  a  disease  in  experiment  calves  that  could 
not  be  clinically  distinguished  from  that  in  calves  which  had  ac- 
quired the  infection  in  the  natural  way.  The  artificially-grown 
bacteria  also  killed  mice,  rabbits  and  guinea  pigs,  and  induced  in 
swine  a  disease  which  appeared  very  much  like  swine  plague. 
The  bacteria  were  found,  upon  post-mortem  examination,  in  the 
blood  and  internal  organs,  and  in  the  pleura  and  pulmonary  exu- 
dates. It  is  believed  that  the  infection  may  enter  through  the 
alimentary  tract,  the  navel,  the  respiratory  organs,  or  wounds 
upon  the  body  surface. 

The  clinical  and  bacterial  differentiation  between  calf  dysen- 
tery and  pleuro-pneumonia  in  calves  is  not  yet  clear.  Some  hold 
the  two  for  identical  ;  others  consider  them  as  distinct  diseases, 
due  to  wholly  distinct  micro-organisms. 

It  is  common  in  outbreaks  of  calf  pleuro-pneumonia,  to  observe 
diarrhea.  In  some  outbreaks  of  pleuro-pneumonia,  diarrhea  is 
the  rule  rather  than  the  exception. 

The  reverse  is  equally  true.  Pleuro-pneumonia  is  b)'^  no  means 
rare  in  outbreaks  of  infectious  dysentery.  Certainly  the  two 
may  coexist.     While  the  evidence  for  and  against  the  idenity  of 


Calf  Septiccemia  I033 

diarrhea  and  pleuro-pneunionia  is  very  confusing,  their  mode  of 
origin,  avenue  of  infection,  prognosis  and  handling  are  essen- 
tially the  same. 

Poels  recommends  that  calves  suffering  from  pleuro-pneumonia 
or  diarrhea  should  be  fed  upon  sterilized  milk,  from  vessels  which 
have  been  sterilized  hy  boiling,  and  that  great  care  should  be 
taken  to  avoid  infection  passing  to  the  young  animal  through  the 
medium  of  dirt}^  milk.  Especially  he  recommends  that  great  care 
should  be  taken  in  those  cows  in  which  there  is  a  septic  dis- 
charge from  the  vulva,  which  may  thence  be  transferred  to  the 
udder  and  gain  entrance  into  the  milk,  and  suggests  that  in  all 
such  cases,  the  parts  which  are  liable  to  be  soiled,  including  the 
tail  and  udder,  should  be  thoroughly  disinfected.  He  further 
suggests  that  the  navel  should  have  antiseptic  handling  at  the 
time  of  the  birth  of  the  young  animal. 

d.  Calf  Septicemia. 

Jensen  has  described  a  fatal  disease  of  calves  occurring  in 
Denmark,  which  is  caused  by  ovoid  bacteria,  closely  resembling 
tho.se  of  swine  plague,  but  in  their  pathogenic  properties  exhibit- 
ing some  characteristic  differences.  Jensen  considers  this  disease 
closely  allied  to  the  pleuro-pneumonia  described  by  Poels,  but  it 
runs  a  more  rapid  course,  without  producing  inflammation  of  the 
lungs.  In  Jensen's  observations  the  calves  died  in  from  12  to 
24  hours  after  the  first  appearance  of  the  disease.  The  calves 
were  attacked  very  suddenlj^,  and  became  at  once  so  weak  that 
they  could  not  stand,  the  temperature  became  elevated  to  about 
41  C,  and  the  patients  quickly  perished,  with  symptoms  of 
diarrhea  and  dyspnoea. 

Upon  post-mortem  examination,  Jensen  found  acute  fibrinous 
inflammation  of  the  pleura  and  pericardium,  with  ecchymoses 
in  these  two  membranes,  gastro-enteritis,  enlargement  of  the 
spleen,  and  infiltrations  about  the  larynx  and  pharynx. 

e.  Bacteri.Emia  of  Thomassen. 

Thomassen  has  described  a  fatal  infection  of  calves  due  to  a 
bacillus  of  the  colon  group,  which  he  could  distinguish  from  the 
bacterimn  coli  communis  only  by  its  greater  virulence.  He  con- 
sidered the  infection  even  more  virulent  than  that  of  diarrhea. 
According  to  Thomassen  the  calves  are  born  sound,  and  show 


I034  Veterinary  Obstetrics 

the  first  symptoms  of  the  disease  within  from  5  to  8  days,  or 
even  more,  when  they  suddenly  become  weak  and  listless,  remain 
recumbent,  and,  when  they  are  compelled  to  get  up,  habitually 
stretch  themselves. 

Along  with  the  dry  muzzle,  the  respirations  are  increased  to 
50  or  120  per  minute,  the  pulse  is  small,  100  to  150  per  minute, 
and  the  temperature  is  elevated  as  high  as  42°  C.  Some  of  the 
patients  cough.  The  appetite  is  greatly  diminished,  though  the 
calf  may  continue  to  drink  some  milk.  In  these  outbreaks 
diarrhea  is  rare,  and  usually  the  feces  are  normal,  while  the 
urine  is  frequently  voided  in  small  amounts  and  contains  epithe- 
lium from  the  bladder  and  tubular  casts  from  the  kidneys. 
In  some  cases  cerebral  symptoms  are  present,  in  the  form  of 
tonic  and  clonic  spasms,  to  be  later  followed  by  paralysis. 

The  disease  has  a  duration  of  5  or  6  days,  and  in  the  experi- 
ence of  Thomassen  is  uniformly  fatal. 

The  pathologic  anatomy  consists  chiefly  of  great  enlargement 
of  the  spleen,  which  is  5  to  6  times  its  normal  size  and  has  a 
weight  of  about  500  grams.  The  pulp  of  the  spleen  is  congested 
and  chocolate  color  or  black,  and  it  sometimes  shows  an  irregular 
form,  being  more  swollen  at  one  point  than  another.  In  smear 
preparations  of  the  spleen,  there  are  found  many  bacilli.  The 
kidneys  are  affected  with  a  parenchymatous  inflammation,  and 
the  mucous  membrane  of  the  bladder  shows  streaks  or  spots  of 
a  brown-red  color.  The  mesenteric  lymph  glands  are  enlarged 
and  show  hemorrhagic  spots.  The  mucous  membrane  of  the 
fourth  stomach,  and  to  a  lesser  degree  that  of  the  small  intes- 
tine, show  numerous  dark  red  petechia.  The  liver  has  under- 
gone parenchymatous  degeneration.  The  endocardium  is  cov- 
ered with  red  petechise. 

Thomassen  administered  various  antiseptics  to  the  di.seased 
animals,  such  as  carbolic  acid,  eucalyptol,  trichloride  of  iodine,. 
Lugol's  solution  and  others,  but  without  any  success. 


NON-INFECTIOUS  DISEASES  AND  DEFECTS    OF    THE 
NEW-BORN  ANIMAL. 

I.  Asphyxia  of  the  New-Born. 

Asphj'xia  is  not  rare  in  the  new-born,  and  may  proceed  from 
a  variety  of  causes.  If  the  mother  has  suffered  from  some  malady 
which  interferes  with  aeration  of  her  own  blood,  just  prior  to 
parturition,  the  fetus  must  necessarily  suffer  in  a  somewhat  simi- 
lar manner.  For  example,  if  a  mare  in  advanced  pregnancy  is 
suffering  from  pneumonia,  hydrothorax,  or  other  di.sease  which 
interferes  with  her  respiration,  the  foal,  during  this  diseased  con- 
dition of  the  mother,  necessarily  suffers  more  or  le.ss  for  want  of 
0X3'gen. 

If  for  any  reason  the  fetal  placenta  becomes  detached  from  the 
maternal  placenta  before  the  fetus  has  sufficiently  emerged  from 
the  genital  tract  to  breathe,  and  parturition  is  in  any  way  de- 
layed, asphyxia  must  necessarily  result  very  quickly.  Especially 
in  the  mare,  where  the  adhesion  between  the  fetal  placenta  and 
the  uterus  is  very  slight,  the  placenta  may  become  partially  or 
wholly  detached  before  the  fetus  is  expelled,  and  may  even  be 
expelled  ahead  of  the  fetus,  causing  in  either  case,  a  fatal 
asphyxiation. 

During  parturition,  if  the  fetus  moves  slowly  through  the  birth 
canal,  especially  when  in  the  posterior  presentation,  and  the 
navel  cord  becomes  tightl}^  compressed  between  the  wall  of  the 
fetal  chest  and  the  pelvis  of  the  mother  in  a  manner  to  interrupt 
the  circulation,  the  delivery  must  be  very  quickly  concluded  or 
fatal  asphyxia  results.  The  navel  cord  may  become  entangled 
about  one  of  the  limbs  or  the  head  of  the  fetus,  and  the  circula- 
tion thus  be  interrupted. 

In  one  instance  of  asphyxiation  in  pigs,  we  observed  upon 
post-mortem  examination  a  firm  clot  of  mucus  occluding  the 
glottis  and  causing,  immediately  after  birth,  difficult  respiration 
accompanied  by  dyspnoeic  sounds. 

It  is  only  rarely  that  any  efforts  which  the  attending  veteri- 
narian may  be  able  to  exert  will  successfuUj'^  overcome  suspended 
animation  due  to  asphyxia  of  the  new-born.  Usually  the  asphyxia 
has  proceeded  too  far  before  the  extraction  of  the  fetus,  and  any 
1035 


1036  Veterinary  Obstetrics 

attempts  at  resuscitation  will  prove  of  no  avail.  If  the  heart  still 
beats,  there  may  be  hope  that  the  asphyxia  can  be  overcome. 
The  attendant  should  attempt  to  induce  artificial  respiration  by 
such  means  as  are  at  hand.  In  some  cases,  like  those  related 
above  in  the  pig,  there  may  be  present  in  the  larynx  a  clot  of 
mucus,  which  should  be  removed.  This  mucus  might  be  dis- 
lodged by  drawing  forcibly  upon  the  tongue  and  then  suddenly 
releasing  it,  and  continuing  this  operation  as  long  as  may  seem 
prudent.  In  the  usual  case  of  asphyxia,  respiration  may  be 
favored  by  alternately  compressing  and  relaxing  the  chest  with 
the  hands,  or  by  extending  the  anterior  limbs  alternately  forward 
and  backward. 

It  has  been  suggested  that  a  tube  might  be  passed  through  the 
nostril  and  larynx  into  the  trachea,  and  amniotic  or  allantoic 
fluids  drawn  off  which  have  been  inhaled  prior  to  the  expulsion 
of  the  fetus.  Such  suggestion  is  based  upon  an  error.  If  the 
fetus  has  inhaled  amniotic  fluid  before  its  expulsion,  it  will  be 
very  quickly  absorbed  from  the  lungs  and  will  cease  to  act  as  an 
impediment  to  respiration  almost  immediately,  and  consequently 
need  not  be  taken  into  account  in  any  measures  for  inducing 
artificial  respiration.  Suspending  the  asphyxiated  young  by  the 
hind  legs  tends  to  stimulate  respiration  by  inducing  cerebral  en- 
gorgement with  venous  blood,  and  incidentally  any  fluids  in  the 
lungs  may  freely  escape. 

One  of  the  most  efficient  means  for  inducing  respiration  is  the 
alternating  electric  current,  but  unfortunately  as  a  rule  such  ap- 
paratus is  not  at  hand  at  the  critical  moment.  In  many  instances 
a  sharp  blow  upon  the  nose  or  other  sensitive  part  tends  to  induce 
respiratory  effort.  It  has  also  been  suggested  that  dilation  and 
irritation  of  the  anus  will  tend  to  produce  inspiratory  effort. 
In  a  similar  manner  one  may  stimulate  efforts  at  breathing  by 
dashing  cold  water  upon  the  skin  of  the  animal.  It  has  also 
been  suggested  that  respiration  be  stimulated  by  the  inhalation  of 
ammonia  fumes  ;  but  the  efficiency  of  this  plan  may  well  be 
doubted  so  long  as  no  respiration  is  taking  place,  because  the 
fumes  cannot  well  be  introduced  into  the  nostril  except  with  the 
aid  of  inspiration. 

It  has  also  been  advised  that  the  lungs  be  inflated  by  means  of 
bellows,  applied  to  one  nostril  while  the  other  is  closed  ;  but 
this  is  not  necessarily  effective,  because  the  larynx  may  be  closed 


Umbilic  Hemorrhage  i037 

and  the  lungs  fail  to  become  inflated.  If  one  would  be  sure  of 
the  introduction  of  the  air  into  the  lungs,  it  would  be  best  to  in- 
troduce it  into  the  trachea,,  and  close  the  nostrils  and  mouth  so 
that  it  could  not  escape  in  that  way.  In  some  cases,  where  the 
larynx  seems  to  be  occluded  and  it  is  impossible  to  induce  free 
breathing  through  that  organ,  it  might  be  well  to  perform 
tracheotomy,  until  whatever  obstruction  existing  in  the  larynx 
may  be  removed.  Ordinarily  tracheotomy  of  the  newborn  involves 
great  danger  of  tracheal  collapse  later,  and  is  accordingly  to  be 
avoided  as  far  as  possible,  and,  instead,  an  incision  made  through 
the  crico-thyroidean  liagament  large  enough  to  admit  the  oper- 
ator's finger 

2.  Umbilic  Hemorrhage. 

Umbilic  hemorrhage  in  the  new-born  animal  is  very  rare.  We 
have  not  had  occasion  to  observe  this  accident  in  any  case. 
Under  normal  conditions,  when  the  umbilic  arteries  rupture  they 
retract  within  the  abdominal  cavity,  as  shown  in  Fig.  56,  and  in 
so  doing  withdraw  with  them,  in  an  inverted  manner,  the  con- 
nective tissue  surrounding  them,  and  thus  form  a  net- work  of 
fibers,  which  serves  to  cause  the  blood  to  coagulate  and  make 
hemorrhage  extremely  improbable.  The  retraction  of  the  arteries 
also  causes  a  thickening  of  their  walls,  and  a  distinct  decrease  in 
their  caliber,  thereby  so  narrowing  the  lumen  that  it  is  exceed- 
ingly diflScult  for  blood  to  escape  from  their  divided  ends.  In 
addition  to  this,  there  is  a  general  physiologic  law  that  the  blood 
pressure  is  decreased  whenever  the  blood  is  no  longer  required 
by  the  tissues.  Since  the  function  of  the  umbilic  arteries  has 
ceased,  the  blood  pressure  within  them  becomes  suddenly  de- 
creased . 

Fleming  states  that  hemorrhage  may  take  place  from  these 
arteries  in  the  foal,  because  they  are  firmly  attached  to  the  um- 
bilic ring.  After  repeated  autopsies,  we  have  failed  to  find 
an  instance  where  such  was  the  case,  except  the  umbilic  cord 
had  been  li gated,  and  the  arteries  thereby  held  so  firmly  that 
they  could  not  retract.  In  addition  to  this,  when  the  cord  is 
ligated  it  is  usually  divided  at  an  abnormal  distance  from  the 
umbilic  ring,  so  that  its  retraction  is  difficult.  In  all  foals  which 
we  have  examined,  where  the  navel  cord  had  been  allowed  to 
rupture    normally,    the  arteries  had   promptly  retracted  to  the 


1038  Veterhiary  Obstetrics 

position  shown  in  Fig.  56,  on  page  337.  Fleming  admits  that 
this  retraction  of  the  artery  takes  place  in  the  ruminant.  The 
only  difference,  so  far  as  we  are  able  to  observe,  is  that  the  cord 
of  the  ruminant  is  so  short  that  it  ruptures  during  birth,  and 
ligation  is  consequently  excluded.  In  the  foal,  the  cord  is  very 
long  and  does  not  spontaneously  rupture  so  promptly.  It  con- 
sequently affords  an  opportunity  for  mischief-making  by  at- 
tendants, who  may  so  fix  the  arteries  with  a  ligature  that  they 
cannot  retract. 

Fleming  claims  that  hemorrhage  may  occur  from  the  umbilic 
vein  in  ruminants,  because  of  the  presence  of  the  ductus  venosus, 
although  why  this  should  predispose  the  animal  to  the  accident 
is  not  made  clear.  Zundel  claims  that  in  some  individuals  a 
predisposition  to  umbilic  hemorrhage  exists.  Fleming  alludes 
to  the  possibility  of  hemorrhage  occurring  from  the  umbilic  cord 
when  the  animal  is  several  days  old.  Perhaps  in  this  case  he  is 
dealing  with  secondary  hemorrhage  due  to  an  infection  of  the 
artery,  probably  as  a  result  of  ligation  of  the  cord  without 
proper  antiseptic  precautions.  It  is  claimed  also  that  hemor- 
rhage may  be  caused  by  the  umbilic  cord  rupturing  too  close  to 
the  umbilic  ring,  though  why  this  should  be  so  does  not   appear. 

A  neighboring  veterinary  practitioner  related  a  case  to  us  of 
fatal  umbilic  hemorrhage  in  a  foal,  in  which  case  the  cord  had 
been  ligated  and  later  excised.  So  far  as  could  be  determined,  it 
seemed  that  the  hemorrhage  was  the  indirect  result  of  the  liga- 
tion. The  artery  had  been  caught  and  held  by  the  ligature, 
but,  since  it  was  not  bound  sufficiently  tight  to  prevent  hemor- 
rhage, remained  stretched.  The  blood  pressure  was  probably 
increased  because  of  the  ligation. 

Whatever  the  cause  of  umbilic  hemorrhage,  such  cause  needs 
be  removed  if  possible,  in  order  to  control  the  escape  of  blood. 
If  the  cord  is  too  long,  and  perchance  has  been  ligated,  it  should 
be  divided  at  the  proper  point  by  scraping  or  tearing.  In  the 
foal,  the  point  for  division  is  about  two  to  three  inches  from  the 
umbilic  ring.  After  the  division  of  the  cord,  the  Whartonian 
gelatine  is  to  be  pressed  out  and  the  arteries  permitted  to  retract 
into  the  abdominal  cavity,  when  hemorrhage  must  necessarily 
cease.  If  for  any  reason  the  artery  does  not  retract,  it  should 
be  separated  from  the  surrounding  tissues  and  carefully  ligated 
under  anti.septic   precautions.       Should    hemorrhage    from    the 


Persistent   Urachus  I039 

umbilic  vein  occur,  it  is  advisable  to  search  for  the  vessel  and 
place  a  ligature  about  it.  The  ligation  of  the  cord  itself,  as 
advised  by  some,  is  not  sufficient,  because  the  arteries  or  vein 
may  not  be  included,  as  they  may  have  broken  at  a  point  higher 
than  that  at  which  the  ligature  is  applied.  In  such  cases  liga- 
tion would  tend  to  favor,  rather  than  prevent  the  hemorrhage, 
because  it  would  simply  prevent  the  blood  from  escaping  from 
the  amniotic  covering  of  the  cord,  which  has  been  converted  into 
a  sac  by  the  ligature,  and  must  eventually  become  filled  with 
blood,  causing  the  ligature  to  be  pushed  off. 

In  a  general  way  we  may  best  avoid  umbilic  hemorrhage  hy 
permitting  the  cord  to  rupture  spontaneously,  or  by  rupturing 
it  at  the  proper  point  by  linear  tension,  laceration  or  ecrasement. 
We  should  avoid  dividing  the  cord  by  cutting. 

3.  Persistent  Urachus. 

Prior  to  the  birth  of  the  young  animal,  in  all  those  which 
have  an  allantoic  sac,  the  urinary  bladder  has  two  openings,  one 
posteriorly  through  the  urethra  into  the  amniotic  cavity,  and  the 
other  anteriorly  through  the  umbilic  ring  and  urachus  into  the 
cavity  of  the  allantois. 

At  the  time  of  birth  the  narrow  anterior  canal,  constituting  a 
part  of  the  umbilic  cord,  becomes  ruptured,  and  under  normal 
conditions  behaves  similarly  to  the  umbilic  arteries,  and  retracts 
with,  or  is  retracted  by  the  arteries,  into  the  abdominal  cavity. 
Thereafter  the  urine  can  escape  only  through  the  urethra.  Some- 
what rarely  the  urachus  remains  open  after  birth  ;  how  rarely 
is  not  clear.  We  have  not  personally  observed  this  condition. 
It  is  probably  very  rare. 

A  more  common  condition  is  the  re-opening  of  the  urachus  in 
cases  of  umbilic  infection,  owing  to  a  destruction  of  the  tissue 
which  has  occluded  the  ruptured  end  of  the  canal  at  the  time  of 
birth.  This  condition  we  have  observed  only  in  the  foal.  Flem- 
ing asserts  that  persistent  urachus  is  most  frequently  observed 
in  the  foal,  because  the  vessel  is  closely  attached  to  the  umbilic 
ring  and  does  not  become  retracted.  However,  so  far  as  we 
have  observed,  the  urachus  retracts  promptly  when  the  cord  is 
ruptured,  and  does  not  protrude  beyond  the  umbilicus  except  in 
those  cases  where  the  cord  has  been  ligated  and  then  excised. 


1040  Veterinary  Obstetrics 

Symptoms.  The  symptoms  of  perforate  urachus  may  be 
divided  into  two  groups,  according  to  causes. 

1 .  In  cases  where  the  urachus  is  for  some  reason  abnormally 
open,  or  has  become  in  some  way  abnormally  divided,  or  if  the 
meatus  urinarius  is  constricted  or  absent,  the  young  animal,  in 
urinating,  discharges  a  large  part  or  all  of  the  urine  through  the 
navel.  If  the  urethra  is  closed,  the  entire  amount  must  flow 
through  the  navel  ;  while,  if  the  normal  passage  is  open,  a  part 
of  the  urine  may  flow  from  each  opening. 

2.  When  the  urachus  becomes  secondarily  re-opened,  as  a  con- 
sequence of  umbilic  infection,  the  discharge  of  urine  through  the 
navel  is  not  very  great  in  amount,  but  dribbles  awaj-  or  flows  in 
a  very  small  stream  during  urination,  and  perhaps  oozes  some- 
what continuously  from  the  navel,  keeping  the  region  soiled, 
moist  and  fetid.  In  such  cases  the  navel  is  inflamed,  and  may 
be  swollen,  or  the  patient  may  show  well-defined  symptoms  of 
pyo-septhaemia  or  inflammation  of  the  umbilic  vessels.  In  these 
cases  the  foal  or  other  young  animal  has  remained  apparently 
well  for  some  days  after  birth,  and  no  discharge  of  urine  from 
the  navel  has  been  noted  during  this  period.  After  infection  of 
the  umbilicus  takes  place,  perhaps  three  to  five  days  after  birth, 
the  dribbling  of  urine  from  the  navel  appears.  This  condition  is 
by  no  means  a  rare  one  in  foals,  and  in  our  observation  has  been 
most  frequently  seen  when  the  cord  has  been  ligated  and  cut 
long,  causing  the  stump  to  undergo  putrid  decomposition  and  the 
urachus  to  re-open. 

Handling.  The  method  of  handling  pervious  urachus  must 
be  based  primarily  upon  its  cause.  If  the  opening  is  present  at 
the  time  of  birth,  it  must  be  regarded  as  a  menace  to  the  health 
of  the  patient,  because  it  invites  infection  of  the  umbilicus  by 
keeping  the  stump  of  the  cord  constantly  moist  and  preventing 
its  dessi cation.  If  it  is  due  simply  to  an  abnormally  large  or 
inefficient  urachus,  it  may  be  closed  by  applying  to  the  part 
dessicating  and  astringent  antiseptics,  which,  at  the  same  time, 
guard  the  umbilicus  against  infection. 

If  the  pervious  urachus  is  dependent  upon  an  imperforate 
urethra,  the  urachus  must  on  no  account  be  closed  until  the 
urethra  has  been  satisfactorily  opened,  since  otherwise  a  rupture 
of  the  bladder  or  other  serious  result  must  necessarily  ensue. 

When  the  urachus  becomes  re-opened  as  a   consequence    of 


Retentio7i  of  the  Meconuan  1041 

umbilic  infection,  its  handling  must  necessarily  be  based  upon 
disinfection  of  the  part.  If  we  can  accomplish  the  disinfection 
by  means  of  astringent  remedies,  we  may  aid  materially  in  over- 
coming the  difficulty.  The  prognosis  in  these  cases  must  be, 
based  upon  the  severity  of  the  umbilic  infection,  and  follow  the 
general  prognosis  of  that  malady. 

The  prognosis  of  persistent  urachus,  in  general,  must  be  based 
upon  its  cause.  If  due  to  an  imperforate  urethra,  the  prognosis 
will  be  dependent  upon  the  possibility  of  overcoming  the  urethral 
atresia.  In  one  case,  recently  brought  to  our  notice  by  a  neigh- 
boring practitioner,  the  urachus  was  still  open  in  a  colt  aged  one 
year,  and  efforts  to  close  it  surgically,  failed. 

Retention  of  the  Meconium. 

During  fetal  life  there  accumulates,  in  the  intestinal  tube,  a 
mixture  of  epithelial  debris  and  secretions  from  the  glands  con- 
nected with  the  alimentary  tract,  especially  from  the  liver,  which 
excrement  is  largely  retained  within  the  alimentary  canal  until 
birth,  though  some  of  it  is  frequently  found  floating  in  the  amni- 
otic fluid.  The  appearance  of  meconium,  in  color  and  consis- 
tency, varies  somewhat  according  to  species  and  individual.  It 
usually  varies  in  color  between  yellow  and  a  dark  green  or 
greenish-black.  In  most  new-born  young,  the  meconium  occurs 
as  a  pasty  mass,  but  in  the  foal  it  is  frequently  hard  and  dry, 
and  moulded  into  pellets  by  the  floating  colon  and  rectum. 
The  mass  is  found  chiefly  in  the  rectum  and  floating  colon,  but 
may  occupy  the  entire  large  colon  and  the  caecum. 

Since  the  meconium  in  most  animals  occurs  in  the  form  of  a 
pasty  mass,  it  is  usually  promptly  expelled  by  the  new-born 
without  difficulty,  and  leads  to  no  complications.  In  the  foal, 
where  it  is  hard  and  dry,  it  is  not  infrequently  retained,  and 
may  induce  more  or  less  serious  disease,  which,  if  not  promptly 
and  efficiently  handled,  may  lead  to  the  death  of  the  animal. 

Causes.  Some  claim  that  retention  of  the  meconium  usually 
occurs  in  foals  which  are  weak  or  poorly  developed,  but  this  we 
have  been  unable  to  wholly  corroborate,  and  have  found  it  in 
foals  which  to  all  appearances  were  strong  and  vigorous  at  the 
time  of  birth,  and  would  presumably  have  continued  so  had 
proper  oversight  been  given  them  at  the  time.  In  our  expe- 
66 


1042  Veterinary  Obstetrics 

rience  it  has  appeared  that  retention  of  the  meconium  is  most 
common  in  foals  whose  mothers  have  been  kept  continu- 
ously stabled  and  upon  dry  food  prior  to  parturition.  Mares 
which  are  regularly  exercised,  enjoy  the  freedom  of  the  pasture, 
or  are  judiciously  worked,  as  a  general  rule  give  birth  to  foals 
which  do  not  have  difficulty  from  retained  meconium.  It  has 
been  asserted  that  retention  of  the  meconium  is  usually  caused 
b}'^  the  failure  of  the  young  animal  to  secure  the  colostrum  or 
first  milk,  but  this  cannot  properly  be  held,  since  the  condition 
exists  at  the  time  the  fetus  is  born,  so  that  the  colostrum  could 
only  act  as  a  curative  agent  and  not  as  a  preventive. 

Symptoms.  The  symptoms  of  retention  of  the  meconium 
appear  very  soon  after  birth,  within  10  to  20  hours,  but  may  be 
so  slight  as  to  escape  observation  by  the  owner  until  some  time 
later.  Usually  within  24  hours  after  birth,  very  evident  symp- 
toms of  illness  appear,  consisting  fundamentally  of  intermittent 
colic,  with  the  general  symptoms  of  impaction  of  the  large  colon. 
These  consist  chiefly  of  stretching,  or  standing  in  a  position  of 
extension,  with  the  hind  limbs  extended  far  backward,  the 
anterior  limbs  forward,  and  the  back  depressed  much  as  if  the 
animal  were  attempting  to  urinate  ;  but  the  position  differs  from 
that  attitude  in  that  the  hocks  are  not  flexed  and  that  there  is 
no  real  effort  being  made  to  urinate.  A  close  watch  will  de- 
velop the  fact  that  there  is  straining,  as  if  to  expel  something 
from  the  abdominal  cavity,  but  the  impaction  of  the  hard,  dry 
meconium  in  the  rectum  prevents  its  walls  from  contracting, 
and  hence  the  actions  of  the  foal  are  wanting  in  the  definite 
symptoms  of  an  attempt  at  defecation. 

The  colic  present  may  be  of  any  degree  of  .severity.  Usually 
it  is  quite  mild  at  the  beginning.  The  young  animal  will  look 
at  its  flank  and  kick  at  the  abdomen  with  its  hind  feet,  will  lie 
down  and  roll,  and  show  a  strong  tendency  to  attempt  to  balance 
itself  upon  its  back.  After  lying  for  some  time  it  will  get  up, 
looking  bright,  and  perhaps  go  to  the  teat  and  feed  with  an 
apparently  normal  appetite  for  a  little  time.  It  will  then  let  go 
the  teat  and  resume  its  stretched  condition,  perhaps  standing  in 
this  attitude  for  10  to  20  minutes  at  a  time,  occasionally  looking 
somewhat  anxiously  at  its  flank  ;  it  may  then  lie  down  and  roll 
again.     Thus  the  symptoms  may  change  more  or  less  rapidly 


Rete7ition  of  the  Meconium  1043 

between  the  stretching,  or  rolling  as  in  colic,  and  the  bright 
intervals  when  the  foal  again  sucks. 

In  one  instance  observed  by  us,  in  addition  to  these  general 
symptoms  there  was  a  morbid  appetite,  which  led  the  young  foal 
to  devour  quantities  of  hay  and  straw,  which  added  very  much 
to  the  intestinal  obstruction. 

The  symptoms  above  related  are  characteristic,  and  in  them- 
selves are  well-nigh  diagnostic,  especially  the  peculiar  stretching 
with  the  dropping  of  the  back  when  the  animal  is  standing.  In 
almost  all  cases  the  diagnosis  can  be  readily  and  completely  veri- 
fied by  inserting  the  index  finger  into  the  anus,  where  the  hard 
pellets  of  meconium  are  readily  felt  and  recognized. 

In  foals,  especially  those  of  value,  the  caretaker  should  observe 
the  new-born  animal  closely,  and  see  that  the  meconium  is  ex- 
pelled within  an  hour.  Should  such  expulsion  not  occur,  the 
caretaker  should  at  once  take  measures  to  bring  it  about.  The 
best  means  for  this  is  enemas  of  warm  water,  to  which  some  soda 
bicarbonate  or  i  %  of  common  salt  has  been  added.  Solutions 
of  soap  or  other  irritants  should  be  carefully  avoided,  as  they 
cause  straining  by  the  pain  which  they  induce.  It  is  not  strain- 
ing that  we  wish  to  accomplish  by  the  enema.  Instead,  it  is  de- 
sired to  soften  and  macerate  the  dry  pellets  so  that  they  will  be 
easily  expelled,  and  to  this  end  it  is  important  that  only  a  small 
amount  of  a  bland  liquid  shall  be  gently  introduced  into  the 
rectum  at  a  given  time.  We  have  usually  found  that  one  pint 
of  the  liquid  at  a  time  is  ample,  and  sometimes  even  less  should 
be  used.  The  amount  should  be  so  gauged  that  the  little  patient 
will  not  throw  it  out  immediately,  but  that  it  will  remain  in  the 
rectum  for  some  time  in  order  to  accomplish  the  maceration 
desired. 

Care  should  be  taken,  in  administering  enemas,  to  avoid  in- 
juring the  anus  or  rectum.  It  is  especially  desirable  to  avoid 
using  a  large  metallic  or  wooden  nozzle  upon  a  syringe,  because 
when  the  intestine  is  so  firmly  impacted  with  dry  pellets  of  me- 
conium there  is  constant  and  serious  danger  of  the  rigid  nozzle 
gliding  to  one  side  and  rupturing  the  intestinal  wall,  inducing  a 
fatal  lesion.  It  is  preferable  to  use  some  other  apparatus  than 
the  ordinary  enema  syringe.  A  very  convenient  implement  is 
the  ordinary  bulb  syringe,  or  the  fountain  syringe  used  in  house- 
holds.    Sometimes  it  is  desirable  to  introduce  the  enema  deeply 


I044  Veterinary  Obstetrics 

into  the  intestine.  For  this  purpose  an  ordinary  soft  rubber 
horse  catheter  ma}^  be  passed  into  the  intestine  as  far  as  possible, 
and  the  end  fitted  upon  a  syringe,  or  a  small  funnel  may  be  in- 
serted into  the  catheter  and  elevated  sufficiently  that  fluid  poured 
into  the  funnel  will  gravitate  into  the  intestine.  If  the  catheter 
is  used,  it  may  be  po.ssible  to  pa.ss  it  gently  along  the  wall 
of  the  intestine,  and,  by  keeping  the  fluid  flowing  through  it, 
to  push  it  beyond  the  pellets  of  meconium,  .so  that  the  fluid  is 
depo.sited  behind  them,  insuring  their  being  forced  out  at  the 
first  expulsive  effort.  In  some  cases  we  have  supplanted  the 
normal  salt  solution  or  soda  bicarbonate  .solution  with  warm  cot- 
ton seed,  olive,  or  raw  lin.seed,  oil. 

Complementary  to  the  enema  it  may  be  advisable  to  admin- 
ister cathartics.  The  choice  of  cathartics  may  vary  with  cir- 
cumstances. If  the  case  does  not  seem  at  all  urgent,  a  bland  oil 
is  the  best.  An  ordinary  foal  may  be  given  2  ounces  of  castor  oil, 
or  4-ounce  doses  of  raw  linseed,  cotton  seed,  or  olive,  oil.  In 
other  instances  the  practitioner  may  not  feel  disposed  to  await 
the  slow  action  of  oil,  and  may  resort  instead  to  the  hypodermic 
cathartics  in  small  doses,  such  as  eserine  sulphate  or  arecoline 
in  do.ses  of  1-20  to  1-12  grain,  which  may  be  repeated  in  30  to  45 
minutes. 

But  with  all  this  treatment,  if  the  case  has  been  neglected,  it 
may  be  impo.ssible  to  dislodge  the  pellets.  They  may  be  tightly 
impacted  for  a  considerable  distance  along  the  rectum  and  float- 
ing colon.  In  one  neglected  case  in  our  clinic,  we  could  recog- 
nize the  pellets  of  meconium,  which  completely  blocked  the  rectum, 
at  a  distance  of  12  inches  from  the  anus.  The  hard  pellets  could 
be  clearly  felt  with  an  ordinary  gum  horse  catheter.  The  liquids 
injected  directly  against  the  obstruction  were  all  to  no  purpose. 
Eserine  failed  to  cause  the  expulsion  of  the  meconium.  The 
foal  eventually  perished,  apparently  from  toxaemia,  .since  there 
was  no  enteritis  present  upon  post-mortem  examination.  The 
conditions  presenting  them.selves  upon  post-mortem  examination, 
in  this  one  case,  suggested  that,  had  we  performed  laparotomy 
and  grasped  the  intestine,  the  pellets  of  meconium  could  have 
been  pushed  backward  and  finally  forced  out,  or  the  intestine 
might  have  been  opened  and  the  pellets  thus  removed.  But,  in 
our  experience,  if  the  case  has  prompt  attention  no  such  opera- 
tion is  demanded,  and  ordinarily  the  case  is  easily  handled. 


Retention  of  the  Meconium  1045 

Some  practitioners  have  devised  and  recommended  meconium 
extractors,  such  as  shown  in  Fig.  150,  with  which  they  have 
claimed  good  results.  In  default  of  these,  a  wire  loop  could  be 
tried.  We  have  observed  but  the  one  case  which  could  not  be 
relieved  by  enemas  and  oil. 

Fig.  150. 
Meconium  Extractors. 

a,  Meconium    extractor  of  Masch. 

b,  Meconium  extractor  of  Mensik- 
Babolna. 

In  the  handling  of  retention  of  the  meconium,  it  is  important 
always  to  determine  when  the  difficulty  has  been  fully  and  com- 
pletely surmounted.  The  expulsion  of  more  or  less  meconium 
does  not  indicate  that  the  difficulty  has  been  completely  overcome. 
The  full  accomplishment  of  the  object  has  been  only  certainly 
attained  when  all  the  pellets  have  come  away  and  there  has  been 
expelled  some  soft,  pasty  meconium.  Whether  looking  at  the 
affection  from  a  preventive  or  a  curative  standpoint,  our  efforts 
should  not  be  relaxed  until  we  are  fully  assured  that  all  pellets 
of  meconium  have  been  expelled. 


ANATOMICAL  DEFECTS  OF  THE  NEW-BORN. 

In  tracing  the  history  of  the  development  of  the  embryo  and 
fetus,  we  have  had  occasion  to  remark  the  occurrence  of  devia- 
tions from  the  normal  course  of  development,  which  serve  to 
render  the  animal  abnormal  at  the  time  of  birth.  In  many  of 
these  cases  the  aberration  from  the  normal  is  so  great  as  to  cause 
what  are  known  as  monstrosities,  in  which  case  the  young  ani- 
mals are  born  so  faultily  developed  that  they  usually  perish  im- 
mediately, or  if  they  live,  the  deformity  renders  them  useless, 
and  they  are  consequentl}^  destroyed.  The  consideration  of 
these  belongs  to  the  domain  of  teratology,  and,  as  such,  are  of 
very  great  scientific  interest. 

Quite  frequently  there  exist,  in  new-born  animals,  various 
deviations  from  the  normal,  insufficient  to  immediately  com- 
promise life,  which  may  be  spontaneously  overcome,  may  be  cur- 
able by  surgical  procedure,  or  may  persist,  and  the  animal  yet  be 
able  to  perform  its  functions  without  very   great  inconvenience. 

This  group  of  minor  deviations  should  be  dul}^  considered  at 
the  time  of  the  birth,  and  handled  according  to  the  outlook 
for  the  ultimate  value  of  the  defective  animal.  It  .should  be 
determined  whether,  by  any  means,  the  defect  can  be  over- 
come, and  to  what  extent  its  persistence  will  destroy  the  use- 
fulness of  the  animal.  If  it  is  irremediable,  and  its  persistence 
destroys  the  value  of  the  animal,  it  is  highly  important,  in  the 
interests  of  economy,  that  the  patient  should  be  at  once  destroyed. 
Still  more  important  is  the  relation  of  these  defects  to  the  ques- 
tion of  hereditary  transmis.sion.  The  majority  of  them  tend 
strongly  to  become  fixed  as  hereditary  defects.  Such  animals 
.show  a  constant  tendency  to  reproduce  their  own  defects  in  their 
progen}',  even  though  artificially  or  .spontaneously  cured.  Such 
animals  are  consequently  unsuitable  for  breeding  purposes. 

The.se  defects  accordingly  assume  a  highly  important  place  in 
the  breeding  of  animals,  whether  viewed  from  the  standpoint  of 
surgery  or  of  zootechnics. 

I.  Umbilic  Hernia. 
ExoMPHALus.     Omphalocele.     Navel  Hernia. 

Umbilic  Hernia  consi.sts  of  the  non-closure  of  the  umbilic  ring 
in  the  abdominal  floor,  while   the  skin  closes  over  the  region  in 
1046 


Lhnbilic  Hernia  1047 

the  normal  manner.  In  tracing  the  development  of  the  embryo 
on  page  558,  we  noted  that  the  somatopleur  folds  ventralwards 
and  finally  unites  upon  the  median  line,  to  constitute  the  um- 
bilicus, through  which  normally  pass  the  allantoic  stalk,  in- 
cluding the  allantoic  or  umbilic  arteries  and  veins,  the  urachus, 
and  the  yolk  stalk,  surrounded  by  the  amnion. 

During  the  earlier  periods  of  fetal  life,  the  abdominal  cavity 
is  comparativel}'  small,  while  the  abdominal  viscera  are  so  volu- 
minous that  there  is  not  sufficient  room  within  the  cavity  to  ac- 
commodate them.  They  consequently  press,  or  grow  outward 
through  the  wide  umbilic  ring  into  the  navel  cord,  so  that,  in 
fetuses  of  an  early  age,  a  large  part  of  the  intestinal  mass, 
omentum,  and  liver,  may  lie  outside  the  abdominal  cavity,  lodged 
in  the  umbilic  cord.  As  the  fetus  develops  and  approaches  ma- 
turity, the  abdominal  cavity  increases  in  size,  while  the  umbilic 
ring  gradually  contracts,  until  finally  the  opening  becomes 
virtually  occluded  and  the  margins  of  the  ring  adhere  closely  to 
the  umbilic  vessels.  For  reasons  unknown  to  us,  the  normal 
closure  of  the  umbilic  ring  may  not  occur,  and  when  the  young 
animal  is  born  there  persists  a  variable-sized  opening  through 
the  abdominal  floor,  usually  elongated  from  before  to  behind  as 
an  oval  .slit,  wider  at  the  anterior  end.  In  some  cases  the  open- 
ing is  almost  circular  in  form.  The  diameter  of  the  opening  may 
vary  from  so  small  a  size  as  to  be  barely  distinguishable,  up  to 
six  or  eight  inches.    The  resulting  hernial  sac  corresponds  in  size. 

The  defect  may  be  present  in  any  species  of  domestic  animals, 
though  it  attracts  the  most  attention,  and  perhaps  is  most  fre- 
quent, in  foals,  pigs  and  puppies. 

Some  writers  recognize  a  congenital  and  acquired  umbilic 
hernia.  Only  the  congenital  defect  is  of  interest  to  us.  Some 
writers  have  claimed  that  an  acquired  or  accidental  umbilic 
hernia  may  be  caused  by  severe  muscular  exertion  of  the  new- 
born animal,  in  running  or  plaj'ing,  but  we  find  no  records  of 
cases  in  our  literature  to  substantiate  the  correctness  of  such  a 
view,  and  have  not  observed  such  an  occurrence  in  actual  practice. 
We  have  observed  from  time  to  time  that  umbilic  herniae,  which 
were  comparatively  inconspicuous  at  the  time  of  the  birth  of  the 
young  animal,  later  became  more  conspicuous,  and  were  in- 
creased in  size  to  such  a  degree  as  to  attract  attention.  When 
umbilic  hernia  exists  at  the  time  of  the  birth,  anything  which 


104.8  Veterinary  Obstetrics 

may  increase  the  intra-abdominal  pressure,  such  as  severe  ex- 
pulsive efforts  due  to  the  retention  of  the  meconium,  or  to  con- 
stipation of  the  bowels,  may  cause  a  marked  increase  in  the  size 
of  the  hernial  sac.  The  same  increase  in  size  may  be  caused  by 
the  allowance  of  large  quantities  of  bulky  food. 

Fleming  cites  Zundel  and  others  in  support  of  his  belief  that 
environment,  and  especially  the  character  of  food,  tends  to  in- 
duce the  disease.  He  believes  that  the  young  of  animals  kept 
upon  low  and  marshy  pastures,  or  subsisting  upon  soft,  luxuriant 
herbage  during  a  rainy  season,  are  especially  subject  to  hernise. 

The  majority  of  writers,  with  whom  we  are  in  full  accord, 
consider  the  defect  to  be  chiefly  hereditary.  We  have  repeatedly 
observed  the  strong  hereditary  tendency  of  this  defect.  In  one 
instance  a  client  purchased  an  imported  French  draft  stallion 
for  service  in  a  valuable  stud  of  pedigreed  draft  mares,  in  the 
progeny  of  which,  umbilic  hernia  had  previously  been  unknown. 
The  first  crop  of  foals  showed  about  50%  of  umbilic  herniae.  The 
stallion  was  promptly  sold,  and  umbilic  hernia  did  not  recur  the 
following  sea.son  or  thereafter.  We  have  noted  the  same  heredi- 
tary tendency  among  swine,  where  a  farmer  has  been  careless  in 
the  selection  of  his  breeding  animals.  In  some  cases  we  have 
observed  an  entire  litter  of  pigs  affected  with  herniae.  It  is  in- 
teresting to  note  that,  in  the  pig  at  least,  umbilic  and  scrotal 
hernia  seem  to  be  interchangeable,  so  that,  in  a  given  litter  of 
pigs,  males  may  suffer  from  scrotal  or  umbilic  hernia  indiffer- 
ently, or  even  from  both,  while  the  females  show  only  the 
umbilic  defect. 

Symptoms.  There  is  present,  at  the  umbilicus,  a  tumor, 
which  may  be  either  spherical  or  pyriform  or  may  be  more  or 
less  elongated  from  before  to  behind.  The  size  of  the  hernial 
ring  varies  greatly  according  to  species  and  individual.  In  the 
puppy  it  may  be  ^  to  i  inch  in  diameter  ;  in  the  foal  i  to  6 
inches  in  diameter. 

The  character  of  the  tumor,  as  revealed  by  palpation,  neces- 
sarily depends  upon  the  contents  of  the  hernial  sac,  and  the 
question  of  their  incarceration  or  freedom  to  return  into  the  ab- 
dominal cavity.  The  contents  of  the  hernial  sac  usually  consist 
of  portions  of  intestine  containing  liquid  feces,  or  of  portions  of 
the  omentum.  Except  these  become  incarcerated,  a  soft,  fluctu- 
ating tumor  results,  which  is  usually  readily  pushed  upward  into 


Utnbi/ic  Hernia  1049 

the  abdominal  cavity,  rendering  the  hernial  ring  easily  recog- 
nizable by  palpation.  Usually  there  is  no  pain  upon  pressure  or 
manipulation.  If  the  young  animal  is  turned  upon  its  back, 
the  tumor  usually  disappears  spontaneously.  If  the  animal  is 
caused  to  struggle,  or  its  nostrils  be  closed  for  a  time  so  as  to 
cause  severe  respirator}'  effort,  or  it  is  made  to  cough,  the  hernia 
temporarily  increases  in  size. 

In  some  cases  the  intestine  occupying  the  hernial  sac  may 
contain  hard,  firm  masses  of  feces,  which  render  the  hernia  hard 
and  firm.  Such  fecal  matter  is  not  readily  pushed  through 
the  ring  into  the  abdominal  cavity. 

The  contents  of  the  hernia  may  become  incarcerated  or  strangu- 
lated, and  induce  thereby  symptoms  differing  very  materially 
from  those  which  have  already  been  described.  If  the  hernial 
contents  consist  of  intestines,  and  strangulation  occurs,  the 
tumor  at  once  becomes  very  tense  and  hard,  and  is  more  or  less 
enlarged  as  compared  with  its  previous  condition,  and  the  animal 
shows  severe  pain,  expressed  by  violent  colic.  The  hernia  may 
also  be  sensitive  to  the  touch. 

When  the  hernial  contents  consist  of  omentum,  and  it  becomes 
incarcerated,  the  tumor  becomes  tense  and  indolent,  cannot  be 
reduced,  and  induces  no  pain  upon  palpation. 

Diagnosis.  Though  umbilic  hernia  is  not  liable  to  become 
mistaken  for  other  diseases,  it  should  be  borne  in  mind  that  there 
are  possibilities  of  error  in  diagnosis.  In  one  instance  we  at- 
tended an  umbilic  hernia  complicated  by  the  presence  of  umbilic 
fistula  from  infection  at  the  time  of  birth.  The  enlargement 
present  was  attributed  to  the  chronic  infection  alone.  In  opening 
the  fistula  we  punctured  the  peritoneal  wall  of  a  small  hernial 
sac,  and  caused  a  prolapse  of  the  omentum.  Abscesses  may 
occur  at  the  navel  as  a  result  of  infection,  and  may  lead  to  diag- 
nosis of  hernia,  but  the  abscess  is  irreducible,  and  may  readily  be 
tested,  in  cases  of  doubt,  by  aspirating  with  a  hypodermic  syringe. 
It  is  virtually  impossible  to  differentiate  between  an  uncompli- 
cated hernia  of  the  intestines  and  hernia  of  the  omentum  ;  nor  is 
the  differentiation  of  any  great  practical  value.  Strangulated 
umbilic  hernia  of  the  intestines  is  recognized  by  the  hernial  colic, 
the  irreducibility  of  the  hernia,  and  the  firm,  hard  character  of 
the  tumor.      Incarcerated  umbilic  hernia  of  the  omentum,  occur- 


1050  Veterinary  Obstetrics 

ring  chiefly  in  pigs,  is  recognized  by  the  firm,  irreducible 
tumor,  unaccompanied  by  inflammation  or  pain. 

Prognosis.  The  prognosis  of  umbilic  hernia  is  favorable. 
Many  cases,  especially  small  herniae  in  foals,  recover  spontane- 
ously, and  the  others  may  be  surgically  overcome  with  compara- 
tive certainty  and  safety.  If  left  undisturbed,  umbilic  hernise 
rarely  become  incarcerated  or  otherwise  interfere  with  the  well- 
being  of  the  animal.  If  the  hernial  ring  is  small,  when  the 
animal  develops  and  the  intestines  increase  in  size,  they  can  not 
pass  through  the  opening.  If  the  hernial  contents  consist  of  omen- 
tum, when  the  animal  grows  older,  the  omental  expanse  becomes 
comparatively  retracted  and  no  longer  reaches  the  open  umbilic 
ring.  Although  the  ring  may  persist  throughout  the  life  of  the 
animal,  the  hernial  sac  no  longer  becomes  filled  and  is  not  notice- 
able. The  greatest  loss  attributable  to  the  defect,  is  the  de- 
creased value  of  pedigreed  animals  for  breeding  purposes,  because 
of  the  well-marked  tendency  to  transmission. 

Treatment.  Umbilic  herniae  in  young  animals  disappear 
spontaneously  so  often  that,  in  all  cases  where  the  hernial  ring 
is  very  small,  an  opportunity  should  be  given  for  a  spontaneous 
recovery.  However,  when  the  hernial  ring  is  large,  such  a  re- 
sult cannot  be  reasonably  anticipated,  and  it  becomes  desirable  to 
use  some  means  for  overcoming  the  defect,  except  in  those 
cases  where  the  animals  are  intended  for  early  slaughter,  where 
handling  may  well  be  ignored  in  most  instances.  Before  under- 
taking any  operative  treatment,  it  is  desirable  that  the  young 
animal  shall  have  acquired  some  age  and  considerable  vigor.  It 
is  generally  preferable  to  postpone  a  radical  operation  until  the 
animal  is  two  to  four  months  of  age.  However,  it  .should  not  be 
too  long  delayed,  because  as  the  animal  grows  larger  it  is  some- 
what more  difficult  to  handle.  When  fatalities  from  an  opera- 
tion occur,  the  loss  becomes  greater  to  the  owner  in  proportion  to 
the  age  of  the  animal.      The  chief  plans  of  handling  include  : 

a.  Bandages.  Many  writers  have  advised  the  application  of 
a  bandage  or  truss  for  the  cure  of  umbilic  hernia,  apparently 
somewhat  in  imitation  of  the  human  surgeon.  For  this  purpose 
a  wide  girth  or  surcingle  is  applied  about  the  body,  over  the 
umbilic  ring,  and  maintained  in  position  by  straps  or  bands.  In 
a  general  way  these  bandages  are  similar  to  the  Sohnle  appara- 
tus,  Fig.    149,   page   1019.      One  or  more  straps  pass    forward 


Urnbilic  Herjiia  1051 

between  the  fore  legs,  and  are  attached  to  a  band  about  the  neck. 
Along  the  back,  the  position  of  the  bandage  is  maintained  by 
a  back-strap,  which  extends  forward  to  the  neck-band,  and  back- 
ward to  terminate  in  a  crupper.  Bandages  or  trusses  are  con- 
structed in  great  variety,  but  they  all  depend  upon  the  common 
principle  of  compression  of  the  umbilicus  in  such  a  manner  as  to 
push  the  intestines  upward,  toward  or  into  the  abdominal  cavity, 
assuming  that,  in  the  meantime,  the  hernial  ring  will  close  and 
retain  them  there. 

Those  who  recommend  a  truss  claim  that  it  requires  from  two 
to  three  months  to  effect  a  cure.  Even  then  it  is  not  perfectly 
clear  that  a  large  proportion  of  the  alleged  cures  may  not  have 
taken  place  spontaneously.  It  is  to  be  constantly  remembered 
that  the  truss  or  bandage  cannot  keep  the  intestine  or  other 
hernial  contents  within  the  abdominal  cavity,  but  can  only  press 
them  upward  as  far  as  the  bandage  pushes  the  walls  of  the  hernial 
sac,  leaving  the  hernial  contents  lying  in  the  hernial  ring.  This 
tends  to  keep  the  ring  open.  If  there  is  a  projection  upon  the 
bandage,  by  which  means  the  contents  are  pushed  up  into  the 
abdominal  cavity  completely,  the  projecting  portion  of  the  ap- 
paratus is  pushed  into  the  hernial  ring,  and,  in  its  turn,  keeps  it 
open  and  prevents  healing. 

Serious  objections  to  the  truss  are  its  expense,  when  well  con- 
tructed,  and  the  long  period  of  time  during  which  it  must  be 
kept  applied  in  order  that  it  may  induce  a  cure.  The  apparatus 
requires  much  careful  watching  and  oversight  on  the  part  of  the 
owner  of  the  animal,  since  it  needs  be  readjusted  frequently,  be- 
cause the  abdomen  is  constantl}^  changing  in  size  according  to  the 
amount  of  food  taken.  A  very  formidable  objection,  also,  is  the 
question  of  injury  and  annoyance  to  the  young  animal.  Its  skin 
is  tender,  and  great  care  is  necessary  to  avoid  galling  and  other 
injuries  from  pressure  or  friction. 

It  must  be  constantly  borne  in  mind  that  the  veterinarian  has 
no  such  opportunity  for  the  efficient  application  of  the  truss  as 
has  the  human  obstetrist.  The  patient  of  the  veterinarian  either 
stands  with  the  body  horizontal,  with  the  entire  intestinal  mass 
resting  directly  upon  the  hernial  ring  ;  or,  when  lying  down,  it 
usually  remains  in  the  sternal  position  with  the  weight  of  the  in- 
testines still  upon  the  defective  part.  The  human  practitioner 
may  keep  his  patient  constantly  upon  the  back,  so  that  the  ab- 


1052  Veterinary  Obstetrics 

dominal  viscera  do  not  bear  upon  the  part.  When  the  hernial 
ring  is  very  large,  hope  of  a  cure,  through  the  agency  of  a  band- 
age, is  virtually  excluded  from  the  first. 

b.  Topical  applications  have  been  used  for  decades,  for  the 
cure  of  umbilic  hernia.  Various  substances  have  been  used  for 
this  purpose,  among  which  may  be  prominently  mentioned  the 
application  of  the  mineral  acids,  either  sulphuric  or  nitric.  The 
intent  is  to  cause  dry  gangrene  of  the  skin  and  hernial  sac  by  the 
application  of  the  acid  thereto  ;  and,  by  causing  an  intense  local 
inflammation  with  much  swelling,  to  induce  closure  of  the  hernial 
ring.  For  this  purpose,  sulphuric  or  nitric  acid  is  applied  over 
the  hernial  .sac,  by  means  of  a  glass  rod,  until  the  skin  has  been 
well  saturated  and  an  extensive  necrosis  of  the  tissues  is  assured. 
Prior  to  the  application  of  the  acid  to  the  skin,  the  hernial  sac 
may  be  shaved  or  clipped.  The  acid  needs  be  applied  quite  lib- 
erally, in  order  that  the  death  of  the  skin  shall  be  complete  and 
the  resulting  swelling  extensive  ;  otherwise  a  cure  is  not  certain, 
or  even  probable.  I^afosse  recommends  the  use  of  24  to  32 
grammes  of  nitric  acid,  applied  over  the  whole  surface  of  the 
hernial  sac,  followed  by  friction,  to  be  continued  for  three  to 
five  minutes.  The  nitric  acid  usually  needs  be  applied  but  once 
in  order  to  produce  the  desired  result,  but,  if  the  first  application 
fails,  it  may  be  reapplied  in  about  15  days. 

Zundel  highly  recommends  this  plan,  although  he  admits  that 
it  is  sometimes  followed  by  accidents,  the  most  serious  of  which 
is  an  extensive  sloughing  of  the  hernial  walls,  which  finally  in- 
volves the  peritoneum  and  permits  the  intestines  to  become  pro- 
lapsed through  the  opening.  Reynal  has  seen  peritonitis  follow- 
ing nitric  acid  cauterization,  and  Lafosse  has  observed  tetanus  as 
a  result.  Hertwig  prefers  sulphuric  to  nitric  acid,  and  applies  it 
in  lines  with  a  glass  rod,  twice  daily  until  four  applications  are 
made.  He  sometimes  added  an  application  of  turpentine  and  oil 
to  the  part,  in  order  to  increase  the  amount  of  swelling  and  edema. 

Other  irritants  have  been  used  and  recommended  in  the  treat- 
ment of  this  defect.  Like  the  mineral  acids,  they  are  intended 
to  induce  an  intense  local  inflammation  and  swelling,  by  which 
means  it  is  hoped  to  block  up  the  open  umbilic  ring.  Blisters  of 
various  kinds  act  in  this  way.  Some  veterinarians  have  prac- 
ticed hypodermic  injections  into  the  walls  of  the  hernial  sac, 
near  to  the   hernial  ring,  of  irritants  of  various  kinds,  such  as 


I'mbilic  Hernia  1053 

oil  of  mustard,  concentrated  solutions  of  salt,  and  spirits  of  tur- 
pentine. Great  care  should  be  taken  not  to  inject  the  irritants 
into  the  peritoneal  cavity,  as  such  an  error  would  be  exceedingly 
dangerous. 

c.  Ligation.  In  umbilic  hernia,  where  the  ring  is  very 
large,  there  is  little  if  any  hope  of  succeeding  by  either  of  the 
previous  methods.  Consequently  some  method  must  be  applied 
for  bringing  the  margins  of  the  hernial  ring  into  close  apposition, 
and  retaining  them  in  contact  until  they  become  adherent.  This 
usually  involves  the  destruction  of  the  hernial  sac.  Numerous 
methods  have  been  introduced  for  bringing  this  about,  one  of  the 
oldest  and  crudest  of  which  is  the  ligation  of  the  entire  hernial  sac 
at  its  base,  so  tightly  as  to  cause  its  death  and  sloughing  away. 
Such,  a  ligature,  if  w^ell  applied,  decreases  greatly  or  closes  the 
hernial  ring,  by  the  tension  exerted  upon  the  walls  of  the  hernial 
sac  and  the  surrounding  tissues.  For  the  application  of  such  a 
ligature,  the  patient  is  secured  upon  its  back,  and  the  hernial  sac 
is  firmly  grasped.  After  the  contents  have  been  safely  returned 
into  the  abdominal  cavity,  the  sac  is  drawn  up  tightly,  and  the 
neighboring  skin  and  skin  muscle  are  brought  together  in  such 
a  manner  as  to  tend  to  draw  the  margins  of  the  umbilic  ring 
nearer  to  each  other.  Then,  around  the  base  of  the  hernial  sac, 
a  stout  ligature  is  tighty  applied.  The  ligature  may  consist  of  a 
strong  silk  or  linen  cord,  in  harmony  with  the  size  of  the  hernia, 
or  of  an  elastic  ligature  which  ma}'  act  more  promptly  than  the 
others.  The  latter  does  not  need  tightening,  because  its  elasticity 
causes  a  continuous  compression  until  the  tissues  become  des- 
troyed and  the  sac  sloughs  away.  If  there  should  appear  to  be 
any  doubt  about  the  security  of  the  ligature,  a  suture  or  a 
skewer  may  be  passed  through  the  hernial  sac  below  it,  and  any 
danger  from  its  slipping  thus  obviated. 

The  results  from  ligatures  have  not  generally  been  satisfac- 
tory, and  the  method  has  largely  fallen  into  disuse.  They  are 
uncertain  in  their  action  ;  they  may  cause  a  very  tardy  slough  ; 
the  hernia  may  reform  before  the  sac  is  completely  destroyed  ;  or 
a  very  rapid  necrosis  may  occur,  resulting  in  prolapse. 

d.  Clamps  have  been  recommended  verj'  highly,  by  some 
practitioners,  in  the  treatment  of  umbilic  hernia.  They  do  not 
differ  materially,  in  their  general  character,  from  the  clamps 
used  in  castration,  and  their  application  is  upon  a  similar  princi- 


I054  Veteri7iary  Obstetrics 

pie.  Various  types  of  clamps  are  listed  by  veterinary  instru- 
ment makers,  based  upon  the  recommendation  of  practitioners 
who  have  used  them  and  found  them  satisfactory  ;  but  no  one 
possesses  any  special  advantage,  and  the  practitioner  may  readily 
make  clamps  from  a  stick  of  wood  which  will  answer  all  essential 
purposes.  The  clamps  are  applied  essentiallj^  the  same  as  the 
ligature.  The  animal  is  secured  upon  its  back  ;  the  contents  of 
the  hernial  sac  returned  into  the  abdomen ;  the  sac  firmly 
grasped  ;  and  the  clamps  applied  antero-posteriorly,  as  close  to  the 
abdomen  as  possible,  and  fixed  very  tightly  so  as  to  cut  off  the 
circulation  from  the  sac  and  cause  its  death. 

Two  dangers  confront  the  practitioner  in  the  use  of  clamps. 
Some  have  found  that,  as  with  the  ligature,  the  clamps  may 
cause  a  very  rapid  gangrene,  with  consequent  early  sloughing 
and  protrusion  of  the  intestines.  In  our  own  experience  we  have 
found  the  clamps  inefficient.  After  having  applied  them  as  close 
to  the  abdominal  floor  as  possible,  and  secured  them  very  tightly, 
we  succeeded  in  producing  necrosis  and  the  destruction  of  the 
entire  hernial  sac.  However,  while  this  was  going  on  the  intes- 
tines were  constantly  pressing  through  the  hernial  ring,  so  that, 
when  the  sac,  which  had  been  included  between  the  clamps,  had 
completely  sloughed  off,  it  was  found,  to  our  disappointment,  that 
the  weight  of  the  intestines  from  above  had  pushed  the  skin  down- 
ward and  a  new  hernial  sac  had  formed,  which,  though  somewhat 
less  in  size,  was  just  as  objectionable  as  the  original  defect  and 
required  further  surgical  attention. 

If  clamps  are  to  be  applied,  the  operation  should  be  carried  out 
under  antiseptic  precautions,  the  area  shaved  and  disinfected,  and 
either  general  or  local  anaesthesia  induced.  The  hernial  sac  is  to 
be  grasped,  drawn  out  as  far  as  possible,  and  the  clamps  applied 
close  to  the  ring,  including  all  the  tissues  which  can  be  drawn 
into  them.  The  clamps  are  then  to  be  closed  by  means  of  forceps, 
and  secured  with  a  cord.  An  abundance  of  antiseptic  cotton 
or  gauze  is  then  to  be  packed  about  the  clamps  and  over  the  in- 
carcerated sac,  and  over  this  a  strong  bandage  is  to  be  placed,  and 
well  secured  in  position  in  such  a  manner  that  it  will  hold  the 
clamps  tightly  against  the  umbilic  ring.  By  so  doing,  the  hernial 
sac  is  held  against  the  ring,  and  the  inflammation  caused  by  the 
necrosis  of  the  sac  induces  inflammatory  adhesion  and  closure  of 
the  hernial  ring. 


Umbilic  Heryiia  I055 

Strict  antisepsis  should  be  maintained,  and  the  necrotic  hernial 
sac  prevented  from  decomposing  or  becoming  harmfully  infected. 
Usually  the  necrotic  sac  drops  away  within  seven  to  ten  days. 
The  atresia  of  the  hernial  ring  may  be  furthered  and  rendered 
more  secure  by  the  continuance  of  the  supporting  antiseptic 
bandage  for  a  few  days  after  the  necrotic  sac  has  dropped  away. 

e.  Sutures  constitute  the  most  radical,  and,  in  our  hands,  the 
most  satisfactory  method  for  handling  umbilic  hernia.  The 
sutures  may  be  applied  by  a  great  variety  of  methods. 

In  very  large  hernise  it  is  best  to  open  the  hernial  sac  freely, 
under  general  anaesthesia  and  strict  asepsis,  and,  after  denuding 
the  margins  of  the  hernial  ring,  to  pass  strong  sutures  through 
the  margins  of  the  ring  and  forcibly  draw  them  together.  In 
one  instance  in  our  clinic,  a  ^^earling  filly  had  an  umbilic  hernia, 
the  oblong  ring  of  which  measured  approximately  4  by  8  inches. 
The  animal  was  secured  in  the  dorsal  position  upon  the  table, 
and  anesthetized.  With  the  aid  of  two  assistants,  the  hernial 
sac  was  opened  from  end  to  end  under  strict  aseptic  precau- 
tions. By  means  of  a  strong  needle,  sutures  were  passed  through 
the  skin  and  other  tissues  into  the  muscular  walls  of  the  abdo- 
men, and  then  carried  across  from  one  margin  of  the  ring  to  the 
point  opposite,  where  they  were  finally  brought  out  through  the 
skin  on  the  opposite  side,  some  distance  from  the  margin  of  the 
hernial  ring.  The  suture  was  then  returned  in  the  opposite  di- 
rection, at  a  distance  of  about  ^  inch,  a  piece  of  rubber  tubing 
passed  between  the  closed  end  and  the  skin,  and  a  second  piece 
of  tubing  laid  between  the  two  free  ends,  which  were  now  tied 
and  drawn  sufficiently  tight  to  bring  the  two  margins  of  the  ring 
into  immediate  contact. 

A  series  of  these  sutures  was  applied,  sufficient  in  number  to 
thoroughly  close  the  entire  hernial  ring  from  end  to  end,  thus 
constituting  essentially  a  quilled  suture.  The  hernial  sac  was 
excised,  and  the  margins  of  the  skin  brought  together  by  ordi- 
nary interrupted  sutures.  A  broad  bandage  was  then  passed 
around  the  body  of  the  filly,  and  a  large  antiseptic  pad  securely 
attached  to  it,  pressing  upon  the  operative  area.  The  pad  of 
absorbent  cotton  was  saturated  several  times  daily  with  i-iooo 
corrosive  sublimate  solution.  There  was  little  reaction  from  the 
operation,    and   the  suppuration   in    the    wound   was   trivial   in 


1056  Veterinary  Obstetrics 

amount.  After  about  two  weeks  the  sutures  were  removed,  and 
the  animal  was  discharged,  completely  cured. 

In  other  cases,  where  the  hernia  was  not  .so  large,  we  have 
operated  by  cutting  a  hole  into  the  hernial  sac,  through  which 
an  index  finger  is  pa.ssed  in  order  to  constitute  a  guide  and  insur- 
ance against  the  wounding  of  the  vi.scera.  A  heavy  needle,  armed 
with  a  strong  suture,  is  then  inserted  into  the  skin  at  a  distance 
of  two  or  more  inches  to  the  right  or  left  of  the  margin  of  the 
hernial  ring,  and  carefully  guided  through  the  abdominal  mus- 
cles of  the  one  side,  and  across  the  hernial  ring,  to  penetrate  the 
abdominal  muscles  on  the  other  side  of  the  ring,  and  through  the 
skin,  to  emerge  some  di.stance  from  the  hernial  ring.  The  needle 
is  then  reversed,  and  thence  returned  at  a  distance  of  about  y^ 
inch  from  the  point  of  beginning,  where  the  two  ends  are  tied  as 
in  the  preceding  case.  Other  sutures  are  added  until  the  ring  is 
completely  closed,  as  determined  by  digital  examination. 

In  small  umbilic  hernise  a  modification  of  this  suture  has  been 
used  by  us,  with  very  satisfactory  results.  The  animal  is  secured 
upon  its  back,  and  the  area  is  shaved  and  disinfected.  The 
hernial  contents  are  returned  into  the  abdomen,  and  the  hernial 
sac  grasped  with  one  hand  and  drawn  out  as  far  as  possible.  The 
hernial  sac  is  then  firmly  grasped  from  side  to  side,  between  the 
thumb  on  one  side  and  the  fingers  on  the  other,  and  the  walls 
brought  tightly  together.  In  small  herniae,  if  as  much  as  possi- 
ble of  the  skin  on  either  side  is  grasped  in  this  manner,  and  the 
two  sides  brought  together,  the  operation  also  draws  the  margins 
of  the  hernial  ring  together.  A  needle  armed  with  a  heavy  silk 
suture  is  inserted  immediately  against  the  thumb  and  finger,  be- 
tween them  and  the  abdominal  floor,  so  as  to  avoid  any  danger 
of  wounding  the  intestine,  and  is  forced  through  to  the  opposite 
side  as  shown  in  Fig.  151  A.  Grasping  the  hernial  sac  anew, 
and  reversing  the  needle  and  inserting  it  about  '4  inch  from  its 
point  of  emergence,  the  operator  carries  it  back  to  the  opposite 
side  parallel  to  the  first  suture,  and  ties  the  two  ends  together, 
as  indicated  in  Fig.  151  B,  so  tightly  as  to  close  the  hernial  ring. 

A  second  suture  is  now  inserted  in  the  same  way,  at  a  point 
about  }2  inch  distant  from  the  first,  and  the  series  of  sutures  is 
continued  until  a  sufficient  number  have  been  inserted  to  prevent 
the  escape  of  the  hernial  contents  between  or  beyond  the  sutures. 
Care  is  to  be  taken  that  at  either  end  the  sutures  extend  beyond 


Umbilic  Hernia 


1057 


the  hernial  ring,  including  all  of  the  hernial  sac,  thus  excluding 
the  possibility  of  the  intestine  slipping  out  from  behind  or  in 
front  of  the  sutures.  By  this  method  the  hernial  sac  does  not 
become  necrotic,  and  is  not  destroyed  if  the  operation  has  been 
carried  out  under  strict  antiseptic  precautions.     Under  this  plan, 


Fig.  151.     Diagrammatic  Illustration  of  Sutures  for 
Umbilic  Hernia. 

A,  Cross  section  through  the  hernial  ring  and  sac,  showing  relations  of  su- 

ture to  hernial  parts,  i.  Peritoneum  ;  2,  Muscles  of  abdominal  floor  ;  3, 
Skin  and  subcutaneous  tissues  ;  4,  Suture  ;  5,  Hernial  opening. 

B,  Diagram  of  hernial  ring  viewed  from  below,  with  hernial  sac  cut  away 

to  show  plan  of  sutures,  i.  Hernial  ring  ;  2,  Margin  of  the  skin  where 
hernial  sac  has  been  cutaway  ;  3,  3,  Areas  between  the  sutures  in  which 
the  hernial  sac  is  not  strangulated  ;  4,  4,  4,  Areas  in  hernial  sac  which 
are  included  in  the  sutures  but  which  still  receive  a  vascular  supply 
from  areas  3,  3. 

according  to  our  experience,  the  hernial  ring  closes  more  surely 
than  with  strangulation  and  necrosis  of  the  hernial  sac,  and  any 
risk  from  rapid  or  extensive  sloughing  is  excluded.  A  broad, 
many-tailed  bandage  is  applied  around  the  body,  and  an  antiseptic 
pack  is  applied  over  the  operative  area  and  repeatedly  saturated 
with  antiseptics  until  danger  from  infection  has  passed.  The 
bandage  is  kept  in  place  for  five  or  six  days,  and  the  sutures  are 
left  in  position  for  three    weeks  or  longer,  when  they  are  to  be 

67 


1058  Veterinary  Obstetrics 

removed.  The  hernial  sac  remains  as  an  empty  pouch,  but  after 
a  time  this  tends  to  disappear  spontaneously,  or  may  be  clipped  off. 

Others  apply  sutures  in  such  a  way  as  to  constitute  essentially 
a  multiple  incarcerating  ligature,  causing  the  entire  hernial  sac 
to  become  necrotic  and  slough  away.  This  plan  has  little  if  any 
advantage  over  the  simple  ligature. 

Ligatures,  clamps  and  sutures  have  the  common  danger  of  in- 
fection, which  should  be  avoided  by  the  application  of  strict  anti- 
sepsis. While  it  is  essential  that  strict  precautions  be  taken  pre- 
liminary to  and  during  the  operation,  it  is  just  as  important  that 
the  resulting  wound  be  handled  according  to  antiseptic  methods. 
Thus,  whether  we  use  the  ligature,  clamps  or  sutures,  an  anti.septic 
dressing  should  be  applied  to  the  area  of  operation,  and  the  part 
should  be  maintained  in  an  antiseptic  state  from  the  completion 
of  the  operation  until  danger  from  infection  has  been  safely 
passed,  which  is  usually  after  about  one  week. 

When  an  intestinal  urabilic  hernia  becomes  strangulated,  radi- 
cal measures  should  at  once  be  taken  to  bring  about  a  cure.  It 
is  first  essential  to  relieve  the  strangulation,  which  may  be  done 
in  some  cases  by  securing  the  animal  upon  its  back  and  carefully 
manipulating  the  hernial  contents,  so  that  they  may  be  pressed 
back  into  the  abdominal  cavity.  This  process  may  be  greatly 
favored  by  general  anaesthesia.  If  the  contents  of  the  intestines 
are  liquid,  the  incarceration  may  be  overcome  by  aspirating  por- 
tions of  the  fluid  contents  by  means  of  a  hypodermic  syringe  or  a 
small  trocar,  after  which  the  prolapsed  intestines  maj^  usually  be 
readily  returned.  If  these  measures  fail,  the  hernia  should  be 
cut  down  upon,  the  ring  dilated  by  cutting,  the  strangulated 
viscera  returned,  and  the  margins  of  the  hernial  ring  brought 
together  by  sutures,  such    as  we  have  described  above. 

When  there  exists  a  hernia  consisting  of  omentum,  and  it  be- 
comes incarcerated,  the  death  of  the  strangulated  portion  pro- 
duces no  general  symptoms,  but  the  hernial  tumor  becomes  rather 
hard  and  unyielding.  By  such  means,  the  hernia  becomes  sponta- 
neously obliterated,  but  the  tumor  remains.  This  condition  we 
have  ob.served  in  several  instances  in  the  pig.  The  condition  is 
not  a  serious  one.  and  its  only  significance  is  the  blemish,  which 
can  readily  be  removed  by  opening  the  hernial  sac  and  excising 
the  necrotic  omentum,  after  which  the  ring  and  sac  are  to  be 
clo.sed  under  antiseptic  precautions. 


Scrotal  Hernia,     higiimal  Her?iia  io59 

2.  Scrotal  Hernia.     Inguinal   Hernia. 

Scrotal  or  inguinal  hernia  may  exist  in  an}^  new-born  domes- 
tic animal,  perhaps  most  frequently  in  the  foal  and  pig,  rarely  in 
ruminants  and  carnivora.  Inguinal  hernia  is  virtually  a  defect 
of  the  male,  though  very  rarely  it  exists  in  the  female.  As  shown 
in  Fig.  57,  page  338,  there  exists,  early  in  fetal  life,  the  internal 
inguinal  or  abdominal  ring,  through  which  passes  the  guberna- 
culum  testis  from  the  scrotum  to  the  testicle.  Later,  as  the  male 
animal  develops,  there  occurs  an  evagination  of  the  peritoneum, 
the  processus  vaginalis,  through  the  inguinal  ring  into  the  scrotal 
pouch,  and  the  testicle  ultimately  descends,  until  finally  theevagi- 
nated  portion  of  the  peritoneum  forms  the  external  or  parietal 
layer  of  the  scrotal  peritoneum. 

As  already  related  on  page  336,  the  descent  of  the  testicle 
occurs  at  a  variable  period  of  time,  controlled  largely  by  species. 
In  solipeds  and  ruminants,  as  well  as  in  swine,  the  glands  are 
usually  in  the  scrotum  at  the  time  of  the  birth  of  the  young 
animal.  In  some  cases  the  inguinal  ring  in  the  fetus  is  abnor- 
mally large,  and  the  intra-abominal  pressure  during  early  fetal 
life  may  cause  portions  of  the  viscera  to  be  forced  out  through 
the  ring,  and,  remaining  there,  prevent  the  latter  from  normally 
closing,  or  narrowing  to  such  a  degree  as  to  prevent  the  escape  of 
viscera  from  the  abdominal  cavity.  In  all  domestic  animals,  the 
inguinal  ring  normally  remains  pervious  throughout  life,  and 
consequently  inguinal  hernia  does  not  depend  upon  the  abnormal 
existence  of  an  opening,  but  merely  upon  its  abnormal  size. 

In  new-born  foals,  especially  among  the  draft  breeds,  scrotal 
hernia  is  very  common  at  birth,  but  is  usually  of  a  temporary 
character,  and  spontaneously  disappears.  However,  this  does 
not  always  occur,  and  in  some  instances  the  internal  inguinal 
ring  is  excessively  large,  so  that  portions  of  viscera  protrude 
through  it,  which,  by  their  weight,  tend  to  render  the  abnormal 
dilation  of  the  ring  permanent  and  to  cause  the  hernia  to  persist 
throughout  the  life  of  the  animal  unless  surgically  handled.  In 
the  pig,  scrotal  hernia  is  quite  common,  and  usually  tends  to  re- 
main permanent   unless  surgical  interference  takes  place. 

The  size  of  the  hernial  ring  shows  every  possible  variation. 
We  have  observed,  in  the  foal,  an  internal  ring  four  or  five  inches 
in  diameter,  through  which   virtually  all  the  abdominal  viscera. 


io6o  Veterinary  Obstetrics 

which  were  not  too  closely  retained  by  mesenter}^  dropped  out 
into  the  hernial  sac,  descending  to  the  level  of  the  hocks.  Such 
conditions  inevitably  persist  unless  surgical  relief  is  applied,  and 
the  size  of  the  hernia  tends  to  grow,  rather  than  decrease.  It  is 
not  rare  to  see  a  stallion  with  a  scrotal  hernia  extending  down  to 
the  hocks,  and  with  the  internal  ring  so  large  that  the  veterinarian 
may  pass  his  hand  through  the  rectum,  into  and  through  the 
hernial  ring,  covered  by  the  intestine,  and  down  into  the  scrotal 
sac.  The  contents  of  the  hernial  sac  may  consist  of  either  in- 
testine or  omentum. 

The  symptoms  of  scrotal  hernia  in  the  new-born  are  usually 
very  apparent,  and  consist  essentially  of  an  increased  size  of  one 
or  both  halves  of  the  scrotum.  Upon  manipulation,  it  is  usually 
found  that  the  herniated  intestine  or  omentum  can  be  readily  re- 
turned into  the  abdominal  cavity,  especially  if  the  patient  is 
placed  upon  its  back.  After  the  contents  have  been  returned, 
the  enlarged  ring  can  be  discovered  by  digital  exploration. 

Strangulation,  or  incarceration,  of  scrotal  hernia  is  very  rare 
in  new-born  animals.  We  have  noted  but  one  instance  in  a  young 
animal,  which  occurred  in  a  foal,  some  weeks  of  age.  When 
strangulation  occurs,  the  ordinary  symptoms  of  strangulated 
hernia  appear,  consisting  of  severe  and  constant  colic,  with 
sweating  and  trembling.  The  volume  of  the  hernial  contents  is 
increased  ;  the  sac  is  tense,  firm  and  painful. 

The  course  and  termination  of  scrotal  hernia  varj-,  according 
to  species  and  the  size  of  the  hernial  ring.  In  most  animals 
scrotal  hernia  tends  to  persist,  and  to  increase  rather  than  de- 
crease in  size,  as  the  patient  grows  older.  In  the  foal,  when  the 
scrotal  hernia  is  small,  it  tends  to  disappear  spontaneously  with 
age.  In  probably  90%,  or  even  more,  of  foals  born  with  scrotal 
hernia,  the  defect  becomes  spontaneously  remedied,  so  far  that 
they  may  be  safely  castrated  by  the  open  operation  when  one 
year  old.  The  contents  of  scrotal  hernia  very  rarely,  if  ever, 
become  adherent,  except  because  of  some  ineffectual  surgical 
handling. 

The  defect  is  markedly  hereditary,  and  its  existence  in  the 
young  animal  serves  to  render  it  of  diminished  value  for  breed- 
ing purposes.  In  the  foal,  it  has  yet  another  significance, 
from  a  clinical  standpoint,  in  that,  even  though  the  defect  may 
be  apparently  overcome  in  a  spontaneous  manner,    it   may  yet 


Scrotal  Her7iia.     Inguinal  Hernia  1061 

lead  to  .serious  or  fatal  accident  in  later  life.  If  such  an  animal 
is  castrated  after  apparent  recovery,  without  unusual  precautions 
having  been  taken,  protrusion  of  the  omentum,  or  still  worse,  of 
the  intestine,  is  liable  to  occur,  and  lead  to  serious  or  fatal  re- 
sults. If  the  animal  is  retained  for  breeding  purposes,  it  may, 
at  any  time  after  reaching  adult  life,  suddenly  develop  strangu- 
lated hernia,  owing  to  some  accident  or  exertion  which  may 
cause  a  sudden  increase  of  the  intra-abdominal  pressure,  such  as 
jumping,  rearing,  or  copulating  with  a  mare. 

Handling.  Since  scrotal  hernia  in  the  foal  usually  recovers 
spontaneously  during  the  first  year,  a  reasonable  opportunity 
for  such  recovery  should  be  advised.  If,  however,  the  hernia  is 
very  large  or  tends  constantly  to  increase  in  size,  or  if  it  threatens 
to  become  strangulated,  a  radical  operation  for  its  cure  should 
not  be  long  delayed.  The  new-born  foal  is  usually  wanting  in 
the  desired  vigor  to  withstand  such  an  operation,  and  whenever 
practicable  the  veterinarian  should  postpone  surgical  interference 
until  the  foal  has  acquired  strength  and  the  tissues  have  de- 
veloped increased  powers  of  resistance. 

The  surgical  handling  of  scrotal  hernia  consists  essentially  of 
the  removal  of  the  testicle,  and  the  closure  of  the  ring  or  of  the 
inguinal  canal.  The  most  common  and  preferable  operation  is 
that  of  "  covered  "  castration.  The  animal  is  cast  and  turned 
upon  its  back.  In  case  of  the  foal,  general  anaesthesia  should 
be  induced. 

Under  thorough  antiseptic  precautions,  the  skin  and  dartos 
are  incised  down  to  the  cremasteric  fascia.  The  testicle  is 
grasped,  inclosed  within  the  cremasteric  fascia  and  peritoneum, 
and  traction  exerted  upon  it,  while  the  dartos  is  separated  from 
the  cremasteric  fascia  and  muscle  by  means  of  the  fingers  or 
scalpel  handle.  The  .separation  is  carried  upwards  to  and  bej^ond 
the  external  abdominal  ring.  In  this  manner  the  two  groups 
of  tissues  of  the  scrotum  are  separated  from  each  other.  The 
skin  and  dartos  derived  from  the  external  body  wall,  are  separated 
from  the  cremaster  and  peritoneum,  which  have  been  carried 
down  from  the  abdominal  cavity  with  the  testicle  in  its  descent. 

A  curved  needle,  armed  with  sterilized  silk,  is  passed  through 
the  cremaster  and  spermatic  cord,  as  high  up  against  the  internal 
ring  as  is  practicable.     After  the  needle  has  been  removed,   the 


io62  Ve/ennary  Obstetrics 

ligature  is  tied  tightly  around  the  entire  cord.  Having  been 
passed  through  the  cord,  the  ligature  is  insured  against  slipping. 

While  catgut  presents  the  advantage  of  being  absorbed  by  the 
tissues,  its  use  is  excluded  in  this  operation  because  it  quickly 
softens  and  relaxes  to  such  a  degree  as  to  permit  hemorrhage 
from  the  .spermatic  arteries,  or  the  ligature  slips  and  prolap.se  of 
the  intestine  or  mesentery  occurs.  In  one  case,  where  we  ligated 
carefully  with  catgut,  severe  and  dangerous  hemorrhage  occurred, 
although  the  ligature  remained  in  position.  The  cord  had  to  be 
later  ligated  with  strong  silk  in  order  to  save  the  patient's  life. 

After  the  ligature  has  been  securely  placed  about  the  parts,  the 
ligated  ti.ssues  may  be  severed  with  a  scalpel,  or  preferably  with 
sci.s.sors,  at  a  distance  of  not  less  than  i  inch  beyond  the  point 
of  ligation.  Great  care  should  always  be  taken  to  leave  a  suflfi- 
ciently  long  stump.  The  pressure  of  intestines  or  omentum 
above  tends  to  pull  a  portion  of  the  ligated  inguinal  wall  out  of 
the  ligature,  even  though  it  has  been  passed  through  the  cord  and 
investing  ti.ssues. 

If  the  hernial  ring  is  comparatively  small,  the  wound  through 
the  skin  and  dartos  may  be  allowed  to  remain  open,  but  we  be- 
lieve such  a  course  inadvisable,  and  would  recommend  the  closing 
of  the  scrotal  wound  by  means  of  sutures.  If  the  ring  is  very 
capacious,  and  the  hernia  very  large,  the  cremaster  muscle  may 
be  so  much  attenuated  that  it  does  not  offer  sufficient  strength  to 
render  the  maintenance  of  the  weight  of  the  viscera  secure 
against  prolapse  of  the  intestine.  In  order  to  guard  against  this, 
it  is  essential  that  the  .scrotal  wound  be  closed.  If  the  sac  is 
very  large,  the  ligation  of  the  cremaster  and  peritoneum,  and  the 
suturing  of  the  wound  of  the  skin  and  dartos,  may  not  prevent 
the  intestinal  mass  from  breaking  through  to  constitute  prolapse. 

As  a  further  guard  against  the  descent  of  the  viscera,  a  portion 
of  the  scrotal  .sac  may  be  removed,  after  which  the  suturing  of 
the  margins  of  the  wound  stretches  the  .skin  across  the  external 
abdominal  ring  and  exerts  some  pressure  upon  the  parts.  This 
pressure  may  be  accentuated,  and  rendered  far  more  efficient,  by 
inserting  into  the  external  abdominal  ring,  against  the  ligated 
stump  of  the  cord  and  exci.sed  cremaster,  a  large  mass  of  anti- 
septic gauze,  so  that,  when  the  .skin  and  dartos  are  brought  to- 
gether and  sutured  over  it,  a  distinct  pre.ssure  and  support  is 
obtained.     Other  means  for  insuring  ample  pressure  upon  the 


Imperforate  A?ius  1063 

part  may  be  used.  The  skin  from  the  inguinal  region  may  be 
drawn  down  tightly  over  the  external  ring,  and  sutures  passed 
through  it  and  the  internal  and  anterior  margins  of  the  ring,  so 
that  the  skin  and  dartos  are  thus  firmly  fixed  to  the  deeper  parts, 
and  the  external  abdominal  ring  virtually  closed.  Or,  with  heavy 
silk,  the  margins  of  the  external  abdominal  ring  may  be  brought 
together. 

The  operation  upon  the  pig  is  carried  out  in  a  similar  manner. 
The  position  of  the  scrotum  in  the  pig  renders  it  less  difficult  to 
retain  the  intestines  within  the  abdominal  cavity. 

After  the  performance  of  the  operation,  the  patient  should  be 
allowed  quiet  and  clean  quarters.  In  the  case  of  the  foal,  the 
parts  should  be  disinfected  several  times  daily,  but  otherwise 
should  go  undisturbed  except  in  those  cases  where  a  pack  of 
gauze  or  other  material  has  been  inserted,  as  above  recommended, 
which  should  be  removed  in  the  course  of  48  hours,  when  a  suffi- 
cient swelling  will  have  taken  place  in  the  part  to  prevent  the 
prolapse  of  the  intestine.  For  a  time  the  animal  should  be  fed 
very  lightly,  in  order  to  avoid  distension  of  the  abdominal  cavity 
and  unnecessary  pressure  upon  the  parts.  Should  the  ligature 
about  the  cord  become  infected,  a  fistulous  opening  may  result,  and 
necessitate  cutting  down  upon  the  cord  at  a  later  date,  and  re- 
moval of  the  ligature.  Sometimes  the  ligature  infection  takes  the 
form  of  botryomycosisor  schirrhous  cord,  and  necessitates  the  re- 
moval of  the  diseased  cord. 

The  age  at  which  scrotal  hernise  should  be  operated  upon  will 
vary  according  to  circumstances.  In  the  foal,  unless  there 
is  some  reason  to  the  contrary,  such  as  strangulation,  or  growth 
of  the  hernia,  it  should  be  postponed  until  the  patient  is  eight  to 
twelve  weeks  old,  but  it  may  be  performed  at  any  age  when  cir- 
cumstances may  demand  it.  In  the  pig  there  is  little,  if  any- 
thing, to  be  gained  by  delay  ;  and  the  animal  may  as  well  be 
operated  upon  at  the  usual  age  of  castration. 

3.    Imperforate  Anus. 

In  considering  the  development  of  the  embryo,  we  have 
learned,  on  page  310,  that  at  an  early  period  in  its  history  the 
posterior  gut  ends  blindly,  and,  opposite  to  it  upon  the  external 
surface,  there  appears  a  depression  in  the  ectoderm  known  as  the 
proctodealpit,  which  gradually  becomes  deeper  while  the  wall  be- 


1064  Veterinary  Obstetrics 

tween  it  and  the  end  of  the  gut  becomes  more  and  more  attenu- 
ated, until  finally  it  disappears  and  the  gut  opens  posteriorly  as 
the  anus.  In  some  cases  the  attenuation  and  disappearance  of 
the  walls  of  the  proctodeal  pit  fail  to  occur,  and  as  a  result  the 
young  animal  is  born  with  an  imperforate  anus. 

In  other  cases,  not  only  is  there  an  arrest  of  the  development 
in  this  part,  but  the  entire  posterior  gut,  or  any  portion  of  it,  may 
fail  to  form  or  may  become  obliterated  early,  so  that  there  is  an 
absence  of  both  the  anus  and  the  rectum. 

The  diagnosis  of  imperforate  anus  is  comparatively  simple, 
since  it  depends  upon  the  absence  of  that  organ.  Upon  examin- 
ation no  posterior  opening  of  the  gut  is  discoverable.  If  only 
the  anus  fails,  the  meconium  may  be  pushed  back  against  the 
thin  membrane,  to  form  a  tumor  in  the  anal  region  ;  while,  if  the 
rectum  itself  is  absent,  no  such  tumor  occurs. 

The  handling  of  imperforate  anus  consists  of  making  an  in- 
cision through  the  skin  of  the  part,  down  upon  the  accumulated 
meconium.  If  the  rectum  is  absent,  so  that  the  accumulation  of 
meconium  in  the  anal  region  does  not  occur,  the  animal  should 
be  destroyed  as  valueless. 

In  some  instances  in  new-born  females,  there  occurs  an  imper- 
forate anus,  accompanied  by  an  imperfect  vulvo-anal  partition, 
and  the  feces  drop  downward  into  the  vulva  through  the  defect- 
ive partition,  and  escape  therefrom  involuntarily.  Such  a  case  is 
illustrated  in  Fig.  42  on  page  310.  It  may  possibly  be  overcome 
by  inserting  the  finger  or  a  curved  sound  through  the  vulva  up 
into  the  anus,  and,  directing  it  backward,  cutting  down  in  the 
anal  region  until  the  wall  is  perforated.  The  communication 
between  the  anus  and  vulva  may  then  be  denuded  of  its  raucous 
membrane,  and  closed  by  sutures.  However,  because  of  the 
difficulty  of  bringing  about  the  closure  of  an  opening  in  this 
place,  it  would  be  better  as  a  rule  to  destroy  the  young  animal, 
unless  it  is  of  unusual  value  for  work  purposes.  An  animal  with 
such  a  defect  should  not  be  used  for  breeding. 

4.    Imperforate  Vulva. 

Imperforate  vulva  is  fundamentally  referable  to  the  same  cause 
as  we  have  already  described  as  operating  in  imperforate  anus. 
The  vulva  is  formed  in  the  same  manner  as  the  anus,  that  is,  it 
originates  from  the  lower  portion   of   the   proctodeal  pit.     The 


Atresia  of  the  Posterior  Nares  1065 

atresia  or  closure  may  not  end  with  the  vulva,  but  may  include 
other  parts  of  the  urino-genital  canal.  If  the  vulva  is  com- 
pletely closed,  it  prevents  the  discharge  of  urine  through  the 
normal  channel,  and  forces  it  to  continue  to  pass  through  the 
urachus. 

The  handling  of  imperforate  vulva  cannot  as  a  rule  be  suc- 
cessful, because  it  is  difficult  or  impossible  to  discover  the 
urethra  and  open  it  in  a  manner  which  will  prove  effective.  The 
animal  may  continue  to  live  indefinitely  with  an  open  urachus, 
but  is  of  no  value.  When  the  vulva  is  only  partially  closed,  and 
there  is  room  for  urine  to  escape  readily,  there  is  no  occasion  for 
surgical  interference.  As  a  general  rule,  such  partial  atresia  or 
absence  of  the  vulva  in  reality  depends  upon  an  asexual  state, 
as  is  observed  in  freemartins,  so  that  the  animal  is  incapable  of 
breeding.  Consequently,  there  is  no  object  to  be  gained  by  any 
surgical  attempt  at  dilating  the  vulva. 

5.  Atresia  of  the  Posterior   ISTares. 

In  studying  the  development  of  the  embryo  on  page  296,  we 
noted  that  the  nasal  and  oral  cavities  are  at  first  one  common 
chamber,  which  later  becomes  divided  into  two  .separate  pas.sages 
by  the  lateral  ingrowth  and  fusion  of  the  palatine  plates,  which 
eventually  become  ossified  throughout  most  of  their  extent,  to 
constitute  the  hard  palate.  In  some  cases  it  is  found  that  this 
partition  between  the  nasal  and  oral  cavities  continues  backward 
to  the  base  of  the  sphenoid  bone,  thus  cau.sing  a  more  or  less 
complete  atresia  of  the  posterior  nares.  The  defect  has  been  re- 
corded in  man  and  in  the  horse.  When  involving  but  one 
nostril,  the  defect  may  escape  detection,  because,  unless  the  young 
animal  is  caused  to  undergo  severe  exertion,  the  one  free  nostril 
answers  all  demands  for  respiration  and  no  inconvenience  ensues. 
If  both  posterior  nares  should  be  occluded,  severe  dyspnoea  re- 
sults, and  oral  breathing  becomes  necessary. 

When  an  animal,  with  atresia  of  one  posterior  naris,  arrives  at 
a  working  age,  and  is  put  to  heavy  draft  or  rapid  travel,  the  de- 
fective respiratory  passage  becomes  at  once  evident,  and  a  dis- 
tinct roaring  noise  is  present.  In  one  case  existing  in  a  three- 
year-old  in  our  clinic,  there  were  no  external  evidences  of  dis- 
ease,   such  as  bulging  or  inequality  of  the  face,   no  nasal   dis- 


io66  Veterinary  Obstetrics 

charge,  no  abnormal  odor.  One  posterior  naris  was  completely 
closed,  and  consequently  there  was  unilateral  breathing.  A 
sound,  passed  along  the  floor  of  the  affected  nostril,  when  it 
reached  the  posterior  naris,  passed  upward  and  backward  until 
it  lodged  against  the  base  of  the  sphenoid  bone,  instead  of  glid- 
ing downward  and  backward  into  the  pharynx. 

The  handling  of  this  defect  should  be  undertaken  early,  or  at 
least  recognized  early,  in  order  to  determine  whether  the  diffi- 
culty can  be  successfully  removed  or  not.  If  the  case  is  properly 
diagnosed,  the  prognosis  is  good. 

By  means  of  a  rigid  curved  sound,  the  membrane  stretching 
across  the  posterior  naris  may  usually  be  ruptured.  In  opera- 
ting, the  occluding  partition  should  be  carefully  broken  down  un- 
til free  respiration  through  the  nostril  is  obtained.  If  necessary, 
the  frontal  bone  may  be  trephined  on  a  level  with  the  posterior 
nares,  and  the  partition  ruptured  with  forceps,  sound  or  other 
instrument,  through  the  trephine  opening. 

6.  Atresia  of  Other  Body  Openings. 

An  imperforate  condition  of  any  other  body  opening  may  ex- 
ist, but  aside  from  those  already  mentioned,  which  are  not  at 
all  common,  such  conditions  in  our  domestic  animals  are  exceed- 
ingly rare,  and  are  of  scientific,  rather  than  practical  interest. 

Imperforate  prepuce  has  been  described  by  Brugnone  as  occur- 
ring in  foals.  He  recommends  that  the  organ  be  divided,  and 
the  opening  held  apart  by  some  suitable  contrivance.  If  such 
an  opening  is  not  made,  the  urine  must  necessarily  be  voided 
through  the  urachus.  The  operation  cannot  usually  succeed 
unless  the  atresia  involves  the  prepuce  only.  If  the  urethra  it- 
self is  closed,  it  is  generally  impossible  to  effectively  open  it. 

Epispadias  is  a  term  used  to  designate  a  defect  in  the  urethra 
by  which  it  opens  upon  its  superior  surface  at  some  point  other 
than  the  extremity  of  the  penis.  In  other  instances  the  ab- 
normal opening  may  occur  upon  the  inferior  surface  of  the  tube, 
and  is  then  known  as  hypospadias.  In  such  instances  there  is 
an  absence  of  the  urethral  canal  beyond  the  point  of  opening. 

In  the  majority  of  cases  in  veterinary  practice,  and  described  as 
epispadias  or  hypospadias,  the  condition  is  in  reality  an  approach 
toward,  if  not  actual  hermaphroditism.  There  are  present,  in 
varying  degrees  of  development,  some  parts  of  both  the  male  and 


Fissure  of  the  Palate  1067 

female  generative  organs.  This  is  especially  true  in  the  horse, 
where  cryptorchid  testicles  frequently  develop,  along  with  a 
more  or  less  imperfect  vagina  and  vulva,  and  an  erectile  organ 
which  may  occupy  an  intermediary  position  between  the  normal 
clitoris  of  the  mare  and  the  penis  of  the  stallion. 

The  handling  of  these  abnormalities  will  vary  according  to 
circumstances.  Unless  by  surgical  interference  the  urine  can  be 
caused  to  be  voided  in  an  unobjectionable  direction  and  manner,  it 
is  advisable  to  destroy  the  young  animal  at  once  as  being  worth- 
less. If  there  is  a  well  developed  vulva,  the  abnormally  long 
clitoris  or  short  penis,  as  one  may  prefer  to  term  it,  may  be 
amputated  within  the  vulva,  so  that  the  animal  will  urinate  as 
though  a  mare.  In  such  cases  of  hermaphroditism  the  testicles 
may  be  remov^ed,  when  the  animal  has  reached  the  proper  age,  in 
the  same  manner  as  ordinary  cryptorchids  are  castrated  ;  or,  as 
in  one  case  upon  which  we  operated,  the  glands  may  be  removed 
through  the  vagina  in  the  same  manner  as  the  ovaries  in  the 
mare. 

Occlusion  of  the  eyelids  sometimes  occurs  in  the  new-born. 
In  carnivora  and  rodents  the  eyelids  are  normally  adherent  at  the 
time  of  birth,  while  in  other  animals  they  are  open.  If  the  eye- 
lids are  adherent  merely  by  their  margins,  they  may  be  separated 
by  tension  or  by  carefully  dividing  them  with  a  scalpel.  In 
some  cases,  however,  the  lachrymal  cavity  is  wanting  and  the 
eyelids  are  adherent  to  the  cornea.  In  such  a  case  there  is  no 
help  for  the  condition.  In  other  instances  we  have  observed  the 
new-born  animal  without  a  cornea,  and  the  sclerotic  coat  cover- 
ing the  entire  eyeball.     This  is  not  subject  to  remedy. 

Occlusion  of  the  auditory  canal  occurs  occasionally,  especially 
in  the  dog.  It  is  recorded  that  in  some  cases  there  is  a  soft 
tumor  at  the  point  where  the  opening  of  the  canal  should  exist, 
which  can  be  readily  seized  with  forceps  and  excised  with  a 
scalpel,  exposing  an  accumulation  of  cerumen  or  ear  wax,  which 
may  be  removed  by  syringing  out  with  tepid  water.  Such  ani- 
mals are  usually  incurably  deaf. 

7.  Fissure  of  the  Palate. 

Fissure  of  the  palate  is  a  comparatively  rare  congenital  defect 
in  the  new-born.     In  our  museum,  there  is  one  specimen  of  fis- 


io68  Veterinary  Obstetrics 

sure  of  the  palate,  in  a  colt  which  lived  to  about  one  year  old, 
when  it  was  destroyed  as  incurable. 

The  defect  consists  of  an  arrest  in  the  development  of  the 
palatine  laminae  or  arches,  which  fail  to  come  in  contact  and  fuse 
upon  the  median  line,  thus  forming  a  direct  opening  from  the 
mouth  into  the  nostrils,  as  indicated  in  Fig.  35  on  page  298.  The 
fissure  permits  the  passage  of  food  from  the  mouth  into  the  nasal 
chambers,  from  whence  it  drops  out  through  the  nostrils.  In 
this  way  the  young  animal  is  placed  at  a  serious  di.sadvantage 
by  losing  a  large  part  of  its  food  through  the  nostrils,  and  thus 
undergoes  partial  starvation.  At  the  same  time,  the  lodgement 
of  food  in  the  nostrils  irritates  the  parts,  and  its  discharge  there- 
from presents  so  repulsive  an  appearance  that  the  animal  is  ren- 
dered valueless. 

The  handling  of  fissure  of  the  palate,  in  domestic  animals,  is 
virtually  barred  by  the  great  depth  of  the  oral  cavity,  which 
prevents  the  surgeon  from  attempting  to  bring  about  an  adhesion 
of  the  two  sides  by  means  of  an  operation,  though  in  some  cases 
it  might  be  theoretically  possible. 

8.     Persistent  Foramen  Ovale.     Cyanosis. 

In  describing  the  fetal  circulation  on  page  328,  it  was  mentioned 
that,  since  the  lungs  are  inactive  up  to  the  time  of  birth,  their  office 
must  be  performed  by  the  placenta.  In  order  that  the  blood 
leaving  the  right  ventricle  may  readily  pass  to  the  placenta  of 
the  mother,  there  exists  in  the  fetal  heart  a  communication, 
the  foramen  ovale,  between  the  two  auricles.  This  should 
normally  close  at  about  the  period  of  birth,  but  sometimes  does 
not,  and  as  a  result  the  new-born  animal  suffers  from  cyanosis 
or  a  mixed  circulation,  in  which  the  arterial  blood  assumes  a 
venous  character  and  gives  to  the  visible  parts  a  blue  color.  This 
defect  is  very  rare  in  animals  When  present  it  is  usually  accom- 
panied at  the  time  of  birth  by  extreme  weakness,  with  rapid 
respiration  and  a  deep  blue  color  of  the  visible  mucous  mem- 
branes, the  consequence  of  the  partial  asphyxia  from  which  the 
animal  is  suffering. 

The  condition  is  beyond  remedy.  Spontaneous  recovery  may 
occur.  If  the  defect  persists  the  animal  may  survive  for  some 
time.     Zundel    records  a  case  in  a  horse  which  reached  the  age 


Tongue- Tie.     Hernia  of  the  Brain.      Odontomes        1069 

of  7  years.  In  man  even  a  greater  age  is  sometimes  attained, 
though  as  a  general  rule  the  patient  succumbs  at  a  comparatively- 
early  date,  except  recovery  ensues. 

9.    ToNGUE-TlE. 

Veterinarians  have  recorded  a  few  instances  of  tongue-tie,  or 
decreased  mobility  of  the  tongue,  due  to  a  too  restricted /r^w?^?^ 
linguce.  According  to  Tyvaert,  who  has  observed  a  number 
of  calves  so  affected,  the  defect  prevents  the  prehension  and  swal- 
lowing of  food.  The  animal  cannot  well  drink  milk  from  a  pail, 
or  readily  grasp  the  teat  to  suck,  and  consequently  tends  to  die 
of  starvation. 

Examination  of  the  tongue  reveals  the  nature  of  the  anamoly. 
The  handling  of  it  is  very  simple,  and  consists  merely  in  dividing 
the  fraenum  linguae  to  a  sufficient  degree  to  permit  of  free  move- 
ments of  the  tongue. 

10.  Hernia  Cerebri.     Hernia  of  the  Brain. 

Serious  defects  in  the  development  of  the  brain  usually  lead  to 
the  death  of  the  fetus  immediately  upon  birth.  We  have  made 
some  interesting  observations,  where  hernia  of  the  cerebrum  be- 
came hereditary  in  a  family  of  swine  bred  upon  one  farm.  The 
female  line  had  been  maintained  unbroken  for  generations,  while 
the  boar  used  for  breeding  purposes  had  been  regularly  changed, 
and  new  blood  introduced.  Year  after  year,  however,  there  oc- 
curred, with  ever  increasing  frequency,  new-born  pigs  showing  a 
tumor  in  the  frontal  region,  which  was  sometimes  covered  over 
with  skin,  and  at  other  times  showed  a  naked  epithelial  covering. 
In  some  litters  of  pigs  the  defect  was  apparent  in  more  than  50%. 
Some  of  the  pigs  died  after  a  few  days,  under  sj'mptoms  of 
epilepsy,  while  others  slowly  recovered  and  the  tumor  disap- 
peared. The  appearance  of  the  hernia  is  shown  in  Fig.  32, 
on  page  294.  The  defective  family  of  swine  was  finally  sold  to 
the  butcher,  in  order  to  avoid  the  recurring  losses  from  the 
difficulty. 

II.  Odontomes. 

In  tracing  the  development  of  the  teeth,  on  page  311,  we  sug- 
gested that  during    the   embryonic   period    the   dental    follicles 


loyo  Veterhiary  Obstetrics 

sometimes  undergo  aberrations  which  lead  to  more  or  less  seri- 
ous consequences,  not  only  for  the  integrity  of  the  teeth,  but 
also  for  the  usefulness  or  the  life  of  the  animal.  Some  of  these 
aberrations  take  place  early  in  fetal  life,  and  at  the  time  of  birth 
have  acquired  such  proportions  as  to  imperil  the  life  of  the  ani- 
mal. This  is  especially  true  of  the  follicular  cysts,  of  the  com- 
pound follicular  odontomes,  and  of  the  composite  odontomes  of 
the  superior  grinders.  In  these  forms  of  aberrations  in  the  de- 
velopment of  the  teeth,  large  cysts  filled  with  lymph  press  their 
way  into  the  sinuses  of  the  face  or  into  the  nostril,  and,  by  their 
great  size,  cause  much  deformity  of  the  face,  and  such  pressure 
upon  the  nasal  passages  as  to  threaten  the  death  of  the  young 
animal  by  asphyxiation. 

When  odontomes,  especially  large  ones  of  the  cystic  variety, 
are  present  at  the  time  of  birth,  the  foal  at  once  shows  difficulty 
in  respiration,  because  of  the  pressure  upon  the  nasal  chamber. 
There  is  bulging  of  the  face  over  the  area  of  the  cyst,  unilateral 
breathing,  and  a  marked  increase  in  resonance  over  the  area  of 
the  cyst. 

The  prognosis  of  odontomes  is  usually  highly  favorable  under 
proper  surgical  handling,  and  equally  unfavorable  if  neglected. 

The  surgery  of  odontomes  is  usually  demanded  for  the  colt  or  for 
the  adult,  and  only  very  rarely  for  the  new-born  foal.  We  have 
observed  and  recorded  odontomes  which  have  threatened  the  life 
of  the  foal  before  reaching  the  age  of  90  days,  and  other  writers 
have  observed  them  at  the  time  of  birth.  Since  we  usually  do  not 
obtain  clinical  evidence  of  their  presence  until  after  the  colt  has 
attained  some  age,  it  is  not  desirable  to  deal  extensively  here 
with  their  handling.  Instead  we  merely  draw  attention  to  the 
occurrence  of  these  in  the  new-born  or  very  young  foal,  and  refer 
the  reader  to  the  more  extensive  literature  upon  the  subject  in 
special  surgery. 

12.  Rupture  of  the  Extensor  Pedis  Tendons  in  the 
Anterior  Limbs  of  the  New-Born. 

We  have  had  occasion  to  observe,  in  the  vicinity  of  Ithaca, 
N.  Y.,  six  cases  of  rupture  of  the  extensor  pedis  tendons,  of  new- 
born foals,  in  the  region  of  the  carpus.  How  common  the  disease 
may  be,  we  cannot  .say,  since  there  are   few  records  of  its  occur- 


Rupture  of  Extensor  Pedis   Te7ido?ts 


107 1 


rence.  Four  of  the  cases  observed  by  us  occurred  upon  one  farm, 
in  two  successive  years,  and  comprised  all  the  foals  dropped  upon 
the  farm  during  that  period.  The  foals  were  in  some  instances 
apparently  well  at  the  time  of  birth.  Attempting  to  stand,  they 
soon  went  over  on  their  knees,  and  were  quite  unable  to  ex- 
tend the  metacarpus  upon  the  radius.  Others  showed  more 
vigor,  and  for  a  time  were  able  to  get  up  and  stand  without  aid. 
However,  there  was  a  constant  tendency  for  the  carpus  to  sud- 
denly flex  forward  and  the  animal  to  fall,  though  the  more  vigor- 
ous ones  were  able,  with  some  difficulty,  to  stand,  and  to  walk 
without  falling. 

In  all  instances  which  we  have  observed,  the  tendons  have 
ruptured  in  both  legs,  and  the  point  of  rupture  is  usually  at  the 
upper  part  of  the  carpal  sheath,  where  the  tendon  merges  with 
the  muscle,  as  shown  in  Fig.  152.  After  the  rupture,  the  end  of 
the  tendon  drops  down  in  its  carpal  sheath,  and  reunion  with  its 
muscle,  either  spontaneously  or  by  surgical  interference,  becomes 
impossible. 

In  one  instance  the  rupture  of  the  tendons  was  accompanied 
by  extreme  luxation  of  both  patellae,  the  two  patellae  being  com- 
pletely dislocated  laterally,  disabling  the  foal  behind  as  well  as 
in  front,  so  that,  when  it  was   raised  upon  its  feet  and  the  ante- 


Fu;.    152.        RlPTlRE   OF   THE    ExTENSOR   PEDIS    LOXGUS   MUSCLE 

IN  New-born  Foal. 
Right  anterior  limb  seen  from  in  front. 
EM,  Extensor  metacarpus.  i,  Proximal  ruptured  end 

EP,  E-xteusor  pedis  longus  2,  Distal  portion  of  tendon  dropped 

EPA,  Extensor  pedis  longus  acces-  down  in  the  sheath,  3. 

sorius. 


1072 


Veterinary  Obstetrics 


rior  limbs  extended,  it  assumed  the  position  shown  in  Fig.  153. 
Of  the  six  cases  observed,  four  died  in  a  few  days  after  birth  or 
were  destroyed  as  hopeless.  Two  recovered,  and  are  still  living 
and  performing  satisfactory  services,  without  extensor  pedis 
muscles.  The  animals  extend  their  fore  feet  by  the  extensor 
pedis  accessoriusand  the  extensors  of  the  metacarpus,  producing 
a  peculiar  gait. 

The  cause  of  rupture  of  the  exten.sor  pedis  tendons  in  the  new- 
born is  unknown.  In  the  region  where  we  have  ob.served  these 
cases,  that  group  of  bone  disea.sesof  which  spavin,  ring  bone  and 
navicular  disease  are  typical,  is  ver}' common,  and   it  is  possible 


Fig.  153.    ExTREMK  Luxation  ok  THJi  Pathm.-K  in  a  Nkw-hokn  I-'oai.,. 

Accompanied  by  rupture  of  the  two  extensor  pedis  longus  muscles  of  the 
anterior  limbs.  From  a  photograph.  a,  Patella  ;  b,  Femoro-tibial  ar- 
ticulation. 


Rupture  of  Extensor  Pedis   Tendons  1073 

that  a  relationship  exists  between  these  and  the  rupture  of  the 
tendons. 

The  prognosis  is  exceedingly  unfavorable,  since,  although 
some  of  the  cases  may  live,  their  locomotion  is  interfered  with 
by  the  absence  of  the  extensor  pedis  lougus  muscles,  and  the 
value  of  the  animals  is  consequently  greatly  lessened  except  for 
slow  work,  because  for  driving  or  riding  they  would  inevitably 
prove  insecure  upon  their  feet.  For  any  fashionable  use,  their 
peculiarity  of  action  would  render  them  unsuitable. 

The  handling  of  the  malady  is  uncertain,  and  apparently  there 
is  little  to  do  beyond  taking  good  care  of  the  animal  and  aiding 
it  in  getting  upon  its  feet  in  order  to  suck.  While  the  foal  is 
sucking,  an  assistant  should  grasp  it  by  the  knees,  and,  pushing 
backward,  prevent  their  flexion,  thereby  assisting  the  animal  in 
standing.  Unless  the  foal  is  of  considerable  value,  it  is  advisable 
in  most  instances  to  destroy  it  at  once. 


68 


APPENDIX.    I. 


THE  GRANULAR  VENEREAL  DISEASE  OF  COWS. 

Infectious    Granular  Vaginitis.      Vaginitis  Verrucosa. 
Infectious  Vaginal  Catarrh. 

On  page  97,  we  have  given  a  brief  account  of  the  granular 
venereal  disease  of  cattle,  basing  our  description  upon  European 
veterinar}'  literature.  We  were  not  aware,  at  that  time,  of  the 
existence  of  the  disease  in  America.  We  there  suggested  that 
the  disease  might  well  be  imported  at  any  time,  and  that  it  might 
even  then  exist  in  America  without  its  presence  having  been  rec- 
ognized or  announced. 

A  few  weeks  later  a  communication  reached  us  which  led  us 
to  suspect  the  existence  of  the  disea.se  in  a  dairy  herd  in  north- 
eastern New  York. 

A  visit  of  inspection  to  the  herd  confirmed  our  suspicions.  It 
was  then  attempted  to  procure  data  regarding  the  probable  dis- 
semination of  the  malady.  The  herd  in  which  we  recognized 
the  malady  was  one  in  which  no  effort  was  made  to  raise  dairy 
cows.  Fresh  cows  were  bought,  milked  and  bred,  their  calves 
used  for  veal,  and  the  cows  butchered  or  sold  whenever  unprofit- 
able for  dairy  purpo.ses.  As  a  consequence,  new  cows  were  fre- 
quently entering  the  herd.  Some  of  the  new  cows,  which  had 
been  in  the  stable  but  a  few  days,  were  badly  affected,  which  in- 
dicated that  they  had  been  disea.sed  when  purchased,  and  conse- 
quently that  neighboring  herds  were  similarly  diseased.  Soon 
afterward  several  herds  in  the  immediate  vicinity  were  inspected 
by  other  veterinarians,  and  reported  similiarly  affected. 

The  results  of  these  inspections  led  us  to  suspect  that  the 
malady  had  a  somewhat  extensive  distribution.  One  large  herd 
in  southeastern  New  York  had  been  reported  to  us  as  suffering 
persistently  from  abortion,  and  we  were  led  to  suspect  that  the 
granular  venereal  disease  was  present,  and  inspection  confirmed 
our  belief.  We  soon  had  opportunity  to  observe  the  affection 
in  western  New  York,  and  e.specially  in  our  immediate  vicinity. 
In  the  region  of  Ithaca  we  have  inspected  a  number  of  dairy  herds, 
finding  them  uniformly  infected.  We  do  not  know  of  a  sound 
herd  in  our  region. 
1075 


1076  Veterinary  Obstetrics 

Veterinarians  in  various  portions  of  the  state,  having  had  their 
attention  drawn  to  the  existence  of  the  malady-,  find,  upon  search, 
that  the  disease  is  common  in  many  localities  in  New  York. 

We  have  observed  the  malady  in  pedigreed  breeding  herds  of 
Holsteins,  Jerseys  and  Guernseys.  Breeding  stock  is  constantly 
being  sold  from  these  herds  to  all  portions  of  the  state  and  country. 
We  have  satisfactorily'  determined  that  affected  animals  have  gone 
from  New  York  to  several  other  states,  and  that  diseased  cattle 
have  been  brought  into  New  York  from  other  states. 

Howlong  the  disease  has  existed  in  New  York  or  in  the  United 
States,  can  not  be  determined.  One  veterinarian  in  Pennsyl- 
vania relates  orally  that  he  observed  the  lesions  in  aborting  cows 
in  his  state  some  five  or  six  years  ago,  but  apparently  made  no 
public  announcement  of  the  fact.  Breeders  state  also  that  they 
have  observed  the  granular  lesions  in  their  herds  for  some  time 
past. 

If  we  are  to  estimate  the  duration  of  the  di.sease  in  America  by 
its  probable  relation  to  abortion,  it  has  existed  for  a  long  time. 
A  serious  malady,  known  as  contagious  abortion,  has  been  wide- 
spread and  has  caused  appalling  losses  to  dairymen  in  New  York 
and  other  states  for  more  than  a  quarter  of  a  century.  How 
much  of  the  abortion  has  been  due  to  this  malad}^  we  do  not 
know,  and  there  is  now  no  method  for  determining.  At  present 
we  have  been  unable  to  find  a  dairy  in  which  abortion  exists,  or 
has  recently  existed,  where  the  granular  venereal  disease  is  not 
present  in  a  severe  form. 

Such  observations  as  we  have  been  able  to  make,  in  the  few 
months  elapsing  since  the  recognition  of  the  malady  in  this 
state,  lead  us  to  conclude  that  the  disease  has  probably  exi.sted 
in  the  United  States  for  a  quarter  of  a  century,  that  it  is  wide- 
ly disseminated  wherever  dairying  is  largely  conducted,  and  that 
it  is  responsible  for  a  very  large  part  of  the  immense  losses  from 
abortion  and  sterility  in  cows. 

For  these  reasons,  we  consider  it  essential  to  add  to  the  de- 
scription already  given  of  this  disease,  some  interesting  data  ac- 
quired through  our  investigations.  Admittedly  our  observa- 
tions are  incomplete,  and  any  conclusions  we  may  now  draw  are 
subject  to  revision.  The  investigations  thus  far  made  should 
suffice,  however,  to  place  veterinary  practitioners  on  their  guard. 


Gramdar    l^enereal  Disease  of  Cows  1077 

lead  them  to  make  careful  observations,  and  enable  them  to  con- 
tribute important  data  to  our  knowledge  of  the  malady. 

Our  suspicions  of  the  existence  of  the  disease  in  this  country 
were  first  aroused  by  a  communication  from  a  veterinary  practi- 
tioner, relating  to  abortion  and  sterility  in  a  dairy  herd  of  40 
cows,  which  we  shall  designate  Herd  i.  The  letter  stated  in 
part,  "They  have  had  considerable  abortion  the  past  year,  and 
now  many  of  their  cows  are  sterile.  Some  have  been  bred  as  many 
as  nine  times  without  becoming  pregnant."  The  sterility  was 
not  confined  to  cows  which  had  aborted,  but  included  some 
which  had  recently  given  birth  to  apparently  healthy  calves.  It 
was  noted  that  the  different  bulls  used  in  the  herd  seemed  to  suf- 
fer from  enlargement  of  the  penis,  and  became  somewhat  indif- 
ferent sexually.  The  practitioner  also  stated  that,  following  an 
interval  of  1 2-24  hours  after  breeding,  the  cows  bled  somewhat 
from  the  vulva.  Apparently  this  latter  phenomenon  was  mis- 
interpreted, and  really  consisted  of  the  regular  menstrual  flow 
following  estrum  without  impregnation.  In  this  disease,  how- 
ever, the  menstruation  seems  exaggerated.  The  general  phe- 
nomena related  are  typical  of  the  history  of  the  prevalence  of 
this  malady  in  a  dairy. 

Herd  i.  An  inspection  of  the  suspected  herd,  Jan.  3,  1909, 
revealed  the  fact  that,  of  the  40  cows,  25,  or  62.5^,  showed 
typical  lesions  of  the  disease  ;  4,  or  10%,  were  regarded  as  ques- 
tionable ;  and  11,  or  27.5%,  were  apparently  well. 

The  symptoms  were  thoroughly  typical.  The  lesions  corre- 
sponded to  those  recorded  by  European  investigators.  Many 
of  the  moderately  affected  cases  were  identical  in  appearance 
with  Fig.  154.  The  mucous  membrane  of  the  vulva  was  thickly 
studded  over  with  countless  granular  elevations  about  the  size  of 
hemp  seed.  The  areas  of  mucosa  in  which  the  granules  were 
located  were  generally  injected,  sometimes  intensely  inflamed 
and  thickened.  In  such  cases,  the  granules  were  very  abundant, 
reddi.sh  in  color,  but  not  so  intensely  injected  generally  as  the 
contiguous  mucosa. 

In  many  cases,  where  abundant  granules  of  large  size  were 
present,  the  mucosa  was  not  greatly  injected.  In  the.se  instances 
the  granules  were  very  prominent,  not  .so  numerous,  but  ap- 
peared larger.     These  were  not  usually  injected,  but   were   more 


1078 


Veterinary  Obstetrics 


or  less  transparent,  appearing  like    small,  deep-seated  vesicles, 
as  if  filled  with  a  transparent,  colorless  lymph. 


mm) 


Fig.   154.     Infectious  Granular  Vaginitis. 

Mucosa  of  the  vestibule  after  three  months  duration  of  the  dis- 
ise.         (Hutyra  and  Marek,  after  Ostertag. ) 


Granular   Venereal  Disease  of  Cows  loyg 

Vulvar  discharge  was  generally  present,  and  the  muco-purulent 
substance  accumulated  in  dirty  crusts  about  the  vulva  and  tail. 
The  herd  of  40  cows  was  established  in  1905,  and  during  the 
three  subsequent  years  74  different  cows  entered  the  stable,  34, 
or  46%,  of  which  have  been  sold  or  slaughtered.  Though  the 
records  of  the  dairy  are  not  explicit  as  to  reasons  for  disposal, 
the  prevailing  reason  for  slaughter  or  sale,  so  far  as  can  be  deter- 
mined, was  abortion,  followed  by  sterility  and  an  unprofitable 
milk  production. 

At  the  date  of  inspection,  24  cows,  or  SC/ ,  were  pregnant, 
and  16,  or  40%,  were  barren.  Many  of  these  had  been  repeat- 
edly bred,  without  result,  and  several  of  them  had  proven  so 
persistently  sterile  that  it  was  intended  to  slaughter  them  for 
beef.  The  institution  to  which  the  dairy  belongs  requires  a  large 
amount  of  beef  for  its  inmates,  and  consequently  they  have  aimed 
to  butcher  each  cow  which  proves  unprofitable  as  a  dairy  animal, 
as  soon  as  she  can  be  put  in  fair  beef  condition.  New  cows  in 
advanced  pregnancy,  or  recently  fresh,  are  bought  to  replace 
them,  and  thus  the  proportion  of  sterile  animals  is  reduced  to  a 
minimum. 

The  data  regarding  abortion  in  the  herd  is  also  inaccurate.  In 
general  terms,  the  superintendent  states  that  abortion  has  been 
frequent  during  the  entire  history  of  the  dairy.  Some  have 
aborted  two  and  three  times  in  succession.  Generally  they  are 
butchered  before  abortion  occurs  more  frequently  than  twice. 

While  the  los.ses  in  this  herd  have  not  been  so  great  as  those 
recorded  by  some  European  observers,  they  have  nevertheless 
been  .serious,  so  much  .so  that  the  governors  of  the  institution  to 
which  the  dairy  belongs  are  very  anxious  to  check  the  severe 
economic  losses.  Since  they  do  not  attempt  to  raise  the  calves, 
they  do  not  feel  severely  the  direct  loss  from  abortion  or  sterility  ; 
and  the  fact  that  the  institution  can  make  good  use  of  each  fat 
cow  for  beef  diminishes  greatly  the  economic  losses  on  the  cows 
themselves.  Even  under  these  exceptional  conditions,  and  with 
the  disease  in  the  herd  of  a  mild  character  as  compared  with  the 
malady  in  some  other  herds  coming  within  our  observation,  the 
economic  losses  from  impairment  of  milk  production  are  proving 
a  severe  burden.  It  is  difficult,  under  the  conditions,  to  produce 
sufficient  milk,  or  at  a  rea.sonablecost,  for  the  use  of  the  inmates 
of  the  institution. 


io8o  Veterinary  Obstetrics 

Herd  2.  The  next  herd  investigated  by  us  consisted  exclu- 
sively of  pedigreed  Jerseys.  There  were  on  hand,  at  the  date  of 
our  first  inspection,  228  cows,  heifers  and  heifer  calves.  In  addi- 
tion, there  were  8  bulls  of  breeding  age  and  10  bull  calves. 

In  three  stables  containing  96  females,  among  which  were  a 
few  cows,  but  mostly  heifers  from  i^  to  3  years  old,  89.6%  were 
diseased  and  10.4%  apparently  well. 

In  a  fourth  stable,  containing  40  cows  and  heifers,  all  in  milk, 
98%  were  affected  and  2%  (i  cow)  apparently  well. 

A  fifth  stable,  designed  for  pregnant  cows  about  to  calve  and 
for  calves,  contained  6  cows  or  heifers  in  advanced  pregnancy  or 
recently  calved,  5  of  which  were  evidently  diseased  and  i  appar- 
ently well.  The  remainder  of  the  stock  in  this  barn  consisted  of 
virgin  heifers,  and  heifer  and  bull  calves. 

Of    8  heifers  about  9  mos.    old,    8  were  afifected,  o  apparently  well. 
"  20     "  "      6     "  '       18     "  "  2  "        '      " 

"     6     "  "3     "  "        I     "  "  5 

"     7     "  "I     "  "        o     "  "  7 

"     3     "  "      I  week      "       o     "  "  3  "  " 

Of  the  total  44  virgin  heifers  and  heifer  calves  in  this  stable, 
61%  were  diseased  and  39%  were  apparently  well.  Excluding 
the  heifer  calves  under  6  months,  93%  of  the  virgin  heifers  were 
affected. 

In  a  sixth  stable,  containing  42  cows,  chiefly  adult  or  aged,  31, 
or  74%,  were  affected,  and  1 1  ;   or  26%,  were  apparently  well. 

In  the  entire  herd  of  22  Sfemales,  198,  or  82.5%,  were  affected  ; 
and  40,  or  17.5%,  were  apparently  well.  If  we  deduct  from  the 
228  females,  the  17  apparently  well  heifers  and  heifer  calves  not 
over  6  months  old,  and  which  we  may  assume  remain  apparently 
well  because  not  yet  infected,  there  remain  211  females,  of  which 
188,  or  89.1%,  are  affected. 

The  foregoing  statistics,  it  has  since  been  determined,  are  de- 
fective, and  show  too  large  a  percentage  of  well  animals.  Cows 
in  advanced  pregnancy,  or  about  to  abort,  when  the  vulva  be- 
comes swollen  and  edematous,  cease  to  show  the  granules  in  the 
vulvar  mucosa,  and  consequently  the  number  of  apparently  well 
is  probably  excessive  to  the  extent  of  all  of  tho.se  cows  which 
were  very  near  to  parturition  or  abortion,  in  which  the  lesions 
were  hidden  by  the  edema  present. 


Granular    Venereal  Disease  of  Cows  io8r 

The  symptoms  in  this  herd  were  far  more  intense  than  those 
observed  in  Herd  i.  In  the  cows  and  heifers  which  had  calved 
or  aborted,  and  in  some  of  the  virgin  heifers,  there  was  present 
a  very  noticeable  muco-purulent  vulvar  discharge,  which  soiled 
the  external  portions  of  the  vulva  and  the  contiguous  portion  of 
the  tail.  The  discharge  adhered  especially  to  the  tuft  of  hairs 
at  the  inferior  commissure  of  the  vulva.  Sometimes  the  muco- 
purulent discharge  dried  upon  the  vulvar  tuft  as  dirty  brownish 
crusts  ;  at  other  times  the  moist,  sticky  discharge  hung  down 
in  ropy  masses  several  inches  long.  Similar  masses  of  discharge 
were  observed  upon  the  ventral  and   lateral  surfaces  of  the  tail. 

Upon  separating  the  vulvar  lips,  there  was  observed,  in  many 
cases,  adherent  masses  of  muco-purulent  secretions.  Frequently, 
when  partingthe  vulvar  lips,  the  muco-purulent  masses  stretched 
across  from  side  to  side  as  adherent,  tenacious  strings,  not  losing 
their  continuity  until  the  walls  of  the  vulva  had  been  parted  for 
a  distance  of  two,  three,  or  more  inches.  The  discharges  were 
generally  tenacious,  stringy,  white,  or  rarely  faintly  yellowish, 
and  more  or  less  opaque.  In  some  instances,  the  discharge  was 
flocculent,  and,  upon  separating  the  vulvar  lips,  the  mucosa  was 
seen  to  be  dotted  over  with  pale  yellow,  repulsive-looking,  flat 
masses,  o.  r  to  i  cm.  in  diameter.  In  one  diseased  cow%  when- 
ever the  vulvar  lips  were  separated  and  the  clitoris  pressed  from 
beneath,  approximately  one  to  two  cc  of  a  thick  white  pus  were 
discharged  from  the  prepuce  of  the  clitoris.  In  addition  to  the 
vulvar  discharges  mentioned,  muco-purulent  discharges  emanated 
from  the  vagina  and  the  uterus.  More  than  2  %  of  the  affected 
cows  had  pyometra  following  parturition  or  abortion,  and  showed 
the  same  character  of  discharge  as  pyometra  from  other  causes. 

The  granular  lesions  in  the  vulvar  mucosa  were  very  much 
more  pronounced  than  in  Herd  i.  In  the  milder  cases,  the 
granules  were  few  in  number,  and  grouped  largely  about  the 
clitoris.  They  were  arranged  in  irregular,  indistinct  rows,  cor- 
responding to  the  ridges  in  the  mucous  membrane.  According 
to  the  severity  of  the  case,  the  granules  spread  forward  toward 
the  vagina  and  upward  along  the  sides  of  the  vulva,  to  finally 
converge  and  meet  on  the  roof  of  the  vulva.  Fig.  154  repre- 
sents a  comparatively  mild  case  as  related  to  the  area  involved 
and  the   profusion  of  granules.     As   the  superficial  area  of  the 


io82  Veterinary  Obstetrics 

disease  increases,  the  irritation  of  the  mucosa  and  the  abundance 
of  granules  tend  to  increase. 

The  granules  are  best  observed  by  refracted  light.  The  vulvar 
lips  are  readily  parted  with  the  fingers,  when  the  granules  are 
easily  observed  upon  some  portion  of  the  mucosa,  usually  best 
on  the  side  opposite  to  the  observer.  Changes  in  position  and 
the  obliquity  of  the  illumination  aid  in  bringing  the  granules  in- 
to clear  vision.  In  fair  daylight,  with  the  vulva  of  the  animal 
directly  or  obliquely  facing  an  open  door  or  a  window,  ample 
illumination  of  the  vulva  is  afforded,  when  the  lips  are  parted. 
In  dark  stables,  on  a  dark  day,  or  at  night,  the  vulva  may  be 
conveniently  and  amply  illuminated  with  the  aid  of  a  good 
stable  lantern.  A  good  reflecting  lamp  or  lantern  is  even  better, 
and  affords  an  illumination  equal  to  sun-light.  The  ordinary 
small  electric  hand  lamp  with  a  dry  battery  gives  an  ideal  light 
at  night  or  in  dark  stables.  When  the  granules  extend  over 
the  entire  circumference  of  the  vagina,  they  may  be  best  ob- 
served by  holding  the  vulvar  lips  well  apart  and  looking  along 
the  vaginal  roof,  when  the  granules  will  stand  out   very  boldly. 

The  granules  differ  greatly  in  color.  In  the  intensely  in- 
flamed cases,  the  granules  usually  partake  of  the  deep  injection 
of  the  surrounding  mucosa,  but  are  somewhat  lighter  in  color 
and  show  a  tendency  towards  transparency.  In  cases  where  no 
great  irritation  is  present,  the  granules  stand  out  prominently, 
as  more  or  less  translucent,  hemispherical  elevations.  They 
are  especially  prominent  in  virgin  heifers. 

When  parturition  or  abortion  is  near,  and  the  vulva  becomes 
edematous,  the  granules  disappear  from  view.  They  apparently 
do  not  cease  to  exist,  but  the  general  edematous  condition  hides 
them  and  produces  an  even  surface  as  seen  in  Plate  II,  Fig.  4. 
So  far  as  we  have  investigated,  we  are  unable  to  detect  the 
disease  clinically  at  this  period.  In  two  or  three  weeks  after 
abortion  or  parturition,  the  granules  again  become  visible. 

The  degree  of  irritation  in  the  vulvar  mucosa  is  not  directly 
dependent  upon  the  numbers  of  granules  present,  though  in  gen- 
eral the  greater  the  number  of  granules,  the  more  intense  the 
inflammation  of  the  mucosa.  In  some  cases,  especially  after  re- 
peated irrigations  with  antiseptics,  the  vaginal  mucosa  is  normal 
or  even  pale  in  color.      In  severe  cases,  the  mucosa  is  intensely 


Gra7iular    Venereal  Disease  of  Coivs  1083 

red  and  angry-looking,  and  bleeds  easily.  It  is  sensitive  to  the 
touch,  and  the  patient  resists  palpation.  Urination  causes  some 
irritation  of  the  parts,  expressed  by  uneasy  stepping  and  whisk- 
ing of  the  tail.  When  the  irritation  is  very  intense,  the  vulva 
becomes  visibly  swollen,  especially  the  upper  portions  of  the 
labi«,  opposite  the  superior  commissure.  The  vulvar  hps  at  this 
region  become  distinctly  enlarged,  tense  and  sensitive. 

It  was  observed,  during  our  investigations  in  this  herd,  that 
copulation  greatly  increased  the  vulvar  irritation.  So  marked 
was  this  coital  irritation  that  we  were  enabled  to  largely  antici- 
pate the  breeding  history  of  a  cow  by  inspecting  the  vulva.  If 
bred  within  a  week  or  two,  the  vulvar  irritation  was  very  greatly 
accentuated.  This  is  in  harmony  with  observations  upon  most 
coital  infections,  and  has  a  distinct  and  important  influence  up- 
on the  question  of  therapeutics.  No  method  of  handling  can 
well  succeed  under  the  irritation  of  copulation. 

Estrum  also  caused  a  somewhat  increased  vulvar  irritation, 
but  not  of  the  same  grade  as  coition.  It  seemed,  also,  that  in 
this  herd  menstruation  following  estrum  was  especially  marked 
and  abundant. 

An  interesting  pha.se  of  the  disease  in  this  herd  was  the  large 
percentage  of  heifer  calves  affected.  European  writers  mention 
the  occasional  transmission  of  the  disease  to  heifers  and  calves, 
but  lead  one  to  assume  that  such  occurrences  are  rare.  In  this 
herd,  61%  of  all  virgin  heifers,  or  93%  of  all  virgin  heifers  over 
6  mouths  old,  were  affected.  This  fact  is  very  important  in 
relation  to  abortion,  sterility  and  the  transmission  of  the  disease 
from  herd  to  herd. 

The  method  of  infection  in  these  cases  is  not  wholly  clear. 
Our  investigations  developed  the  fact  that  the  same  grooming 
implements,  metal  currycombs  and  stiff  fiber  brushes,  were  used 
alike  on  diseased  cows  in  adjoining  stalls,  and  on  the  heifer  calves. 
In  grooming,  the  vulvar  region  necessarily  received  extra  atten- 
tion in  order  to  rid  the  region  of  dried  fecal,  and  other  accumu- 
lations. In  doing  this,  the  vulvar  lips  were  parted  and  the  in- 
fected currycomb  and  harsh  brush  were  brought  into  contact 
with  the  vulvar  mucosa. 

Later  observations,  upon  other  herds,  disclose  the  fact  that 
such  infection  of  virgin  heifers  is  not   common   when   they   are 


io8+  Veterinary  Obstetrics 

kept  in  stables  with  diseased  cows,  if  the  lieifers  are  not 
groomed. 

The  relation  of  the  disease  to  abortion  in  this  herd  was  appar- 
ently very  important.  In  Herd  i  abortion  was  persistent  but 
scattering.  While  no  large  number  of  abortions  occurred  in  any 
month  or  year  during  the  existence  of  the  herd,  the  total  for  the 
three  years  was  of  distinct  economic  importance. 

In  Herd  2,  abortion  was  far  more  frequent  and  serious.  It 
might  be  said  that  abortion  was  comparatively  as  much  more 
frequent  in  this  herd  than  in  the  first  one,  as  the  vulvar  lesions 
were  more  abundant  and  intense.  That  is,  the  number  of  the 
abortions  in  the  two  herds  was  approximately  parallel  to  the 
respective  intensity  of  the  lesions  in  the  two  herds. 

In  this  herd,  156  cows  were  bred  to  calve  during  1908,  and 
kept  on  the  farm  until  the  result  was  known.  Of  these,  42,  or 
27  % ,  aborted ;  and  1 4,  or  9  % ,  were  slaughtered  because  of  sterility. 
Four  cows  or  heifers,  which  had  been  bred  and  conceived,  were 
sent  to  the  butcher  as  sterile,  after  having  aborted.  Exact  sta- 
tistics for  prior  years  are  not  available,  but  abortion  and  sterility 
have  been  causing  serious  losses  for  a  number  of  years.  The 
ravages  of  abortion  reached  the  climax  in  1908.  As  accurately 
as  statistics  can  be  readily  compiled,  the  losses  in  the  herd,  be- 
tween January  1901  and  May  1905,  averaged  0.5  abortions  per 
month;  between  May  1905  and  March  1907,  0.86  abortions 
per  month  ;  and  during  1908,  3.5  per  month. 

Most  of  the  animals  aborting  in  1908,  and  indeed  throughout 
the  history  of  the  herd,  have  been  young  cows  and  heifers. 
Very  largely  they  have  been  heifers  pregnant  for  the  first  time. 
This  is  in  harmony  with  our  observations  in  other  aflfected  herds. 
Abortions  occur  chiefly  in  heifers,  or  in  cows  newly  introduced 
into  the  herd. 

In  this  herd,  one  stable  is  made  up  almost  wholly  of  adult 
cows,  42  animals  in  all.  Of  these,  31,  or  74%,  were  affected, 
as  against  an  average  of  82.5%  for  the  entire  herd,  though,  in 
arriving  at  this  percentage  for  the  herd,  new-born  heifer  calves 
were  included.  In  this  stable,  where  the  largest  percentage  of 
apparently  well  cows  was  found,  abortion  was  virtually  ab.sent, 
there  being  records  of  but  two  cases  during  a  period  of  several 
years. 


Granular    Venereal  Disease  of  Cozes  1085 

We  have  stated  above  that  the  comparative  frequency  of  abor- 
tion in  affected  herds  is  in  harmony  with  the  percentage  of  ani- 
mals affected  and  the  average  virulence  as  revealed  by  the  vulvar 
lesions.  This  harmony  is  quite  as  well  emphasized  between  the 
various  stables  in  this  herd.  The  abortions  have  occurred  in 
those  stables  where  the  disease  is  most  universal  and  the  vulvar 
lesions  most  intense.  In  the  stable  of  40  cows,  with  98^  affected, 
the  abortion  was  decidedly  the  most  severe  in  the  herd. 

The  observations  relative  to  the  variations  in  the  prevalence  of 
abortion,  in  the  different  stables  on  this  farm,  bring  up  other  in- 
teresting questions.  Of  the  17.5%  of  apparently  well  females, 
1 7  animals  or  4 2 . 5  %  of  those  not  showing  vulvar  lesions  were  virgin 
heifers,  so  young  that  it  is  a  fair  assumption  that  they  were  free 
essentially  because  the3'  had  thus  far  failed  to  become  infected. 
Of  the  remaining  23  apparently  well  females,  1 1,  or  27.5%,  were 
adult  cows  in  barn  six  ;  and  8  others,  or  20%,  mostly  adult  and 
aged  cows,  were  in  another  barn.  Thus,  in  a  herd  consisting 
for  the  most  part  of  young  cows  and  heifers,  there  were  40  ap- 
parently well  females,  42.5  ''/r  of  which  were  virgin  heifers  or  heifer 
calves,  47.5%  adult  or  aged  cows,  and  but  lo^r  among  the 
young  cows  and  heifers,  which  constitute  the  majority  of  the 
herd. 

Two  assumptions  seem  to  be  warranted  by  the  observations  in 
this  herd  : 

1.  As  the  cows  grow  old,  and  have  been  infected  for  several 
years,  they  acquire  an  indefinite  immunity  from  the  effects  of  the 
malady.  The  lesions  become  less  intense,  and  abortion  occurs 
less  frequently  or  is  wholly  absent. 

2.  The  cow  may  eventually  recover  spontaneously,  and  the 
lesions  disappear.  This  is  in  accord  with  the  popular  belief 
relative  to  ' '  contagious  abortion  ' ' ,  w^hatever  that  term  may  mean. 
It  is  commonly  said  that  a  cow  aborts  twice,  and  becomes  im- 
mune. While  in  this  herd  there  are  sufficient  cases  to  disprove 
this  as  a  universal  fact,  there  is  much  to  support  the  rule.  Sev- 
eral important  questions  w^hich  repeatedly  arise  in  reference  to 
spontaneous  recovery  may  be  tentatively  answered  by  the  observa- 
tions in  this  herd.  It  is  one  thing  for  a  cow  to  recover  from  the 
disease  and  cease  to  be  capable  of  transmitting  it  to  other  ani- 
mals, and   quite  a  different  matter   for    her    to  cease  to   abort. 


io86  Veterinary  Obstetrics 

Many  cows  have  the  disease  more  or  less  intensely,  yet  breed 
regularly,  and  produce  healthy,  vigorous  calves.  The  cows  in- 
cluded in  the  /o  apparently  healthy  animals,  in  this  herd,  breed  regu- 
larly, and  drop  healthy  calves. 

Based  upon  this  feature  of  the  malady,  a  thriving  trade  is 
carried  on  by  fraudulent  veterinarians  with  "abortion  cures". 
When  a  dairyman  has  lost  one  or  two  crops  of  calves,  and  turns 
with  a  forlorn  hope  to  the  "abortion  cure"  fraud  and  applies 
the  remedy,  if  the  time  is  opportune,  the  abortion  ceases  and  the 
dairyman  writes  a  "testimonial",  but  the  disease  remains  in 
the  herd,  and  sooner  or  later  will  again  bring  disaster.  Should 
the  fraudulent  remedies  be  applied  at  an  inopportune  epoch,  the 
abortion  goes  on,  and  the  remedy  seems  almost  to  cultivate  it. 
Thus  in  this  herd  the  writer  was  informed  that  one  of  the  most 
highly  lauded  "  abortion  cures  "  in  America  was  given  a  com- 
plete trial  in  one  of  the  stables,  with  the  result  that  a  far  higher 
percentage  of  the  cows  aborted  in  that  than  in  either  other  stable 
on  the  farm.  The  remedy  was  just  as  effective  as  it  ever  is,  but 
was  used  at  the  wrong  time,  when  the  abortion  was  not  ready  to 
cease. 

Another  important  element  in  connection  with  the  outbreak  in 
this  herd  is  the  prevalence  of  sterility.  In  dealing  with  the 
problem  of  sterility,  and  quoting  Professor  Hess,  on  page  171,  it 
is  asserted  that  the  granular  venereal  disease  is  one  of  the  most 
common  causes  of  sterility  from  cystic  degeneration  of  the 
ovaries.  That  is,  according  to  the  observations  of  Hess,  that 
malady  causes  the  ovarian  disease.  Our  studies  upon  the  herd 
in  question  went  far  to  substantiate  the  views  of  Profes.sor  Hess, 
differing  from  his  observations  in  some  important  respects, 
though  in  no  wise  contradictory. 

The  herd  records  showed  the  most  serious  sterility,  not  in 
cows,  but  in  heifers  which  had  not  bred  at  all,  or,  if  they  con- 
ceived, had  suffered  from  invisible  abortion,  i.  e.,  had  aborted 
ere  the  fetus  had  reached  a  size  that  its  expulsion  was  detected 
by  the  keepers.  Fourteen  such  heifers  were  sent  to  the  butcher 
during  1908  because  all  efforts  at  breeding  proved  futile.  Some 
were  served  five  to  ten  times  each,  without  avail,  estrum  recur- 
ring regularly  every  three  weeks.  Others  would  show  estrum 
regularly  two  or  three  times,  then  miss  one,  two  or  more  periods 


Granular    Venereal  Disease  of  Cows  1087 

(pregnant?)  and  unexpectedly  again  show  estrum  (invisible 
abortion?).  Finally,  in  despair,  they  were  sent  to  the  butcher, 
and  the  highly  pedigreed  animals  of  otherwise  great  promise  be- 
came a  total  loss. 

The  majority  of  the  heifers  became  pregnant,  and  carried  the 
fetus  to  the  sixth,  seventh,  or  eighth  month,  when  they  aborted, 
or  gave  birth  to  a  premature  calf,  which  with  careful  handling 
sometimes  survived.  After  aborting,  various  troubles  arose. 
Many  suffered  from  retained  placenta.  A  few  died  from  septic 
metritis  following  the  retained  placenta.  Some  suffered  severely 
from  chronic  metritis  or  pyometra.  Many  of  the  aborted  heifers 
proved  difficult  or  impossible  of  impregnation. 

Cystic  degeneration  of  the  ovaries  and  persistent  hypertrophied 
corporealutea  abound  in  the  herd.  In  one  stable  of  38  females, 
manual  examination  of  the  internal  genital  organs  was  made,  ex- 
cept in  pregnant  animals.  Of  those  examined,  five  had  cystic 
ovaries  ;  four  had  persistent,  hypertrophied  yellow  bodies  ;  and 
two  had  pyometra.  One  of  the  cows  affected  with  pyometra  also 
had  a  cystic  ovary,  making  five  animals  with  cystic  degeneration. 
Thus,  amongst  38  animals,  11  or  29%  had  disease  of  the  ovaries 
or  uterus  which  would  probably  bar  fecundation  until  properly 
handled. 

In  a  second  stable  of  40  cows,  preparatory  to  handling,  man- 
ual exploration  was  made  per  rectum,  revealing  cystic  ovaries  in 
1 1  cases  and  persistent  yellow  bodies  in  9  animals,  or  abnormal 
ovaries  in  ^o'/e  of  the  cows.  Some  of  these  were  not  sufficiently 
affected  to  clearly  interfere  with  breeding  ;  others  were  badly  de- 
generated, and  sterility  very  probable.  Numerous  cows  re- 
mained sterile  after  several  breedings.  One  was  nymphomaniac. 
One  heifer  had  aborted  some  months  ago,  and  has  not  been  ob- 
served in  estrum  since.  The  right  ovary  contained  a  yellow 
body  lYz  inches  in  diameter,  which  was  pressed  out.  Three  weeks 
later,  a  new  yellow  body  of  nearly  the  same  size  was  again  pres- 
ent, in  the  same  location  as  before,  and  it  too  was  pressed  out. 

The  investigations  in  this  herd  thus  indicate  the  correctness  of 
the  views  of  Professor  Hess,  that  ovarian  and  uterine  diseases 
very  largely  follow  virulent  attacks  of  the  granular  venereal  dis- 
ease. 

Observations  in  this  herd  carry  us  even  further  in  one  impor- 
tant respect.     The   investigations  indicate  that  in  highly  bred 


io88  Veteri7iary  Obstetrics 

and  unusually  highly  kept  cows  and  heifers,  are  exposed  to 
special  dangers  from  the  malady.  Through  grooming,  with- 
out proper  precautions  being  taken,  the  disease  is  trans- 
ferred to  heifers  and  heifer  calves,  and  the  infection  is  al- 
ready in  the  genital  tract  before  the  animal  is  bred. 
Consequently,  when  the  heifer  is  bred,  the  disease  already  ex- 
ists, rendering  fecundation  difficult  or  impossible.  Should  the 
heifer  become  impregnated,  the  chronic  infection  of  the  genital 
tract,  already  present  for  months,  imperils  the  life  of  the  fetus 
and  may  induce  either  abortion  or  premature  birth,  to  be  followed 
b}'  various  complications. 

Another  interesting  question  has  been  raised  by  the  clinical 
history  of  this  herd.  Mammitis  of  a  very  peculiar  type  sometimes 
occurs  in  heifers  which  are  threatening  to  abort.  In  such,  a 
severe,  purulent  mammitis  now  and  then  arises,  causing  atresia 
of  the  milk  cistern  or  larger  milk  canals,  so  that  when  the  heifer 
finally  calves  or  aborts,  one,  two  or  more  of  the  quarters  are 
blocked,  and  no  milk  can  be  withdrawn. 

At  the  time  named  there  is  an  excessive  vulvar  discharge 
which  soils  the  perineum,  tail,  thighs  and  posterior  portions  of 
the  udder.  Thus  it  is  suggested  that  the  disease  may  indirectly 
cause  some  cases  of  mammitis. 

Herd  3.  A  third  dairy  inspected  consisted  of  87  cows,  heifers 
and  heifer  calves.  In  one  stable  containing  30  cows  in  milk,  27, 
or  90%,  were  affected.  In  the  same  stable,  in  stalls  compara- 
tively detached,  were  24  heifers  and  heifer  calves,  of  which  6  or 
25%  were  diseased,  and  18  or  757^  apparently  well.  In  two 
other  barns  were  33  females,  mostly  cows,  with  some  heifers  one 
year  old  or  over,  of  which  31  or  94%  were  found  affected.  In 
the  entire  herd  of  87  females,  64  animals,  or  74%.  were  affected. 
There  is  at  present  no  abortion  in  the  herd.  Four  5'ears  since, 
approximately  50%  of  the  pregnant  cows  aborted,  and  the  fol- 
lowing year  25%  aborted,  since  which  time  the  herd  has  been 
free  from  abortion.  During  this  period  of  freedom,  few  if  any 
new  cows  have  been  introduced.  While  abortion  prevailed,  the 
service  bulls  were  subjected  to  disinfection  of  the  penis  and 
sheath  before  service.  Granular  venereal  disease  was  not  in 
mind,  and  not  looked  for  by  the  veterinarian  in  charge. 

Since  the  cessation  of  abortion,  sterility  has  prevailed  to  a  de- 
gree which  has  caused    considerable    economic    loss.     Three   or 


Granular    Venereal  Disease  of  Co'cvs  1089 

four  cows  have  been  sent  to  the  butcher  on  this  account.  One 
was  sent  to  the  butcher  because  we  had  diagnosed  ovarian 
abscesses.  Our  diagnosis  was  verified  by  post  mortem  examination. 
Aside  from  these,  approximately  10%  of  the  cows  of  breeding 
age  have  been  handled  annually  by  us  for  sterility  due  to  ovarian 
disease. 

The  lesions  of  the  disease  in  this  herd  are  more  intense  and 
more  universal,  in  the  cows  of  breeding  age,  than  found  in  Herd 

1,  and  far  less  intense  than  in  Herd  2.  The  prevalence  of  abor- 
tion and  sterility  in  the  herd  is  in  harmony  with  the  observations 
in  the  two  prior  herds.  The  lesions  are  not  severe  ;  no  new  cows 
have  entered  the  herd  ;  no  abortions  are  occurring.  The  lesions 
are  more  intense  than  in  Herd  i,  and  sterility  is  present  in  a 
marked  degree,  and  assumes  definite  economic  importance.  The 
sterility  is  due  almost  wholly  to  cystic  ovarial  degeneration,  some 
cases  to  persistent  hypertrophied  yellow  bodies,  and  one  case  to 
ovarial  abscesses. 

The  recorded  observations  by  European  investigators,  coupled 
with  the  history  of  the  abortion  in  this  herd,  followed  by  the 
large  percentage  of  sterility  and  the  high  prevalence  of  the  granu- 
lar venereal  disease  in  the  herd  at  present,  warrant  the  assump- 
tion that  the  malady  was  present  when  the  abortion  raged. 

The  small  percentage  of  affected  heifers  and  heifer  calves  in 
this  herd  is  interesting,  when  compared  with   Herd  2.     In  Herd 

2,  the  heifers  and  heifer  calves  are  kept  in  the  same  barn,  and 
in  close  contact  with  a  few  badly  diseased  cows.  The  calves  in 
that  herd  are  regularly  groomed,  and  the  same  currycomb  and 
harsh  fiber  brush  are  used  for  grooming  both  cows  and  calves. 
The  cows  usually  kept  in  the  stable  with  the  heifers  are  those  in 
advanced  pregnancy,  and  those  which  have  recently  calved  or 
aborted.  Many  of  them  have  abundant  vulvar  discharges,  which 
greatly  befoul  the  grooming  implements  and  afford  ample  oppor- 
tunity for  the  carrying  of  the  disease  from  cows  to  calves. 

In  Herd  3,  the  conditions  are  different.  The  calves  are  kept  in 
a  distant  part  of  the  stable,  virtually  equivalent  to  a  separate 
building.  They  are  abundantly  bedded  and  scantily  groomed. 
They  are  not  kept  on  exhibition  for  prospective  buyers,  as  are 
those  in  Herd  2. 
69 


1090  Veteri7iary  Obstetrics 

Herd  4.  This  small  herd  consisted  originally  of  grade  cows, 
to  which  were  added,  by  purchase,  a  few  months  prior  to  our  ob- 
servations, 3  pedigreed  Guernsey  heifers  and  i  pedigreed  Guern- 
sey bull  calf.  We  were  asked  to  examine  two  of  the  three 
Guernsey  heifers  because  of  sterility.  The  three  heifers  and  the 
bull,  as  well  as  the  other  cows  and  calves  on  the  premises,  were 
well  kept,  in  good  flesh  and  vigorous  general  health.  In  spite 
of  repeated  breeding,  only  one  of  the  three  heifers  had  become 
pregnant. 

Inspection  showed  all  three  Guernsey  heifers  affected  with 
granular  venereal  disease  (100^  ),  while  of  the  6  original  grade 
cows,  3  or  50%  were  affected.  2  heifer  calves  kept  in  another 
stable  were  healthy.  In  the  herd  of  9  females  of  breeding  age, 
3  animals,  or  33%,  were  sterile,  one  of  the  original  stock  having 
become  sterile  since  the  introduction  of  the  Guernsey  heifers. 
Abortion  has  not  existed  in  the  herd.  Of  the  total  of  1 1  females 
in  this  herd,  6  or  54%  are  affected.  The  history  and  condi- 
tions in  this  herd  suggest  that  it  was  free  from  the  malady  until 
introduced  by  the  purchase  of  the  pedigreed  heifers. 

Herd  5.  A  herd  of  10  females,  attended  by  my  colleague, 
Dr.  J.  N.  Frost,  In.structor  in  Surgery,  because  of  sterility  in  2 
heifers.  Of  the  10  cows  and  heifers,  8,  or  10%,  were  affected. 
The  herd  had  suffered  severely  from  abortion  for  several  years. 
The  two  apparently  well  cows  were  adults.  They  have  at  no 
time  suffered  from  abortion  or  sterility.  The  two  sterile  heifers, 
20%  of  the  herd,  were  badly  affected  ;  and  each  had  cystic  ovaries, 
which  were  crushed. 

Herd  6.  A  milk  dairy  consisting  of  40  cows  and  6  heifers. 
No  herd  records  are  kept,  so  that  losses  from  abortion  or  sterility 
can  only  be  estimated.  In  1906,  about  20%  aborted  ;  in  1907 
about  15%  ;  and  in  1908  about  10%.  The  degree  of  sterility 
could  not  be  determined.  The  cows  are  mostly  grades,  and 
whenever  sterility  threatened,  and  the  cow  was  at  all  fit  for 
slaughter,  she  was  sent  to  the  butcher.  Inspection  showed  44, 
or  96%,  affected  ;  and  2,  or  4%,  apparently  well.  The  cows  and 
heifers  of  breeding  age  were  all  affected.  The  sound  animals 
were  yearling  heifers  which  had  not  been  bred.  The  lesions  were 
very  moderate  in  intensity.  One  heifer  had  aborted  in  the  sum- 
mer of  1908,  was  bred,  and  aborted  in  April,  1909.  The  abortion 
was  followed  by  retained  placenta. 


Grayiular    Ve?iereal  Disease  of  Coivs  1091 

Herd  7.  A  herd  consisting  of  12  cows  and  i  yearling  heifer. 
No  definite  record  of  abortions  and  failures  to  breed.  Owner 
estimates  loss  by  abortion  in  1907  at  20%.  In  1908,  10%  of 
herd  was  sent  to  butcher  because  of  sterilit}'.  The  original  herd, 
all  common  cows,  have  been  sold  recently,  except  4  aged  cows 
and  the  yearling  heifer,  and  in  their  stead  8  pedigreed  Holstein 
cows  introduced.  Of  the  four  original  cows,  2  are  slightly  af- 
fected, 2  apparently  well.  The  yearling  heifer  is  affected.  The 
8  new  cows  are  affected  mildlj-  to  moderately,  the  lesions  in  these 
animals  being  apparently  old. 

Examination  of  the  genital  organs  of  the  8  Holstein  cows  re- 
vealed I  pregnant,  3  wath  enlarged  persistent  yellow  bodies  in 
ovaries,  2  with  cystic  degeneration  of  ovaries,  i  with  enlarged 
uterus  and  cystic  ovary,  and  i  normal,  non-pregnant. 

Herd  8.  A  herd  of  high-grade  Jerseys,  consisting  of  53 
females.  The  herd  has  been  kept  unusually  isolated.  Few  new 
cows  have  been  added  during  the  entire  history  of  the  herd  ;  52 
of  the  53  females  were  born  on  the  farm  ;  and  the  one  remain- 
ing cow  was  introduced  into  the  herd  some  years  since. 
New^  bulls,  or  rather  bull  calves,  have  been  added  from  time  to 
time.  Eight  or  ten  years  ago  a  breeding  bull  was  hired  tempo- 
rarily from  Herd  3.  Owing  to  the  continued  comparative  isola- 
tion of  the  herd  and  a  history  of  virtual  freedom  from  abortion 
for  half  a  century,  it  was  hoped  to  find  a  sound  herd.  An  in- 
spection revealed  3  animals  so  near  parturition  that  the  presence 
or  absence  of  the  granular  lesions  of  the  vulva  could  not  be  de- 
termined. Of  the  other  50  females,  33  or  66^  w^ere  affected, 
and  17  or  34%  were  apparently  well.  Among  these  50  females, 
6  were  heifers,  6  to  12  months  old,  which  had  not  been  bred. 
They  were  kept  in  the  same  stable,  but  fairly  well  isolated.  They 
w^ere  carefully  and  plentifully  bedded,  but  not  groomed  at  all.  Of 
these  6  heifers,  i  or  1673%  was  diseased,  and  5  or  83^/3%  .sound. 
This  is  in  marked  contrast  with  Herd  2,  where  the  heifers  were 
regularly  groomed  with  infected  utensils. 

The  other  12  sound  animals  were  mostly  aged  cows,  which 
may  have  spontaneously  recovered. 

On  the  whole,  the  percentage  of  affected  animals  is  the  lowest 
we  have  yet  observed  in  a  large  herd.  The  lesions  in  the  vulva 
are  also  less  severe,  the  granules  less  numerous  and  less  promi- 


1092  Veterbiary  Obstetrics 

nent,  the  irritation  of  the  vulvar  mucosa  ahnost  wanting,  and 
vulvar  discharge  recognizable  in  but  few  animals. 

In  harmony  with  these  clinical  data,  abortion  is  rare,  never 
exceeding,  according  to  the  owner's  estimate,  2  to  4'/r  in  any 
year,  while  sterility  is  low.  Probably  an  average  of  4  to  5%  of 
the  females  are  sent  to  the  butcher  annually  for  sterility,  but 
dairymen  in  New  York  have  come  to  regard  this  as  possibly 
normal.  Still,  some  abnormal  losses  from  sterility  are  recognized 
by  the  owner  of  the  herd.  In  1908,  2  heifers  were  sent  to  the 
butcher  because  of  sterility,  a  loss  in  these  alone  of  4^^  of  the 
females  of  breeding  age.  These  animals  were  of  an  age  at  which 
they  should  have  bred  promptly. 

The  owner  of  the  herd  complains  chiefly  of  the  excessive 
occurrence  of  retained  placenta,  estimating  the  retention  at  20%, 
although  the  cows  are  very  well  kept,  strong  and  vigorous.  We 
have  casually  inspected  numerous  other  herds  in  the  vicinity  of 
Ithaca  and  elsewhere,  uniformly  finding  them  infected.  Where 
the  disease  is  severe,  abortion  is  common  ;  where  the  malady  is 
mild,  the  losses  are  correspondingly  low.  In  no  herd  investi- 
gated do  the  results  vary  in  any  material  way  from  those  described 
in  the  8  herds  we  have  already  reported  in  detail. 

The  symptoms  of  the  disease  have  been  largely  related  above. 
Within  2-5  days  after  infection,  the  vulvar  mucosa  becomes  in- 
jected, dark-red  and  swollen.  The  longitudinal  rugae  of  the 
mucous  membrane  become  more  prominent,  and  within  a  few  days 
small  granular  elevations  about  the  size  of  mustard  seed  appear 
in  the  vulvar  mucosa  as  hemispherical  elevations  above  the  sur- 
rounding epithelium.  They  appear  mostly  in  somewhat  indis- 
tinct longitudinal  rows.  Usually  they  are  most  prominent  about, 
or  just  anterior  to,  the  clitoris,  and  are  seen  chiefly  along  the 
summits  of  the  longitudinal  mucous  ridges.  In  heifer  calves, 
where  the  granules  are  usually  few  but  very  large  and  clear-cut, 
they  sometimes  tend  to  be  confined  to  the  immediate  region  of 
the  clitoris. 

In  moderate  and  .severe  cases,  the  granules  spread  completely 
around  the  vulva,  but  do  not  extend  to  the  cutaneous  margin. 
We  have  not  observed  the  enlarged  follicles  nearer  to  the  margins 
of  the  labile  than  14  inch.  Forward,  they  extend  as  far  as  may  be 
seen  by  parting  the  vulvar  lips.  The  irritation  of  the  mucosa 
increa.ses  anteriorly. 


Granular    Venereal  Disease  of  Cows  1093 


INFECTIOUvS  VAGINAL  CATARRH  OF  COWS. 

Photo-Micrographs  after  Thorns,  from  the  Monalshefte  fiir  Praktische 
Tierheilkunde,   Vol.    17.     P  25. 

PLATE  L 

Fig.  I.  Section  from  the  left  side  of  the  vestibule  of  the  vagina  showing 
an  elevation  in  the  mucosa  due  to  a  single  follicle. 

Fig.  2.  Section  through  4  contiguous  follicles  which  cause  a  single, 
rather  flat  elevation  of  the  surface. 

PLATE  IL 

Fig.  3.  A  Knob-like  elevation  of  the  mucosa  due  to  several  contiguous 
follicles. 

Fig.  4.  A  section  from  roof  of  the  vagina,  showing  marked  follicle-form- 
ation without  macroscopically  visible  elevation  of  the  mucosa. 


PLATE  I. 


Fig. 


Fig.  2. 


PLATE  II. 


Fig.  3. 


Fig.  4- 


1096  Veterinary  Obstetrics 

The  injection  of  the  mucosa  varies  in  intensity  in  different 
herds,  in  different  individuals  of  the  same  herd,  and  in  the  same 
individual  at  different  periods.  The  variations  in  intensity  are 
frequently  very  abrupt,  and  sometimes  not  readily  explained. 
When  a  non-pregnant  animal  comes  in  estrum,  the  mucosa  be- 
comes increasingly  irritated  and  reddened.  If  coition  occurs, 
the  irritation  is  very  greatly  increased.  The  entire  visible  portion 
of  the  mucosa  is  intensely  inflamed,  dark  red,  and  swollen,  and 
the  epithelium  is  covered  over  with  flocculent  muco-purulent  ex- 
udates. After  estrum  and  service,  the  intensity  slowly  abates, 
and  the  mucosa  may  largely  lose  its  irritated  appearance  in  10 
to  15  days.  If  pregnancy  occurs,  the  vulvo- vaginal  irritation 
may  remain  static,  increase,  or  decrease.  In  old  cows  which 
have  been  long  diseased,  the  mucosa  becomes  more  pale,  yellow- 
ish and  flaccid.  Ecchymo.ses  in  the  mucosa  are  frequently 
ob.served. 

The  vulvo- vaginal  discharge  is  parallel  to  the  degree  of  vagini- 
tis. Whenever  the  di.sease  is  intense,  there  is  more  or  less  con- 
stant mucous,  muco-purulent  or  purulent  discharge,  which  soils 
the  tail  and  vulva,  and  especially  adheres  to  the  vulvar  tuft  of 
hairs.  When  complicated  with  pyometra,  there  is  usually  a  pro- 
fuse purulent  discharge,  and  one  or  two  pints  are  frequently  ob- 
served in  the  gutter  behind  the  cow. 

The  prepuce  of  the  clitoris  is  occasionally  the  seat  of  profuse 
suppuration.  In  such  cases, pressure  from  outside  and  beneath 
the  clitoris,  while  the  labise  are  parted,  causes  15  or  20  drops  of 
thick  white  pus  to  be  pressed  out.  The  lips  of  the  vulva  are 
frequently  swollen,  tense  and  somewhat  sensitive   to  the  touch. 

When  parturition  or  abortion  approaches,  the  enlarged  follicles 
become  less  conspicuous,  and  finally  disappear  more  or  less  com- 
pletely from  vision.  As  soon  as  the  vulva  and  vulvar  mucosa 
become  markedly  edematous,  when  the  animal  is  "springing", 
the  granules  rapidly  become  less  conspicuous,  and  sometimes  2,  3 
or  more  weeks  prior  to  parturition  or  abortion,  the  enlarged  folli- 
cles are  no  longer  visible.  After  the  animal  calves  or  aborts,  the 
granules  usually  remain  invisible  for  one  or  more  weeks,  until 
the  edema  of  the  external  genitals  subsides,  when  they  reappear. 

The  nodules  have  not  ceased  to  exist,  .so  far  as  we  can  deter- 
mine, but  have  merely  become  hidden  in  the  edema  of  the  mucosa. 
In  some  cases  one  may  still  recognize  the  hidden  granules  with 


Granular    Veftereal  Disease  of  Cows  1097 

the  finger  tips.  In  some  cases  the  granules  may  remain  hidden 
for  even  a  longer  period  of  time.  In  pyometra,  following  abor- 
tion or  retained  placenta,  the  vulvar  mucosa  may  remain  edema- 
tous and  swollen  for  a  long  period  of  time,  and  the  granules 
scarcely,  if  at  all  visible.  According  to  our  observations,  the  in- 
jection of  the  genital  mucosa,  just  prior  and  subsequent  to  partu- 
rition or  abortion,  is  more  intense,  and  the  tissues  are  darker 
and  are  usually  more  swollen  than  at  the  same  period  in 
healthy  cows. 

The  invisibility  of  the  granules  during  the  parturient  state  is 
significant  and  important.  Failure  to  recognize  the  fact  may  lead 
to  overlooking  the  disease,  especially  in  cases  of  abortion  and  re- 
tained placenta,  and  cause  the  veterinarian  to  render  a  false  diag- 
nosis. The  error  in  diagnosis  tempts  the  veterinarian  to  conclude 
that  the  malady  has  no  important  relation  to  abortion,  because 
the  cows  which  show  the  granules  in  abundance  do  not  abort, 
and  those  which  do  abort  show  no  granules  immediately  before 
or  after  abortion.  If  the  disease  exists  in  the  herd,  and  the  vet- 
erinarian is  called  to  attend  an  animal  for  abortion  or  retained 
placenta,  he  should  tentatively  regard  the  patient  as  infected  with 
granular  venereal  disease,  and  handle  the  case  accordingly.  Later, 
when  the  puerperal  edema  vanishes,  the  granules  will  generally 
become  evident  and  verify  the  diagnosis. 

The  symptoms  in  the  bull  are  far  less  conspicuous  than  in  the 
cow.  This  has  led  some  veterinarians  to  conclude  that  the  bull 
is  immune  to  the  disease  and  acts  only  as  a  passive  bearer  of  the 
infection  from  cow  to  cow  through  coition.  Others  observe 
catarrhal  inflammation  of  the  genital  mucosa,  with  muco-puru- 
lent  dischage  from  the  prepuce.  The  penis  of  the  bull  is  not 
freely  open  to  deliberate  inspection.  We  have  noted  very  marked 
muco-purulent  discharges,  which  disappear  under  antiseptic  irri- 
gations. The  penis  seems  enlarged,  and  the  mucosa  injected  and 
roughened.  In  some  cases,  ecchymoses  about  the  preputial  ring 
are  very  evident.  In  one  herd,  the  herdsman  complained  that 
the  bulls  became  lethargic  and  were  slow  to  copulate. 

The  diagnosis  in  the  cow  needs  offer  little  or  no  difficulty.  As 
in  other  diseases,  so  in  this,  an  individual  case  may  be  question- 
able, but  in  a  herd  where  it  prevails,  with  the  exception  of  preg- 
nant animals  near  to  parturition  or  abortion,  or  during  the  puer- 


1098  Veterinary  Obstetrics 

peral  state,  the  affected  animals  show  definite  and  easily  recogni- 
zable lesions. 

Pathology.  The  bacteriology  has  been  extensively  studied 
by  Ostertag'  and  other  European  investigators.  Ostertag  found 
a  diplococcus  or  short  streptococcus,  which  he  grew  in  pure  cult- 
ures, and  injected  into  the  vaginae  of  healthy  heifers,  inducing 
the  symptoms  of  the  disease.  He  recovered  pure  cultures  of  the 
organisms  from  the  vulvar  discharges  of  the  diseased  animals. 
The  organism  grows  readily  in  glycerine  agar,  urine  agar,  and 
other  neutral  or  alkaline  media.  It  stains  with  most  aniline 
bases,  especially  with  methyline  blue. 

The  organisms  are  found  in  the  muco-purulent  discharges,  be- 
tween the  pus  cells  or  within  the  protoplasm  of  these.  They  are 
able  to  penetrate  the  vaginal  mucosa,  and  are  found  between  the 
epithelial  cells,  as  well  as  in  the  mucous  pappillae,  a  fact  which 
explains  the  great  tenacity  of  the  infection  and  the  difficult}^  of 
curing  it. 

While  transmission  experiments  on  healthy  female  cattle  suc- 
ceeded, attempts  to  transmit  the  malady  to  horses,  sheep,  swine, 
goats,  rabbits  and  Guinea-pigs  were  negative.  Ostertag  also  at- 
tempted to  transmit  the  disease  to  a  bull,  but  failed  to  induce 
visible  symptoms,  and  concludes  that  the  bull  does  not  become 
affected  with  the  malady.  This  is  in  conflict  with  our  observa- 
tions, since  the  breeding  bulls  in  Herd  2  showed  in  some  cases  a 
distinct  preputial  catarrh.  When  the  penis  was  exposed  for  copu- 
lation, it  seemed  swollen  and  deeply  injected,  and  showed  very 
niarked  ecchymotic  areas  at  the  preputial  ring.  We  believed, 
also,  that  we  saw  granules  similar  to  those  in  the  vulvae  of  the 
cows,  but  the  opportunity  for  deliberate  inspection  was  not 
present. 

Ostertag  found  the  organisms  in  the  uterus  of  one  cow,  while 
in  others  he  failed  to  find  the  cocci  beyond  the  vagina,  and  con- 
cludes that  it  may  persist  in  the  vagina  month  after  month, 
without  invading  the  uterine  cavity. 

For  three  months  Ostertag  handled  one  artificially  infected 
heifer  with  alum  and  tannin  (1-5%  solution)  and  Lysol  and  Cre- 
oline()^-i%)  without  results.  Ostertag  regards  the  disease, 
from  his  observation,  as  a  very  serious  malady.     Out  of  250  ani- 

'  Monatshefte  fiir  Praktische  Thierheilkunde,  1901,  p.  536. 


Gramilar    Venereal  Disease  of  Cows  1099 

mals  inspected  by  him,  120  had    to  be  abandoned  for  breeding, 
because  of  vaginal  discharge,  sterility  or  repeated  abortion. 

Ostertag  recommends  that  the  disease  be  handled  by  the  official 
veterinarians,  and  quarantine  be  maintained  against  the  intro- 
duction of  diseased  animals  into  health}'  herds.  His  cultures 
from  the  closed  uterine  cavity  were  pure.  The  extension  of  the 
infection  into  the  uterine  cavity  is  significant.  The  fact  prob- 
ably has  a  definite  relation  to  the  induction  of  abortion  and 
sterility.  Abortion,  retained  after  birth  and  pyometra  are  per- 
haps referable  directly  or  indirectly  to  the  invasion  of  the  uterine 
cavity  by  the  organisms.  Others  have  recognized  the  organisms 
in  the  degenerated  ovaries.  These  facts  or  assumptions  exert 
an  influence  upon  the  prognosis  of  the  malady. 

The  experiments  of  Ostertag  and  others  indicate  that  the  period 
of  incubation  is  very  short,  2-5  days,  and  that  sometimes  irrita- 
tation  is  evident  within  24  hours. 

The  granular  elevations  in  the  mucosa  are  due  to  swelling  of 
the  lymph  follicles  in  the  vulvar  mucosa.  They  are  most  promi- 
nent in  heifers. 

The  complications  and  sequelae  of  granular  venereal  disease 
are  diverse  and  important. 

Abortion.  European  authors  are  practically  unanimous  in 
regarding  it  as  the  cause  of  much  of  the  abortion  in  cows.  Some 
regard  the  disease  as  identical  with  "  contagious  abortion",  while 
most  observers  regard  it  as  wholly  distinct,  nevertheless  highly 
important  as  a  cause  of  abortion.  Many  have  observed  20,  50, 
70,  and  80%  of  abortions  for  one,  two  or  more  successive  years. 
In  other  affected  herds,  the  disease  exists  for  several  years  with- 
out the  occurrence  of  abortion.  In  America  we  have  no  data 
available  upon  the  question,  beyond  the  observations  related 
above.  In  numerous  herds,  where  the  disease  exists  in  a  mild 
form,  no  history  of  prior  abortions  can  be  obtained.  We  have 
no  positive  data  how  long  the  disease  has  existed  in  any  one 
herd,  but  its  wide  dissemination,  its  presence  in  well  nigh  every 
herd  in  the  regions  inspected,  indicate  that  it  is  not  new.  In  our 
observations,  ^o'/(  of  abortions  appears  to  represent  the  maxi- 
mum. It  is  not  rare  in  the  dairying  districts  of  this  state  for 
80%  to  90%  or  more  of  the  pregnant  cows  to  abort,  but  we  have 
not,  in  the  brief  time  elapsing  since  the  recognition  of  the  malady, 
had   opportunity  to  determine  the  presence  or  absence  of  the 


I  loo  Veterhiary  Obstetrics 

malady  in  such  herds.  Whenever  the  vulvar  lesions  are  generally 
intense  in  a  herd,  we  have  observed  abortion  in  a  serious  degree, 
10-50%.  When  the  vulvar  lesions  in  the  herd  are  as  a  rule  mild, 
abortion  is  rather  unimportant  or  absent. 

Premature  births  are  also  not  rare.  They  occur  in  those  herds 
where  abortion  is  common.  The  calves  are  weak,  though  some 
of  them  survive.  Prematurely  born  calves  apparently  suffer  di- 
rectly from  the  infection  in  many  cases,  and  repeatedly  emit  a 
peculiar  bleat  which  dairymen  recognize  as  belonging  to  conta- 
gious abortion. 

Retained  placenta  is  common,  following  abortion,  premature 
birth  and  calving  at  full  term.  The  retention  is  comparatively 
severe  and  serious.  It  occurs  in  well  kept,  vigorous  cows  and 
heifers,  as  well  as  those  which  are  emaciated  or  weak. 

Septic  metritis,  septicaemia,  pyaemia,  and  pyometra  fre- 
quently follow  abortion,  premature  birth  and  full  term  parturi- 
tion. These  complications  are  severe  and  malignant.  They  offer 
otherwi.se  the  usual  symptoms,  course  and  prognosis. 

Death  of  the  fetus,  without  expulsion,  but  undergoing  emphy- 
sematous decomposition  instead,  occasionally  occurs.  The  fetus 
perishes  ;  the  cervical  canal  dilates  tardily  and  incompletely  ; 
emphysema  occurs  promptly  ;  the  uterus  becomes  paretic  from 
distension  or  gangrene  ;  no  visible,  or  only  feeble,  labor  pains 
occur  ;  and  the  first  symptom  to  attract  the  owner's  attention  is 
the  protrusion  from  the  vulva  of  decomposing  afterbirth,  or  the 
appearance  of  a  dirty  reddish  or  brownish,  thin,  fetid  discharge 
from  the  vulva. 

Diseases  of  the  ovaries  are  among  the  most  common  and 
serious  complications  and  .sequelae.  These  have  been  alluded  to 
in  our  account  of  the  prevalence  of  the  di.sea.se  in  various  herds. 
When  the  disease  is  mild  in  a  herd,  ovarian  diseases  may  be  un- 
important or  absent,  but  when  severe,  10-50%  of  the  animals 
may  suffer  from  ovarian  diseases,  and  become  thereby  sterile. 

Cystic  degeneration  of  the  ovaries  is  the  most  common 
form  of  resulting  ovarian  disease.  We  have  already  discussed 
this  disease  under  "  Sterility  "  on  page  161. 

Persistent,  hypertrophied  corpora  lutea  are  also  common 
following  this  disease.  These  too  have  been  discussed  while  deal- 
ing with  sterility. 


Grayiular    Venereal  Disease  of  Cows  iioi 

Accompanying  these  ovarian  diseases  are  frequently  nympho- 
mania or  absence  of  estrum  (stillochsigkeit).  One  large,  vigor- 
ous heifer  in  Herd  2  aborted  at  2  years,  and  after  an  interval  of 
6  months  has  not  been  in  estrum  so  far  as  discovered.  The  left 
ovary  contained  a  hypertrophied  corpus  luteum  i}4  inches  in 
diameter.  It  was  crushed  out.  Three  weeks  later,  another  of 
similar  size  had  formed  in  the  same  place.  It  too  was  pressed 
out.  These  diseases  ma}'  possibly  recover  spontaneoush\  In 
mild  cases  of  the  disease,  a  large  proportion  of  cows  breed,  if  the 
cysts  or  yellow  bodies  are  pressed  out. 

Abscess  of  the  ovaries  occasionally  occurs.  In  one  case,  we 
diagnosed  the  condition  by  rectal  palpation,  supported  our  diag- 
nosis by  digital  exploration  through  an  incision  in  the  vagina  as 
for  .spaying,  and  verified  the  conclusion  by  post  mortem 
examination. 

Inflammation  of  the  oviducts,  pyosalpinx,  is  also  observed. 
Presumably  the  diseases  of  the  uterus,  oviducts  and  ovaries  are 
due  to  an  extension  of  the  infection  along  the  genital  tract,  in- 
volving the  oviducts,  which  may  leave  them  permanently  affected, 
containing  pus  (pyosalpinx)  or  causing  atresia.  When  ovaritis 
or  abscess  of  the  ovaries  occurs,  the  pavillion  of  the  oviduct  may 
become  adherent  to  the  gland. 

The  significance  of  the  disease  to  the  cattle  breeder  is 
highly  important.  European  investigators,  in  Switzerland, 
Austria,  Italy,  Germany  and  Denmark,  are  practically  unani- 
mous in  regarding  the  disease  as  one  of  the  worst  scourges 
known  to  dairymen.  Hutyra  and  Marek  (Special  Pathology 
and  Therapy  of  Domestic  Animals),  Friedberger  and  Frohner 
(Special  Pathology  and  Therapy),  Ostertag,  Hess,  Zschokke, 
Nielsen,  and  other  European  investigators,  teachers,  and  authors 
of  the  highest  rank,  unite  in  regarding  the  malady  as  exceed- 
ingly serious  from  the  standpoint  of  economics.  Some  observers 
regard  it  as  more  to  be  dreaded,  economically,  than  Foot-and- 
Mouth  Disease. 

The  data  submitted  in  regard  to  the  various  infected  herds  in- 
vestigated by  us  indicate  that  it  is  no  less  serious  in  America. 
The  fact  that  some  affected  herds  apparently  suffer  no  ill  conse- 
quences from  the  malady  neither  removes  nor  ameliorates  the 
losses  incurred  in  others.  In  one  herd,  where  tuberculosis  has  ex- 
isted in  a  large  measure  and  the  Bang  method  is  being  applied,  the 


II02  Veterinary  Obstetrics 

manager  is  very  emphatic  in  the  view  that  the  granular  venereal 
disease  is  much  the  more  expensive  and  dreadful  of  the  two 
maladies,  coexisting  in  the  herd. 

The  frequently  appalling  losses  from  abortion,  and  the  sterility 
accompanying  the  malady,  make  it  highly  important  that  the 
dairyman  and  cattle  breeder  recognize  this  as  a  serious  affection, 
and  enlist  the  best  veterinary  advice  for  the  purpose  of  prevent- 
ing and  eradicating  the  disease. 

To  the  veterinarian,  the  recognition  of  the  malady,  and 
its  importance,  is  of  even  greater  consequence.  "Conta- 
gious Abortion"  and  "Sterility"  have  long  been  a  nightmare 
to  the  American  veterinarian.  He  has  been  helpless  to  extend 
any  scientific  aid  or  advice  to  the  dairyman  or  breeder,  and  has 
opened  the  way  and  left  the  field  unoccupied  and  undisputed  for 
the  charlatan,  with  his  nostrums  for  abortion,  and  his  panaceas, 
impregnators  and  sorcery  for  sterility. 

If  the  veterinarians  will  but  recognize  and  scientifically  study 
this  malady,  much  of  the  abortion  and  sterility  may  be  brought 
under  control,  and  a  long-standing,  unfortunate  odium  of  ineflli- 
ciency  in  reference  to  these  common  diseases  removed. 

The  clinical  proof  of  the  seriousness  of  the  malady,  and  its 
connection  with  abortion  and  sterility,  is  well  supported  by  our 
observations,  as  well  as  by  the  testimony  of  the  highest  Euro- 
pean writers.  The  relation  of  the  granular  venereal  disease  to 
abortion  and  .sterility  is  supported  by  the  following  data,  already 
enumerated  above  : 

1.  In  each  herd  where  abortion  and  sterility  are  causing,  or 
have  caused,  serious  losses,  the  granular  venereal  disease  is  very 
prevalent,  and  of  medium  or  severe  degree. 

2.  The  amount  of  loss  from  abortion  and  sterility  is  in  harmony 
with  the  intensity  of  the  visible  lesions.  If  the  general  average 
of  the  lesions  in  the  herd  is  intense,  the  losses  are  severe  ;  if  the 
lesions  are  mild,  abortion  and  sterility  are  rare  or  may  be  absent. 

3.  In  infected  herds,  when  the  animals  are  kept  in  .separate 
groups  in  different  stables,  and  the  disease  varies  in  intensity  in 
the  different  stables,  abortion  and  sterility  show  like  variations. 

4.  In  affected  herds,  adult  animals  which  show  no  lesions  in 
the  vulva,  without  exception  breed  regularly  and  do  not  abort. 

5.  No  other  tangible  explanation  for  the  occurrence  of  the 
abortion,  or  of  the  ovarian,  uterine  or  tubal  disease  leading  to 
sterility,  has  yet  been  offered. 


Gj-anular    Venereal  Disease  of  Cows  1 103 

The  prognosis  of  the  disease,  based  upon  European  observa- 
tions and  those  thus  far  made  in  America,  is  very  unfavorable 
unless  vigorous  prophylactic  and  curative  measures  are  insti- 
tuted. Some  believe  in  spontaneous  recovery,  and  there  is  much 
to  support  this  belief.  In  one  stable  in  Herd  2,  there  is  a  number 
of  aged  cows,  which  are  apparently  sound,  breed  regularly  and 
promptly,  and  give  birth  annually  to  healthy,  vigorous  calves. 
These  animals  stand  side  by  side  with  diseased  cows  year  after 
year,  and  are  served  by  the  same  bull,  and  the  diseased  and 
healthy  cows  are  groomed  with  the  same  utensils  and  handled 
by  the  same  persons  without  precautions.  These  facts  combine  to 
indicate  either  that  these  cows  have  always  possessed  immunity 
or  have  at  one  time  been  diseased,  have  recovered,  and  acquired 
immunity  against  the  malady. 

How  long  a  time  is  required  for  such  spontaneous  recovery  is 
purely  speculative.  In  most  of  the  herds  observed,  50  to  80%  of 
the  aged  cows  are  now  affected,  and  the  history  of  most  of  these 
herds  indicates  that  they  have  been  infected  four  or  more  years. 
If  these  assumptions  are  correct,  the  outlook  for  early  spontane- 
ous recovery  is  certainly  poor.  A  pregnant  affected  cow  brought 
to  the  college  has  now  been  under  observation  five  months,  is  not 
exposed  to  fresh  infection,  and  is  well  kept  ;  but  the  lesions  are 
now  as  pronounced  as  they  were  when  first  examined. 

Our  observations  indicate,  however,  that  diseased  animals, 
after  a  time,  acquire  a  degree  of  immunity  against  the  effects  of 
the  disease.  A  cow  aborts  one  year,  perhaps  a  second  year,  and 
possibly  a  third,  and  then  proceeds  to  carry  her  calf  full  time, 
and  it  is  born  vigorous  and  healthy.  In  an  aborting  herd,  the 
body  of  the  herd  largely  ceases  to  abort.  New  cows  introduced 
into  the  herd  very  largely  abort.  Heifers  raised  in  the  herd, 
and  probably  infected  at  the  first  breeding,  abort  the  first  calf ; 
and,  if  they  remain  fertile,  probabl}'  abort  the  second  calf;  and, 
passing  this  ordeal,  may  breed  regularly. 

The  prevalence  of  sterility  is  apparently  somewhat  analogous. 
If  the  cow  continues  to  breed  for  the  first  few  years  after  she 
has  become  diseased,  she  will  probably  continue  to  breed  per- 
manently. Sterility  is  very  common  and  ruinous  in  herds  where 
the  disease  is  already  present  in  the  virgin  heifers,  and  the  basis 
for  the  sterility  is  laid  prior  to  coition.  Such  sterility  defeats 
the  breeder  and  dairyman  wholly. 


II04  Veteriyiary  Obstetrics 

The  acquired  immunity  to  abortion  affords  the  charlatan  his 
opportunity  to  play  upon  the  credulity  of  the  owner  and  profit 
by  the  sale  of  his  nostrums.  If  he  sells  his  nostrums  at  the 
opportune  moment,  the  owner  believes  a  cure  has  been  effected, 
when  in  fact  there  is  an  acquired  immunity  to  abortion  in  the 
animal,  though  the  actual  disease  is  still  there,  ready  to  spread 
to  other  susceptible  animals,  or,  upon  provocation,  to  again  flare 
up  and  cause  abortion,  sterility,  or  other  disagreeable  con- 
sequences. 

Intelligently  handled,  the  prognosis  is  good.  Such  is  the 
general  view  of  European  authors,  and  such  are  the  indications 
based  upon  our  ob.servations.  Our  experience  is  too  brief,  how- 
ever, to  warrant  unqualified  acceptance  of  any  of  the  conclusions 
to  which  we  may  have  come.  The  cure  of  the  disease  is  no  idle 
task. 

The  germs,  being  deeply  imbedded  among  the  epithelial  cells 
and  in  the  follicles  of  the  genital  mucosa,  can  neither  be  readily 
washed  away  nor  killed  in  position.  Evidently  the  basis  of 
treatment  is  disinfection,  but  the  thorough  destruction  of  disease- 
producing  organisms  so  deeply  entrenched  is  a  difficult  task. 
Yet  the  experience  of  others,  and  our  brief  efforts,  indicate  that  it 
is  by  no  means  a  hopeless  task,  but  one  which  promises  definite 
and  satisfactory  results,  at  a  \^xy  small  expenditure  of  labor  and 
material,  when  compared  with  the  benefits  to  accrue. 

The  prophylaxis  is  simple.  The  handling  of  sterility  following 
the  malady  is  quite  satisfactory. 

The  treatment  of  the  disease  is  based  fundamentally  upon 
disinfection.  Four  important  questions  arise,  none  of  which  are 
fully  decided.  It  has  not  been  determined  what  disinfectant  is 
best,  in  what  degree  of  concentration  the  di.sinfectant  shall  be 
used,  the  extent  of  the  area  requiring  disinfection,  or  the  manner 
and  frequency  of  application.  Richter  (B.  T.  W.  No.  42,  p.  774) 
advises  bacillol  ointment,  and  reports  cures  in  28.6%  of  ca.ses  in 
4-6  weeks.  Diem,  (W.  f.  T.,  Vol.  LI,  p.  181),  prefers  irriga- 
tions to  ointments,  and  commends  >^-i%  formalin.  Wohlmutter 
(Thierartzliche  Centralblatt,  1906,  No.  2,  p.  4)  favors  bacillol 
ointment  in  capsules,  and  considers  two  months  the  minimum 
time  for  healing.  Raebiger  (B.  T.  W.,  1906,  No.  13,  p.  241) 
advises  a  6-io'/f  bacillol  ointment  as  the  best  method,  and  applies 
this  with  a  special  syringe.    This  he  would  alternate  with  a  2-3  9<) 


Granular    Venereal  Disease  of  Coivs  1105 

iodine  ointment.  Poschel  (B.  T.  W.  1906,  p.  323)  advises  a 
mixture  of  lard  and  bacillol  enclosed  in  gelatine  capsules  and  in- 
serted with  the  fingers  twice  weekly  into  the  vagina.  Blau  ( Alla- 
torvosi  Lapok,  1906,  No.  2)  recommends  3^^  creoline  injections, 
with  which  he  claims  to  induce  a  cure  in  8-10  days  (?). 

Ostertag  (Monatshefte  f.  Prakt.  Tierheilkunde,  1901,  p.  532) 
would  handle  the  malady  with  a  2  to  5%  solution  of  lactic  acid 
or  2  to  5  9f  solution  of  creolin.  He  warns  against  stronger 
solutions  than  2.5*/^,  because  they  irritate  greatly  and  cause  con- 
tinued straining.  He  excludes  silver  nitrate  as  a  disinfectant 
on  account  of  its  cost.  He  warns  veterinarians  to  use  care  in 
prescribing  to  laymen,  and  to  get  the  measurements  precise. 
Such  irrigations  of  the  vagina  should  occur  2  to  3  times  daily. 

Ostertag,  in  harmony  with  the  recommendations  of  R.  Frohner, 
Martens  and  Ellinger,  recommends  the  following  measures  for 
control  and  eradication  : 

1.  The  isolation  of  the  sound  from  the  diseased,  as  far  as 
possible. 

2.  Disinfection  of  the  stables,  especially  of  the  stanchions, 
floors,  gutters  and  passage  ways. 

3.  Cleansing  the  vulva  and  neighboring  parts  from  the  accumu- 
lated vulvar  discharges. 

4.  Withdrawal  of  affected  cows  from  breeding. 

The  same  rule  should  be  applied  to  breeding  bulls.  If  there 
are  evidences  of  preputial  discharges,  the  bull  should  not  be  used 
for  breeding  until  apparently  cured. 

In  infected  herds,  the  penis  and  sheath  should  be  disinfected. 
Ostertag  is  of  the  opinion,  also,  that  the  disease  should  be 
officially  recognized,  and  dealt  with  as  contagious  by  the  veteri- 
nary police  service. 

Without  noteworthy  exception,  all  investigators  report  the 
malady  very  obstinate  to  handle,  requiring  vigorous  and  per- 
sistent treatment,  but  finally  yielding. 

Our  experience  in  handling  has  been  confined  to  Herd  2.  In 
this  herd,  a  stable  containing  38  cows  and  heifers  was  placed 
under  treatment  on  March  6th,  or  the  following  days. 

Two  cows  were  placed  upon  vaginal  injections  of  0.57;  carbolic  acid  on 
March  7.  From  March  7-15  inclusive.  No.  i  apparently  improved.  On 
March  16.  she  strained  severely,  and  the  straining  was  continued  after  each 
irrigation,  along  with  increased  irritation  and  injection  of  the  genital  mu- 

70 


I  io6  Veterinary  Obstetrics 

cosa,  and  increased  discharge,  until  the  iSth,  when  treatment  was  omitted. 
On  the  19th,  \'',  solution  of  soda  bicarbonate  was  injected,  which  caused 
no  straining,  but  the  irritation  and  increased  vaginal  discharge  continued 
until  April  4th,  when  she  was  placed  upon  daily  vaginal  irrigations  with 
0.75'i  bacillol.  vSince  that  date  there  has  been  gradual  improvement,  and 
no  further  change  has  been  made. 

In  No.  2  no  irritation  appeared  until  March  20th,  and  then  only  slight, 
but  it  persisted  to  some  extent,  and  the  irrigations  were  continued  until 
April  4,  when  the  improvement  was  slow  and  unsatisfactory,  and  the  treat- 
ment changed  to  0.75'/^  bacillol. 

A  third  cow  was  handled  by  inserting  into  the  vagina,  once  daily,  a  gela- 
tine capsule  containing  two  drams  of  powdered  iodoform.  This  treatment 
was  continued  from  March  y-ijth,  with  con.stantly  increasing  irritation  of 
the  vulvar  mucosa  and  increasing  muco-purulent  discharge.  At  this  time  a 
change  was  made  to 0.5 'v  carbolic  acid,  which  caused  much  irritation,  and 
another  change  to  i  '/i  soda  bicarbonate  solution,  which  was  continued  until 
March  30th.  A  return  was  then  made  to  o.^'/i  carbolic  acid,  which  was 
continued  with  little  improvement  till  April  4,  when  a  change  was  made  to 
0-75^  bacillol,  since  which  time  progress  has  been  satisfactory. 

A  group  of  7  cows,  5  on  March  6  and  2  on  March  7,  were  placed  upon 
daily  vaginal  irrigations  of  0.75%  bacillol.  Each  cow  improved  markedly 
and  satisfactorily  from  the  first.  The  irrigation  caused  no  straining,  the 
vaginal  discharge  decreased,  the  injection  of  the  vulvar  mucosa  receded  until, 
on  April  26,  they  had  so  far  recovered  that  it  was  advised  to  breed  them 
whenever  in  estrum.  The  granular  elevations  were  still  present,  but  very 
inconspicuous,  flattened  and  pale.  One  of  this  group  had  been  served  by  4 
different  bulls,  in  all  8  services,  and  aborted  at  8  months  on  February  2,  1909. 
At  beginning  of  handling,  pyometra  was  present,  and  the  uterus  contained 
about  I  gallon  of  pus.  The  os  uteri  was  firmly  closed.  The  ovaries  could 
not  be  grasped  per  rectum.  The  uterus  was  massaged  per  rectum  from  be- 
fore backwards  April  4,  the  titer  us  was  normal.  The  right  ovary  contained 
a  yellow  body  ^^  inch  in  diameter,  which  was  pressed  out.  The  left  ovary 
was  normal.  Between  April  26  and  May  23,  the  cows  in  this  group  had 
been  bred.  Inspection  on  May  23  showed  irritation,  apparently  as  a  re- 
sult of  copulation,  in  but  one  animal,  the  cow  which  had  suffered  from 
pyometra. 

On  March  6,  a  group  of  5  cows  was  handled  by  introducing  deeply  into 
the  vagina  of  each  a  gelatine  capsule  containing  2  drams  of  powd.  iodoform. 
This  was  continued  daily  until  March  17th,  or  10  days.  The  muco-purulent 
discharge,  the  irritation,  and  the  prominence  of  the  granules  increased,  but 
the  patients  did  not  strain. 

On  March  17,  each  animal  in  the  group  received  an  application  of  oint- 
ment containing  ^'/i  each  of  iodoform  and  tannin.  This  caused  intense 
straining,  and  the  experiment  was  discontinued. 

On  March  iS,  the  group  was  placed  upon  0.75'v  bacillol,  since  which 
time  the  animuls  have  slowly  improved,  but,  after  more  than  5  weeks  under 
bacillol,  did  not  show  such  improvement  as  those  which  had  been  placed  on 
bacillol  from   the  first  had  shown  after  3  or  4  weeks  of  handling.     Appar- 


Granular    Ve7iereal  Disease  of  Cows  1 107 

ently  the  iodoform  treatment  had  proven  harmful,  and  interfered  with  the 
progress  after  the  cases  had  been  placed  on  bacillol. 

A  group  of  4  virgin  heifers  received,  March  6,  one  gelatine  capsule  each, 
containing  10%  bacillol  ointment,  introduced  deeply  into  the  vagina.  For 
a  few  days  they  appeared  to  bear  the  ointment  well,  and  it  was  repeated 
daily.  Gradually  irritation  appeared  and  increased,  the  discharge  became 
more  conspicuous,  the  vulva  became  swollen,  straining  began  and  loss  of 
appetite  occurred.  On  March  12,  the  irritation  had  become  so  marked  that 
treatment  had  to  be  suspended.  In  place  of  bacillol  ointment,  we  used,  for 
a  day  or  tw-o,  a  0.1%  permanganate  of  potash  solution,  and  on  the  17th 
changed  to  5  %  bacillol  ointment.  This  could  not  be  borne,  and  we  again 
usedo.  I'/i^  potassium  permanganate,  under  which  the  irritation  abated,  but 
no  marked  progress  was  made.  On  April  5,  two  of  the  heifers  were  removed, 
and  the  other  2  were  changed  to  o.Js'/c  bacillol. 

A  2>^  year  heifer,  after  having  been  served  9  times  and  by  5  diflferent 
bulls,  presumably  conceived,  and  later  aborted.  This  conclusion  was  predi- 
cated upon  suspension  of  estrum  for  4  months,  after  which  it  returned.  On 
March  6,  1909,  she  received  an  irrigation  of  1 ',-  carbolic  acid,  tannin  and 
glycerine,  which  caused  severe  straining  for  i  )4  hours.  On  March  7,  the 
vulvar  mucosa  was  much  irritated.  She  received  a  1-4000  corrosive  subli- 
mate solution,  which  caused  severe  straining.  The  same  was  repeated  on 
the  8th.  March  9  she  received  a  2^^  solution  of  lactic  acid,  which  caused 
very  intense  straining.  On  March  10,  she  received  an  application  of  10% 
carbolic  acid  ointment,  which  caused  some  straining.  This  was  continued 
for  5  days.  On  March  15  and  16,  she  received  iC^r  bacillol  ointment,  which 
caused  slight  straining.  From  March  17  to  April  5,  she  received  daily  a  2% 
iodine  ointment,  with  little  straining  or  irritation.  On  April  6,  she  was 
placed  upon  0.75^^  bacillol,  since  which  time  she  has  improved  slowly. 

A  group  of  5  cows  received,  on  March  6,  vaginal  injections  of  i  Of  carbolic 
acid  ;  all  strained  violently  for  i  }4  hours.  As  all  were  in  somewhat  advanced 
pregnancy,  it  was  deemed  dangerous  to  continue  so  irritant  an  application. 

On  March  7,  each  animal  in  the  group  received  in  ihe  vagina  a  gelatme 
capsule  containing  2  drams  iodoform.  This  treatment  was  continued  till 
March  16,  accompanied  by  little  or  no  straining,  but  the  irritation  and  dis- 
charge did  not  improve.  On  March  17,  a  change  was  made  to  5'y  carbolic 
acid  ointment,  which  caused  straining  and  irritation. 

On  March  18,  a  change  was  made  to  irrigations  with  0.1 '/r  potassium 
permanganate  solution,  under  which  there  was  slight,  but  unsatisfactory 
improvement  until  April  6,  when  they  were  placed  upon  o.  75  '■■/■■  bacillol 
solution,  from  which  date  slow  improvement  has  occurred. 

A  group  of  5  affected  animals  was  placed  upon  daily  vaginal  irrigations 
of  o.  I  '/f  potassa  permanganate  on  March  6.  All  seemed  to  do  well  and  im- 
proved slowly  for  3  or  4  weeks,  when  they  began  to  show  irritation  and  in- 
creased discharge,  without  any  marked  decrease  in  the  number  or  size  of 
the  granules  in  the  vulva.  One,  well  advanced  in  pregnancy,  showed 
signs  of  approaching  parturition  on  April  7,  and  the  vaginal  irrigations 
were  suspended  on  April  14th.  Another,  also  pregnant,  showed  increased 
irritation,  and  on  April  4  the  potassium  permanganate  solution  was  reduced 


iio8  Veterinary  Obstetrics 

to  I-2000,  but  the  irritation  continued,  and  the  irrigation  was  stopped. 
A  third  animal  behaved  similarly  to  the  two  preceding ;  treatment 
suspended  because  of  approaching  parturition.  Calved  March  22,  re- 
turned to  stable  March  29  and  treatment  resumed.  The  animal  was  ill  April 
I,  apparently  from  overfeeding.  On  April  17  she  was  removed  to  another 
stable,  and  treatment  suspended.  The  two  remaining  animals  made  little  or 
no  progress  up  to  April  4,  or  one  month,  and  the  experiment  was  abandoned. 
The  general  result  from  potassium  ])ermanganate  irrigations  had  proven  un- 
satisfactorv.  At  first  it  was  deceptive,  the  animals  apparently  improving 
and  straining  none,  but  later  irritation  became  marked,  more  or  less  strain- 
ing appeared,  and  there  was  a  decided  increase  in  the  muco-purulent  vagi- 
nal discharge.  At  the  end  of  the  experiment  the  granules  were  as  numerous 
and  prominent  as  ever,  Three  of  the  group  were  placed  upon  bacillol  at 
the  close  of  the  experiment,  but  after  three  weeks  of  handling  were  not 
nearly  so  much  improved  as  new  cases  placed  upon  the  bacillol  at  the  same 
time. 

A  group  of  5  animals  received,  March  6,  vaginal  injections  of  2  '/r  bacillol 
solution,  which  induced  severe  straining  for  one  hour.  A  change  was  made 
on  March  7,  to  lo'v  bacillol  ointment  in  capsules,  which  by  March  17  was 
causing  .so  much  straining  that  it  was  abandoned,  and  for  one  day  a  0.75'^ 
bacillol  solution  used.  On  March  i8th  a  ^'/i  bacillol  ointment  was  tried, 
but  again  caused  irritation,  and  on  the  following  day  o.  i '/(  potassium 
permanganate  solution  was  substituted,  and  continued  with  indifferent  and 
unsatisfactory  results  until  April  19,  when  a  change  was  made  to  o.^^'/r 
bacillol. 

Owing  to  many  inquiries  concerning  the  efficacy  of  various  proprietary 
abortion  nostrums,  it  was  decided  to  test  one  of  them  alongside  other  reme- 
dies for  comparison.  For  this  purpose,  one  of  the  best  known  was  selected, 
and  a  supply  ordered.  A  group  of  4  cows  was  placed  upon  this  remedy, 
each  animal  receiving  the  treatment  daily,  according  to  directions,  from 
March  17  to  April  18,  without  any  improvement  in  the  .symptoms  If  any 
change,  the)'  were  worse  than  at  the  beginning.  They  were  then  placed 
upon  0.75%  bacillol  solution,  since  which  their  progress  has  been  slow,  but 
definite. 

On  April  4,  a  group  of  40  cows,  all  in  milk,  some  pregnant,  were  placed 
upon  daily  vaginal  irrigations  with  0.75'/  bacillol  solution,  vulvar  irriga- 
tions with  2'/i  bacillol  and  daily  washing  of  the  tail,  perineimi and  buttocks, 
with  2'/^  carbolic  acid  solution.  Inspection  22  days  later,  on  April  26, 
showed  uniform  and  satisfactory  improvement. 

Inspection  of  this  group  on  May  23,  or  49  days  after  commencement  of 
the  treatment,  revealed  a  very  satisfactory  condition.  All  had  greatly  im- 
proved. Quite  a  number  had  been  bred  without  causing  any  visible  relapse. 
In  3  or  4  cows  the  breeding  had  apparently  retarded  the  progress  toward 
recovery,  though  only  .slightly.  In  general  the  granules  were  decreased  in 
number,  flatter,  less  conspicuous,  the  vulvar  mucosa  slightly  or  not  visibly 
irritated.  vSome  animals,  badly  affected  at  the  commencement  of  the 
handling,  7  weeks  before,  were  to  all  visible  appearances  wholly  recovered. 
Everything  indicated  a  complete  recovery  at  an   early  date. 


Granular    Venereal  Disease  of  Cows  1 109 

In  all  the  foregoing  experiments,  the  cows  received  daily  wash- 
ings of  the  tail,  buttocks  and  perineal  regions  with  2%  carbolic 
acid  solution,  except  for  a  short  interval  when,  in  the  absence  of 
carbolic  acid,  lysol  or  bacillol  was  used  instead.  It  was  found, 
however,  that  2%  bacillol  or  lysol  on  the  skin  proved  irritant, 
causing  much  switching  of  the  tail  and  stamping  with  the  feet. 
It  was  consequently  reduced,  for  external  washing,  to  i  %. 

In  the  foregoing  work  we  limited  ourselves,  at  the  beginning, 
to  the  external  washings  and  the  introduction  of  the  ointments, 
powders,  solutions,  etc.,  deeply  into  the  vagina.  The  latter 
caused  much  irritation  and  straining  whenever  even  moderately 
strong  antiseptics  were  introduced. 

Above  we  have  quoted  European  authors  as  using  and  recom- 
mending vaginal  irrigations  with  2-3%  bacillol,  creolin  or  lysol 
solutions,  or  other  antiseptic  solutions  of  similar  strength.  We 
were  quite  unable  to  u.se  these,  because  of  the  straining  and  irri- 
tation. But  we  found  that  we  could  use  concentrated  antiseptic 
applications  in  the  vulva  without  serious  difficulty. 

European  authors  do  not  definitely  record  the  amount  of 
irritation  induced  by  2%  vaginal  injections.  We  do  not  under- 
stand how  good  results  could  be  obtained  under  such  violent  irri- 
tation as  we  induced  with  concentrated  solutions.  In  our  expe- 
rience, the  irritation  retards  recovery.  After  the  use  of  irritant 
injections,  we  have  found  that  not  only  has  no  progress  toward 
recovery  been  made  while  they  were  used,  but,  after  their  aban- 
donment, the  application  of  otherwise  efficient  remedies  induces 
a  much  more  tardy  improvement  than  in  cases  which  have  not 
been  touched.  Possibly  the  quoted  European  authors  do  not 
differentiate  between  the  vulva  and  vagina,  and  introduced  the 
antiseptic  solutions  into  the  vulva  only.  If  so,  our  experience 
thus  far  coincides,  as  we  can  use  similarly  concentrated  solutions 
in  the  vulva. 

Hess,  speaking  of  sterility,  intimates  that  much  harm  is  done 
by  using  too  concentrated  vaginal  injections,  inducing  thickening 
of  the  vaginal  walls,  adhesions  and  other  lesions  which  may  cause 
insurmountable  sterility. 

Based  upon  our  limited  experience,  we  advise  daily 
vaginal  irrigations  of  0.75'/  bacillol  solution,  preceded  by- 
disinfection  of  the  tail,  perineum  and  buttocks  with  a  i^/(, 
carbolic  acid   solution  and  followed  by  a  vulvar  irrigation 


mo  Veterijiary  Obstetrics 

with  2%  bacillol  or  carbolic  acid.  The  solution  should 
have  a  temperature  of  approximately  ioo°  F. 

We  advise  that  a  suitable  galvanized  iron,  or  other  pail,  of 
about  5  gallons  capacitj'.be  procured,  and  fitted  with  a  metal 
faucet.  A  lo  foot  pure  gum  horse  stomach  tube  should  be 
attached  to  the  faucet.  The  stomach  tube  is  by  all  means  the 
best  appliance  known  to  us  for  conducting  the  fluid  from  the 
container  to  the  desired  part.  When  washing  the  external 
parts,  the  operator  can  shut  off  or  control  the  rate  of  flow  by 
placing  a  finger  over  the  outlet  of  the  tube.  The  tube  is  smooth 
and  pliable,  so  that  its  introduction  deeply  within  the  vagina 
can  work  no  injury,  and  yet  has  enough  rigidity  that  it  can  be 
introduced  through  the  vulva  into  the  deepest  part  of  the  vagina 
without  introducing  the  hand. 

A  heavy  wire  is  tightly  stretched  just  behind  the  row  of  cows, 
and  a  puUy  and  hook  placed  upon  it.  The  wire  should  be 
stretched  by  means  of  a  heavy  screw  bolt,  so  that  the  track  can 
be  so  tightly  stretched  that  it  will  not  materially  sag  in  the 
middle  when  loaded  with  the  five  gallon  pail.  The  pail  contain- 
ing the  solution  for  washing  or  for  irrigating  the  vulva  or  vagina 
is  then  suspended  from  the  pulley,  the  stopcock  opened,  and  the 
work  carried  out. 

We  believe  it  desirable  as  a  rule,  to  introduce  the  remedy  to 
the  deepest  part  of  the  vagina,  and  not  content  ourselves  with 
irrigating  the  vulva  only.  The  findings  of  Ostertag  and  others, 
that  the  infection  sometimes  gains  the  uterine  cavity,  suggest 
that  in  some  cases  the  irrigations  must  extent  into  that  cavitj'. 
After  the  outside  is  well  washed,  the  operator  may  open  the  vulva 
with  a  thumb  and  finger,  and  flush  it  with  the  same  solution, 
but  it  is  better,  in  our  judgment,  to  disinfect  the  vulva  after  the 
vagina  has  been  irrigated.  The  vaginal  irrigation  is  to  be  per- 
formed by  inserting  the  tube,  by  a  somewhat  rotary  movement, 
through  the  vulva,  deeply  within  the  vagina,  where  it  is  gently 
maintained  until  the  vagina  is  well  filled.  When  the  vagina  be- 
comes thoroughly  distended,  the  fluid  obliterates  the  mucous 
folds  and  reaches  every  part.  This  sometimes  requires  2  or 
more  quarts  of  solution.  Ordinarily  about  5  gallons  are  required 
for  washing  the  external  parts  or  irrigating  the  vaginae  of  15 
cows.  The  complete  handling  of  50  cows  for  one  day  can  be 
accomplished  by  one  man  in  about  2  hours.  The  cost  per  day 
for  disinfectants  by  this  plan  is  about  2.5  cents  per  cow. 


Gfamdar    Venereal  Disease  of  Cows  iiii 

Bacillol  appears  to  possess  some  very  important  advantages  as 
a  disinfectant  in  this  disease.  The  saponaceous  solution  breaks 
up  and  washes  away  the  vulvo-vaginal  discharges  apparently 
more  completely  than  any  other  disinfectant  we  have  tested. 
Permanganate  of  potash  seems  to  precipitate  the  muco-purulent 
discharge  and  cause  it  to  remain  in  place,  and  other  disinfectants 
behave  somewhat  similarly.  I^ysol,  cresol,  and  some  other  drugs 
of  this  group,  may  prove  quite  as  efficient.  One  party  reports  good 
results  with  o.oi%  corrosive  sublimate.  Ointments,  highly 
recommended  by  European  writers,  have  failed  in  our  hands. 
Perhaps  we  have  introduced  them  too  deeply  into  the  vagina, 
when  they  should  have  been  placed  in  the  vulva  only.  Ap- 
parently 6o-go  days  are  required  for  successful  treatment. 

The  handling  of  bulls  should  be  similar  to  that  advised  for 
cows.  With  a  gravity  apparatus,  we  irrigate  the  sheath  of  the 
penis  daily  with  0.75%  bacillol.  We  use,  for  inserting  into  the 
sheath,  a  pure  gum  horse  catheter.  We  direct  that  after  the  in- 
sertion, the  preputial  orifice  be  held  shut  until  the  sheath  is 
fully  distended  and  all  mucous  folds  obliterated,  so  that  the 
fluid  shall  reach  every  part. 

In  the  presence  of  pyometra,  the  vaginal  irrigations  with 
warm  bacillol  solutions  seems  to  favor  the  normal  contraction  of 
the  uterine  walls  and  emptying  of  the  cavity.  This  may  be 
aided  by  massaging  the  distended,  paretic  organ,  from  before, 
backwards,  through  the  rectum.  As  soon  as  the  ovaries  can  be 
reached  per  rectum,  any  cysts  or  persistent  yellow  bodies  should 
be  crushed  out.  When  an  affected  cow  calves  or  aborts,  the 
uterine  cavity  should  at  once  receive  careful  attention.  It 
should  be  thoroughly  irrigated  with  the  warm,  0.75%  bacillol 
solution,  three  or  four  times  daily  till  the  afterbirth  comes  away. 
When  the  afterbirth  is  easily  detached,  it  may  be  manually  re- 
moved . 

After  the  expulsion  of  the  afterbirth,  the  uterine  cavity  should 
be  irrigated  once  or  twice  daily  as  long  as  the  cervical  canal  re- 
mains open  and  uterine  discharge  continues.  Any  neglect  in 
this  respect  ma}^  lead  to  a  chronic  uterine  infection  to  be  followed 
by  sterility  or  abortion.  For  a  full  discussion  of  retention  of 
the  afterbirth  see  page  791. 

The  prophylaxis  of  the  disease  is  important  and  economic.  In 
introducing  new  animals  into  a  sound   herd,  precautions  should 


1 1 1 2  Veterinary  Obstetrics 

be  taken  against  the  entrance  of  the  infection.  There  is  every 
reason  why  the  buyer  of  cattle  should  resort  to  the  same  expedi- 
ent in  guarding  his  interests  as  has  long  been  common  among 
horsemen — a  veterinary  examination  for  soundness.  In  cows 
and  heifers,  the  disease  is  usually  easily  detected.  At  present, 
any  examination  of  a  bull  may  be  unreliable.  Of  more  value  are 
the  examinations  of  the  cows  which  he  has  recently  served.  A 
bull  calf,  which  has  not  been  used,  but  has  been  kept  in  a  herd 
where  the  disease  exists,  should  be  regarded  as  dangerous  for 
introduction  into  a  clean  herd  until  subjected  to  quarantine  with 
daily  disinfection. 

The  prevention  of  the  extension  of  the  disease  to  heifer  calves 
in  an  infected  herd  is  apparently  a  simple  matter.  In  Herd  8, 
66'/  of  all  females  are  diseased,  while  of  virgin  heifers  but  17% 
are  affected.  In  Herd  2,  the  percentage  of  infection  was  61 
among  heifer  calves.  In  Herd  2,  during  the  time  elapsing  be- 
tween inspection  in  January  and  inspection  on  May  23rd,  each 
heifer  recorded  as  sound  by  the  first  inspection  had  become  in- 
fected, without  having  been  bred.  From  our  investigations,  it 
appears  highly  probable  that  the  disease  is  transmitted  to  heifer 
calves  largely  by  grooming  with  utensils  befouled  by  .use  on 
diseased  animals.  Caretakers  may  carry  the  disease  to  calves 
in  other  ways,  which  prudence  would  suggest  should  be  avoided. 
If  practicable,  they  should  be  kept  in  separate  stables  or  en- 
closures, and  not  groomed  with  utensils  used  on  diseased  animals. 
They  should  on  no  account  be  served  by  suspicious  bulls. 

In  Herd  2,  are  some  very  young  infected  heifer  calves  which 
have  not  been  groomed.  Having  drawn  the  attention  of  the 
manager  to  the  dangers  of  grooming  with  infected  utensils,  no 
further  grooming  occurred.  Still  the  calves  were  infected.  In- 
quiries revealed  the  fact  that  the  calves  had  suffered  from 
diarrhae  and  the  feces  had  been  washed  from  the  tail,  vulva,  etc, 
with  a  sponge  u.sed  for  .sponging  away  the  muco-purulent  vulvar 
discharges  of  neighboring  di.seased  cows.  The  sponge  had  been 
u.sed  in  water  containing  a  little  creolin,  far  too  little  to  disinfect, 

The  bull  is  the  fundamental  transmitter  of  the  disease,  through 
copulation.  A  herd  bull  should  not  be  allowed  to  serve  strange 
cows,  unless  they  are  regarded  sound  by  a  competent  examiner. 
Even  then,  it  is  good  economy  to  regard  the  cow  as  suspicious 
and  disinfect  the  prepuce  and  penis  of  the  bull  immediately  after 
coition. 


Gra?i2ilar  Veueral  Disease  of  Cozvs  1113 

When  the  disease  exists  in  a  herd,  all  breeding  should  be  sus- 
pended during  treatment.  When  it  is  deemed  safe  to  resume 
breeding,  the  sheath  and  penis  of  the  bull  should  be  disinfected 
by  irrigating,  immediately  before  and  after  each  service,  as  ad- 
vised above.  The  vulva  of  the  cow  should  be  carefully  inspected 
daily  after  service,  and  antiseptic  irrigations  resumed  at  any 
time  conditions  may  so  indicate. 

The  attitude  of  veterinary  sanitary  authorities  toward  the  dis- 
ease in  this  country  is  yet  to  be  determined.  In  Europe,  many 
investigators  recommend  listing  it  among  the  serious  infectious 
disea.ses,  and   controlling  it  by  quarantine. 

It  is  to  be  hoped  that  a  careful  study  of  this  malady  will  now 
be  made  b}^  numerous  practitioners,  and  its  nature  and  best  mode 
of  handling  promptly  determined. 


APPENDIX 


THE    VENEREAL  DISEASE   OF   SHEEP. 

Without  having  been  aware  of  its  existence  in  America,  we 
have  inserted  on  page  io8,  a  brief  description  of  a  venereal  dis- 
ease occuring  in  sheep  in  Great  Britain. 

According  to  a  recent  communication  from  Mohler  of  the 
Bureau  of  Animal  Industry,  this  venereal  disease  of  sheep  pre- 
vails in  certain  portions  of  the  sheep  raising  section  of  the  West, 
especially  in  Montana  and  Wyoming.*  His  investigations,  as  yet 
unpublished,  indicate  that  the  bacillus  necrophorus  is  the  causa- 
tive agent,  and  that  the  infection  may  be  transmitted  to  healthy 
sheep  by  injecting  pure  cultures  of  this  organism  into  the  sheath 
or  vulva,  if  a  slight  abrasion  or  catarrhal  condition  of  the  mucosa 
is  present.  The  disease  is  apparently  identical  to  that  described 
by  McFadyean,  Flook,  and  Williams,  and  is  most  frequently  ob- 
served in  this  country  during  the  fall,  winter  and  early  spring. 
It  is  not  uncommonly  found  to  co-exist  with  similar  ulcerations 
and  wart-like  crusts  on  the  legs,  lips  and  muzzles  of  sheep 
(necrotic  dermatitis).  The  latter  affection  is  known  locally  as 
lip  and  leg  ulceration.  Bucks  with  infected  lips  are  said  to 
contaminate  the  vulvae  of  ewes  by  nosing  them,  and  the  sheath 
and  penis  of  the  bucks  in  turn  become  involved  by  copulation. 

The  treatment  will  be  found  very  efl&cacious  if  the  disease  is 
handled  like  contagious  abortion.  The  healthy  sheep  should  be 
separated  from  the  diseased,  and  the  sheath  and  vagina  irrigated 
with  mild  antiseptic  solutions,  while  the  external  ulcers  should 
be  covered  with  vaseline  containing  five  per  cent  carbolic  acid. 


ERRATA. 

On  page  129,  in  description  of  Fig.  14,  for  "CC,"  read  "UC." 
On  page  687,  for  "  Vaginal  Hysterectomy."  read  "  Vaginal 
Hysterotomy." 

On  page  855,  Page  Heading,  for  "Evorsion,"  read  "Eversion." 
On  page  244,  3d  line,  for  "  Under,"  read  "  Under." 
On  page  149,  Page  Heading,  for  "Phymosis,"  read  "Paralysis." 
On  page  104,  Title,  for  "Granulamota,"  read  "Granulomata." 
On  page  141,  Heading,  for  "Ov^er work,"  read  "Over- feeding." 


INDEX. 


Abnormalities  in  the  Development  of 
the  fetus,  727. 

Abnormal  Presentations  and  Positions 
of  the  Fetus,  753. 

Abdominal  Floor,  Edema  of  the,  436. 

Aberrations  and  Anomalies  in  ihe  De- 
velopment of  the  Fetus,  744. 

Abortion,  466. 

Abortion,  Accidental,  467. 

Abortion,  Artificial,  67.^. 

Abortion,  Enzootic,  473. 

Abortion  from  Infectious  Diseases  of 
the  Mother,  473. 

Abortion,  Granular  Venereal  Disease 
as  Cause,  1198. 

Abortion,  Infectious,  474. 

Abortion,  Infectious,  of  Cows,  495. 

Abortion,    Infectious,   of    Mares,  477. 

Abortion,  Sporadic,  467. 

Abscesses,  Actinomycotic,  of  the 
Broad  Ligament  of  the  Uterus,  113. 

Abscesses,  Peri-Vaginal,  901. 

Abscess,  Uterine,  S96. 

Absence  of  Estrum,  198. 

Acardia,  289. 

Accessorv  Organs  of  Reproduction, 
The,  3: 

Accidental  Abortion,  467. 

Actinomycosis  of  the  Broad  Liga- 
ments of  the  Uterus,  113. 

Actinomycosis  of  the  Genital  Organs, 
113. 

Actinomycosis  of  the  Prepuce,  113. 

Actinomycosis  of  Udder,  972. 

Acute  Endo-Metritisin  the  Mare,  874. 

Acute  Infections  of  the  Mammae,  940. 

Acute  Mammitis  in  Cow,  940. 

Acute  Metritis,  872. 

Acute  Metritis  in  Cow,  878. 

Acute  Metritis  in  Smaller  Animals, 
884. 

Acute  Metro-Peritonitis  in  Cow,  878. 

Acute  Metro-Peritonitis  in  the  Mare, 
877. 

Adhesions  of  Penis  and  Prepuce, 
Sterility  from,  148. 

Afterbirth,  Retained,  791. 

Agalactia,  Infectious,  of  Cows,  965. 

Agalactia  in  Goats  and  Sheep  (In- 
fectious), 977. 

Age  as  a  Cause  of  Sterility,  150. 

AUantois,  Dropsy  of  the,  424. 

Allantois,   I  he,  353. 

Amaurosis  of  Pregnancy,  435. 

Amnion,  Dropsy  of  the,  424. 


Amnion,  The,  347. 

Amputation  at  Humero-Radial  Articu- 
lation, 648. 

Amputation,  Intra  Pelvic,  of  the  Pos- 
terior Limbs,  653. 

Amputation  of  Anterior  Limbs,  Sub- 
cutaneous, 645. 

Amputation  of  the  Fetal  Head,  642. 

Amputation  of  Head  and   Neck,  644, 

Amputation  of  Posterior  Limbs  at 
Tarsus,  651. 

Amputation  of  Uterus,  844. 

Anomalies  in  Fecundation  and  Gesta- 
tion, 413. 

Anterior  Limbs,  Dystokia  from  De- 
viation of,  753. 

Anasarca  of  the  Fetus,  740. 

Anatomical  Defects  of  New-Born, 
1046. 

Anatomy,  Obstetric,  3. 

Anorchidy,  125. 

Ante-Partum  Prolapse  of  the  Vagina, 

449 
Anterior   Presentation,    Dystokia  in, 

753- 
Anus,  Imperforate,  1064. 
Apparatus  for  Obstetric  Work,  576. 
Application  of  Traction  to  the  Fetus, 

586. 
Apoplexy;    Parturient,     of  the  Cow, 

920 
Apthous  Venereal  Disease,  95. 
Arrested  Development  of  the  Penis, 

Sterility  from,  144. 
Arteries  of  the  Fetus,  The,  319. 
Artificial  Abortion,  678. 
Artificial  Impregnation,  279. 
Artificial    Respiration    in   New-Born 

Animal,  557. 
Ascites  of  Fetus,  739. 
Asphyxia  in  New-Born  Animal,  557, 

1035- 
Ass,  Duration  of  Pregnancy  in,  398. 
Atresia  of  Anus,  1064. 
Atresia  of  Body  Openings,  1066. 
Atresia  of  Cervix  Uteri,  685. 
Atresia  of  Posterior  Nares,  1065. 
Atresia  of  Teats,  993. 
Atrophy  of  the  Ovaries,  Senile,  245. 
Azoospermie,  125. 
Azoospermie  from  Systemic  Disease, 

137- 
Bacteriaemia  of  Calves,  1033. 
Bands,  Obstetric,  576. 
Beschalseuche,  73. 


I  ii6 


Index 


Ricornual  Pregnancy,  716. 

Birth,   Maiia.iienient  of    Normal,  53.S. 

Birth,  Premature,  466. 

Birtli,  vStill,  466. 

Bitch,  Duration  of  Pret^nancy  in,  39.S. 

Bitch,  Manmiitisin,  978. 

Bitch,  Pyometra  in,  895. 

Bitch,  Nymphomania  in,  244. 

Bladder,  334. 

Bladder,  Eversion  of,  855. 

Bladder,  Injuries  to,  durinjj;  Coition, 

Bladder,  Prolapse  of,  855. 

Bladder,  Prolapse  of,  through  Vagina, 
822 

Bladder,  Rupture  of,  820. 

Blastoderm,  284. 

Blastodermic  Vesicle,  284. 

Body  Cavity,  2S7. 

Botryomycosis  of  the  Udder,  974. 

Brain,  Hernia  of,  1069. 

Brain,  The,  291. 

Breech  Presentation,  783. 

Broad  Ligaments  of  the  Uterus,  Ac- 
tinomycosis of  the    1 13. 

Broad  Ligaments,  The,  21. 

"  Broken  Penis  "  as  a  cause  of  Ster- 
ility, 147. 

Bursattee  of  the  Penis  and  Prepuce, 
1 1 1. 

Cttsarian  Section,  663. 

Calcareous  Degeneration  of  Ovaries 
as  Cause  of  Sterility,  15S. 

Calculi,  Milk,  987. 

Calf  Septicaemia,  1033. 

Calves,  Bacterisemia  of,  1033. 

Calv^is,  Infectious  Diarrhea  of,  1028. 

Calves,  Septic  Pleuro-Pneumonia  of, 
1032. 

Campylorrhachis,  744. 

Canal,  Cervical,  26. 

Castration,  Influence  of  upon  the 
milk,  230. 

Castration  in  Sterility,  218. 

Cat,  Duration  of  Pregnancy  in,  398. 

Cat,  Pyometra  in,  895. 

Care  of  New-Born  Animal,  550. 

Care  of  the  Parturient  Animal,  550. 

Care  of  Umbilic  Cord,  558. 

Carnivora,  Duration  of  Pregnancy  in, 
398. 

Catarrh,  Infectious  Vaginal,  of  Cattle, 
97,  1075. 

Cattle,  Apthous  Venereal  Disease  of, 
95- 

Cattle  Granular  Venereal  Disease  of 
97,  1075, 

Cattle,  Infectious  Vaginal  Catarrh  of, 
97,  1075. 

Cattle,  Venereal  Diseases  of,  95. 


Cattle,  Vesicular  Exanthem  of,  95. 

Cellulitis,  Contagious,  68. 

Cellulitis    Epizootic,  68. 

Cephalotomy,  643. 

Cervical  Canal  of  the  Uterus,  26. 

Cervix  I  'teri   26. 

Cervix  Uteri,  Atresia  of,  685. 

Cervix  Uteri,  Induration  of,  685. 

Cervix  Uteri,  Rigidity  of,  682. 

Cervix  Uteri,  vSpasm  of,  682. 

Chisels,  Obstetric,  605. 

Chorion,   Rupture  of  in   Parturition, 

548. 
Chorion,  The,  355. 
Chronic  Metritis  in  Cow,  894. 
Chronic  Metritis  in  Mare,  885. 
Circulation,  The  Fetal,  328. 
Circulatory  S)'stem,  The,  319 
Clavicles  in  Pig,  345. 
Cleft  Palate,  298. 
Clothing,  Obstetric,  613. 
Clitoris,  Prepuce  of  the,  35. 
Clitoris,  The,  34. 
C<i?liim,  The,  287. 
Coital  Exanthema,  92. 
Coition,  49. 

Coition,  General  Infections  of,  64. 
Coition,  Injuries  to  the  Bladder  from, 

■^.^: 
Coition.  Injuries  to  the  Penis  during, 

60. 
Coition,  Injuries  to  the  Vagina  from, 

56. 
Coition    Physical  Injuries  of,  50. 
Coition,  Specific  Infections  of,  73. 
Coition,    Strangulated   Hernia  from, 

62. 
Coition,  The  Dangers  and   Infections 

of,  50. 
Columns,  Egg,  44. 
Congenital  Defects  of  the  Ovaries  as 

a  cau.se  of  Sterility,  155. 
Congenital  Tumors  of  Testicles,  125. 
1  Construction    of     Obstetric      Instru- 
ments, 608. 
Contagious  Cellulitis,  68. 
Contractures    of    Fetal    Extremities, 

746. 
Control  of  Expulsive  Efforts,  619. 
Control  of  the  Patient  in  Dvstokia, 
i      615. 

Contusion  of  the  Guteal  Nerves,  867. 
Contusion   of  the  Obturator  Nerves, 

868. 
Contusion     of      the      Lumbo-Sacral 

Nerves,  866. 
Co])ulation,  49. 
Cojjulation,  False,  53. 
Copulation,   Sterility   from    Phj'.sical 

Inability  to  Perform,  144. 


Index 


1117 


Cords,  Application  of  to  Inferior 
Maxilla  of  Fetus,  581. 

Cords,  Applications  of  to  Limbs  and 
Head  of  Fetus,  579. 

Cords,  Obstetric,  576. 

Corpus  f.uteum,  16. 

Corpus  i.uteum,  Dislodgement  of,  for 
Sterility,  227. 

Corpus  Luteum,  Hypertrophy  of ,  229. 

Corpus  Luteuui,  Persistent,  229. 

Cow,  Acute  Mammitis  in,  940. 

Cow,  Acute  Metritis  in,  S78. 

Cow,  Chronic  Metritis  in,  894. 

Cow,  Duration  of  Pregnancy  in,  398. 

Cow,  Granular  Venereal  Disease  of 
the,  in  America,  1075. 

Cow,  Infectious  Abortion  of  the,  495. 

Cow,  Infectious  Agalactia  of  the,  965. 

Cow,  Infectious  IMamnutis  of  the,  965. 

Cow,  Metro- Peritonitis  in,  S78. 

Cow,  Retained  Placenta  in,  793. 

Cow-Pox,  Mammitis  of,  968. 

Coxte,  The,  5. 

Cryptorchidy,  Sterility  from,  126. 

Cyanosis,  106S. 

Cyclops,  291 

Cystic  and  Cysto-Fibrous  Degenera- 
tion of  Ovaries  as  Cause  of  Sterility, 
161. 

Cystitis,  900. 

Cysts,  Dermoid,  of  the  Testicles,  125. 

Cysts  of  Fetal  Organs,  740. 

Dangers   and   Infections  of   Coition, 

The,  50. 
Death  of  Fetus,  460. 
Death  of  Fetus,  Causes  of,  547. 
Death  of  Fetus,  Diagnosis  of,  546 
Death  of  Fetus,  Dystokia  from,  733. 
Debilitating  Diseases  and  Overwork, 

Sterility  from,  137. 
Decapitation,  642. 
Decomposition  of  Fetus,  463. 
Defective  Secretions  of  the  Accessory 

Glands,  Sterility  from,  144. 
Defects,   Anatomical,    of    New-Born, 

1046. 
Defects  and    Diseases  of  the  Ovaries 

as  Cause  of  Sterility,  155. 
Degeneration   of  Ovaries,  Cystic  and 

Cvsto- Fibrous,  as  Cause  of  Sterility, 

161. 
Degeneration  of  Testicles,  Spontane- 
ous;  Sterility  from,  135. 
Dermatitis  of  the  Udder,  988. 
Dermoid  Cysts  of  the  Testicles,  125. 
Destruction  of  the  Pelvic  Girdle,  649. 
Detruncation,  648. 
Development  of  the  Organs  of  Special 

Sense   296. 


Development    of    the    Urino-Genital 

System,  332. 
Deviation   of   Anterior   Limbs,    Dys- 
tokia from,  753. 
Deviation  of  the  Uterus  692. 
Deviations  of   ihe  Head   and   Neck, 

Dystokia  from,  765. 
Diagnosis  of  Multiple  Pregnancy,  401. 
Diaphragm,  Rupture  of,  821. 
Diarrhea,  Infectious,  of  Calves,  1028. 
Diarrhea,  Sporadic,  1022. 
Digestive    Apparatus,     Functions   of 

the,  304. 
Discus  Pfoligerus,  14,  46. 
Diseases  of  Fetus  and  its  Membranes, 

460. 
Diseases  of  Pregnant  Animal,  421. 
Diseases,  Venereal,  73,  1075. 
Diseases  of  the  Fetus,  736. 
Diseases  of  New-Born   Animal,  1003. 
Diseases  of  the  Mammary  Glands,  939. 
Diseases  of  the  Fetus,  Dystokia  from, 

727. 
Dislodgement  of  Corpus  Luteum  for 

Sterility,  227. 
Displacements   of    Uterus,    Dystokia 

from,  692. 
Dog,  Venereal  Disease  of  the,  104. 
Dorsal  Transverse  Presentation,  786. 
Dorso-Ilial  Position,    Dystokia  from, 

780. 
Dorso-Ilial  position  of  Fetus,  753. 
Dorso- Pubic   Position,    Dystokia   of, 

780. 
Dorso-Pubic  Position  of  Fetus,  753. 
Double  and  Triple  Monstrosities,  748. 
Dourine,  73. 

Dress  of  the  Operator,  613. 
Dropsy  of  the  Amnion  and  Allantois, 

424.' 
Dropsy  of  the  Uterine  Cavity,  430. 
Dropsy  of  the  Uterus,  430. 
Ducts,'  the  Muellerian,  19. 
Duration  of  Pregnancy,  395. 
Dystokia,  568. 

Dystokia,  Apparatus  for,  576. 
Dvstokia,   Artificial  Abortion  as  pre- 
ventive, 678. 
Dystokia,  Control  of   Patient  in,  615. 
Dystokia,  Equipment  for,  576. 
Dystokia,  Fetal,  568,  714. 
Dystokia   From  Defective  Expulsive 

Powers,  673. 
Dystokia  From  Deviation  of  Anterior 

Limbs,  753. 
Dystokia   From     Deviations   of    the 

Head  and  Neck,  765. 
Dystokia  From  Displacements  of  the 

Uterus,  692. 


iii8 


Index 


Dystokia  From  Interlocking  of  Ma- 
ternal and  Fetal  Pelves,  773. 

Dystokia  From  Pelvic  Constriction, 
674.    . 

Dystokia  From  Pelvic  Fractures,  675. 

Dystokia  From  Rachitis,  674. 

Dystokia  From  Retention  of  Hind 
Limbs,  781. 

Dystokia  From  Tumors  of  Genital 
Passages,  690. 

Dystokia,  Instruments  for,  576. 

Dystokia    Maternal,  568,  673. 

Dystokia   of    Anterior    Presentation, 

753- 
Dystokia    of    Anterior    Presentation 

with   Forward  Extension  of   Hind 

Limbs,  776. 
Dvstokia  of   Posterior   Presentation, 

780. 
Dystokia  of  Twins,  752. 
Dystokia,  Position  of  Patient  in,  615. 
Dystokia,    The   Examination   of   the 

Patient  in,  623. 
Dvstokia,  The  General  Handling  of, 

627. 
Dysentery,  Infectious  of  Calves,  1028. 
Dysenteria  Neonatorum,  1022. 
Dysentery  of  New-Born,  1022. 
Dysentery,  Sporadic,  1022. 

Ear,   Dermoid  Cyst  of,  301. 

"Ear  Tooth,"  303. 

Ear,  The,  300. 

Eclampsia,  Parturient,  of  the  Mare, 
914. 

Eclampsia,  Puerperal.  See  Puerperal 
Eclampsia. 

Eclampsia,  Puerperal  in  the  Sow,  936. 

Eclamptic  Diseases,  Puerperal,  910. 

Edema  of  the  Abdominal   Floor,  436. 

Edema  of  the  Ovaries  as  a  Cause  of 
Sterility,  160. 

Edema  of  Udder,  979. 

Egg  Columns,  44. 

Egg,  Segmentation  of  the,  281. 

Emljr\o,  Formation  of  the   286. 

Embryology,  281. 

Embryotomes,  602. 

Embryotomy,  641. 

Embryotomy,  Exercises  in,  661. 

Embryotomy  Instruments,  599. 

Embryotomy  in  the  Anterior  Presen- 
tation, 642. 

Embryotomy  in  the  Posterior  Pre- 
sentation, 651. 

Embryotomy  Knives,  599. 

Embryotomy  Under  Special  Condi- 
tions, 660. 

Emphysema  of  Fetus,  733. 

Endo-Metritis  acute  )in  the  Mare, 874. 


Engorgement,   Mammary,  979. 

Enzootic  Abortion  from  Infectious 
Diseases  of  the  Pregnant  Animal, 
473- 

Epiblast,  285. 

Epididymitis,  Sterility  from,  130. 

Epizootic  Celhditis,  68. 

Equine  vSyphilis_,  73. 

Equipment  for  Obstetric  Work,  576. 

Eruptive  Venereal  Disease  of  the 
Horse,  92. 

Estrum,  48. 

Estrum,  Absence  of,  198. 

Estrum,  Relation  of  to  Ovulation 
Fertilization  and  Menstruation,  1 16. 

Eversion  of  the  Bladder,  855. 

Eversion  of  Uterus,  823. 

Eversion  of  Vagina,  848. 

Evisceration,  658. 

Ewe,  Milk  Disease  in,  937. 

Ewe,  Parturient  Paresis  in,  937. 

Ewes,  Gangrenous  Mammitis  of,  976. 

Ewes,  Infectious  Agalactia  in,  977. 

Ewes,  Infectious  Abortion  of,  507. 

Examination  of  the  Female  for  Ster- 
ility, 234. 

Examination  of  the  Male  for  Ster- 
ility,  151. 

Examination  of  the  Patient  in  Dys- 
tokia, 623. 

Examination  of  Udder,  968. 

Exanthem,  Vesicular,  95. 

Excess  of  Volume  of   the   Fetus,  727. 

Excessive  Erection  of  Penis,  Sterility 
from,  146. 

Excessive  Sexual  Use,  Sterility  from, 
142. 

Exercises  in  Embryotom}-,  661. 

Exercises  in  Mutations,  661. 

Exomphalus,  1046. 

Expulsive  Efforts,  Control  of,  619. 

Expulsion  of  the  Fetal  Membranes, 
527- 

Expulsive  Powers,  Inadequate,  as  a 
Cause  of  Dystokia,  673. 

Extension  and  Adjustments  of  the 
Fetal  Extremities,  636. 

Extensor  Pedis  Longus  Tendons, 
Rupture  of  in  Foals,  1070. 

Extraction,  Forced,  640. 

Extractor,  Pflanz,  Obstetric,  604. 

Extra-Uterine  Pregnancy,  415. 

Extremities,  Fetal,  Adjustment  of, 
636. 

Eye,  The,  29S. 

False  Copulation,  53. 
False  Corpus  Luteuni,  16. 
Fecundation,  Anomalies  in,  413. 
I'eeding  of  New-Born,  564. 


Index 


1119 


Feet  and  Limbs,  Painful  Diseases  of, 
as  a  Cause  of  Sterility,  150. 

Female,  Sterility  of,  151. 

Fertilization,  1 15. 

Fertilization,  Relation  of,  to  Estrum, 
Ovulation  and  Menstruation,  116. 

Fetal  Circulation,  The,  328. 

Fetal  Dystokia,  568,  714. 

Fetal  Emphysema,  727. 

Fetal  Extremities,  Contractures  of, 
746. 

Fetal  Envelopes,  Retention  of  the, 
791. 

Fetal  Extremities,  Extension  and  Ad- 
justment of,  636. 

Fetal  Membranes  and  the   Placenta, 

347- 
Fetal  Membranes,  Diseases  of  the,  460. 
Fetal  Membranes,  Expulsion  of,  527. 
Fetal  Organs,  Cysts  of,  740. 
Fetus,  Anasarca  of,  740. 
Fetus,    Application     of   Traction   to, 

586. 
Fetus,  Ascites  of,  739. 
Fetus,  Causes  of  Death  of,  547. 
Fetus,    Changes   of    Position    of,    in 

Dystokia,  631. 
Fetus,  Death  of,  460,  733. 
Fetus,  Development  of,  in  an  Abnor- 
mal Position,  716. 
Fetus,  Diagnosis  of  Death  of,  546. 
Fetus,  Diseases  of,  460,  736. 
Fetus,  Emphysema  of,  727. 
Fetus,  Excess  of  Volume  of  the,  727. 
Fetus,  Hydrothorax  of,  739. 
Fetus,  Masceration  of,  463. 
Fetus,  Mummification  of  the,  461. 
Fetus,   Mutations    of,     in     Dvstokia, 

631. 
Fetuses,  Number  of,  399. 
Fetus,  Presentations  of  the,  530. 
Fetus,  Position  of,  in  I'terus,  379. 
Fetuses,    Position    of,     in      Multiple 

Pregnancy,  402. 
Fetus,  Positions  of  the,  530. 
Fetus,  Putrid  Decomposition  of,  463. 
Fetus,  Repulsion  of,  632. 
Fetus,  Rotation  of,  632. 
Fetus,    Transverse    Development    of 

the,  as  a  Cause  of  Dystokia,  716. 
Fetus,  Tumors  of  the,  741. 
Fetus,  Version  of,  634. 
Finger  Knives,  599. 
Fissure  of  the  Palate,  1067. 
Fistula,  Milk.  985. 
Fistula,  Vesico- Vaginal,  863. 
Foramen  Ovale,  Persistent,  1068. 
Follicle,  Graafian,  46. 
Forced  Extraction,  640. 
Forceps,  Obstetric,  586. 


Formation  of  the  Embryo,  286. 

Forward  Extension  of  Hind  Limbs, 
Dystokia  from  in  Anterior  Presen- 
tation, 776. 

Fractures,  Pelvic,  Dystokia  from,  675. 

Freemartins,  .Sterility  of,  156. 

Furunculosis  of  the  Udder,  990. 

Gangrene  of  Mammae,  946. 
Gangrenous  Mammitis  of  Ewes,  In- 
fectious, 976. 
Gastro-Hysterotomy,  663. 
''  Gell)er  Gait  "  of  Cows,  965. 
General  Infections  of  Coition,  64. 
Generative  Organs,  The,  11. 
Genital  Cells,  Wandering  of,  414. 
Genital  Horse  Pox,  92. 
Genital     Organs,    Actinomycosis    of 

the,  113. 
Genital  Organs,  Wounds  and  Injuries 

of,  812. 
Germinal  Layers,  284. 
Germinal  Spot,  45. 
Gestation,  369. 

Gestation,  Anomalies  in,  413. 
Gluteal  Nerves,  Contusion  of,  867. 
Gluteal  Paralysis,  867. 
Goats,  Infectious  Abortion  of,  507. 
Goats,  Infectious  Agalactia  in,  977. 
Goat,  Nymphomania  in  the,  244. 
Goat,  Parturient  Paresis  in,  937. 
Goats,  Venereal  Disease  of,  1 10. 
Graafian  Follicle,  46. 
Graafian  Follicle,  Maturation  of  the 

44. 
Granular  Venereal  Disease  of  Cattle, 

97- 
Granulomata,  Venereal,  of  the  Dog, 

104,     1075. 
Gravid  I'terus,  Form  of,  374. 
Gravid  Uterus,  Hemorrhage  from  the, 

457- 
Gravid  Uterus,  Rupture  of,  417,  447. 
Gubernacuhcni  Testis,  336. 

Halters,  Obstetric,  577. 

Handling  of  Dystokia,   General,  627. 

Head  and  Neck,  Dystokia  from  De- 
viations of  the,  765. 

Hematoma  of  Vulva,  864. 

Hemorrhage  from  the  Gravid  Uterus, 
457- 

Hemorrhage,  Post-Partum,  812. 

Hemorrhage,  Unibilic,  1037. 

Hemorrhages  in  the  Udder,  983. 

Hermaphroditism,  Sterility  from, 
^57. 

Hermaphrodites,  Sterility  of,  127. 

Hernia  of  Brain,  1069. 

Hernia  Cerebri,  294,  1069. 


II20 


hidex 


Hernia,  Inguinal,  1059. 

Hernia,  Navel,  1046. 

Hernia,  Scrotal,  1059. 

Hernia,  Strangulated  Inguinal,  from 

Coition,  62. 
Hernia  of  Uterus,  445.  692. 
Hernia,  Unibilic,  1046. 
Hock,  Ani])utation  at  the,  651. 
Hooks,  Long  Cutting,  602. 
Hooks,  Obstetric,  582. 
Horse,  Eruptive  Venereal  Disease  of 

the,  92. 
Horse  Pox,  genital,  92. 
Hybrids,  Sterility  of,  127,  157. 
Hydrallantois,  424. 
Hydrocele,  Sterility  from,  136. 
Hydrocephalus,  293,  736. 
Hydrometra.  430. 
Hydrops  Amnii,  424. 
Hydrothorax  of  Feius,  739. 
Hygiene  of  Pregnant  Animals.  404. 
Hymen,  The,  32. 

Hy])ertrophy  of  Corpus  Luteum,  229. 
Hypoblast,  2.S5. 
Hysterectom}',  669. 
Hysterotomy,  Vaginal,  687. 
Hysterocele,  445,  692. 
Hysterotomy,  Gastro-,  663. 

Idleness  and  Overfeeding,  Sterility 
from,  138. 

Ilium,  The,  5. 

Imperforate  Anus,  1064. 

Imperforate  Vulva,  1064. 

Impregnation,  Artificial,  279. 

Induration  of  Cervix  Uteri,  6S5. 

Infection  During  Obstetric  Opera- 
tions, The  Prevention  of,  620. 

Infection,  Purulent  of  the  Navel, 
1005. 

Infection  Pyaemic,  902. 

Infections  of  Coition,  General,  64. 

Infections  of  Coition,  Specific,  73. 

Infections  of  the  New  Born,  1003. 

Infections   Puerperal,  871. 

Infectious,  Abortion,  474. 

Infectious  Abortion,  Granular  Vene- 
real Disease  as  Cause.  1098. 

Infectious  Abortion  of  Cows,  495. 

Infectious  Abortion  of  Goats,  507. 

Infectious  Abortion  of  Mares,  477. 

Infectious  Abortion  of  vSheep,  507. 

Infectious  Abortion  of  Swine,  507. 

Infectious  Agalactia  of  Cows,  965. 

Infectious  Agalactia  of  Goats  and 
Sheep.  977. 

Infectious  Diarrhea  of  Calves,    1028. 

Infectious  Diseases  as  a  Cause  of  Ste- 
rility, 151. 


Infectious  Diseases  of  Pregnant  Ani- 
mals as  Cause  of  Abortion,  473. 

Infectious  Gangrenous  Mammitis  of 
p;wes,  976. 

Infectious  Granular  Vaginitis  of 
Cows,  97,  1075. 

Infectious  Mammitis  of  Cow,  965. 

Infectious  Vaginal  Catarrh  of  Cattle, 
97,  1075- 

Inferior  Maxilla,  Securing  of,  with 
Cord,  638. 

Inflammation  of  Ovaries,  as  a  Cause 
of  Sterility,  158. 

Inflammation  of  the  Penis,  Sterility 
from,  147. 

Influenza,  Rheumatic,  68. 

Inguinal  Hernia,  1059. 

Inguinal  Hernia,  Strangulated,  from 
Coition.  62. 

Injuries,  Physical  of  Coition,  50. 

Injuries  to  the  Bladder,  during 
Coition,  58. 

Injuries  to  the  Penis  during  Coition, 
60. 

Instruments,  Construction  of  Obste- 
tric, 608. 

In.struments  for  Obstetric  Work,  576. 

Instruments  for  Section  of  P'otus,  599. 

Interlocking  of  Maternal  and  Fetal 
Pelves,  D\stokia  from,  773. 

Intestine,  Prolapse  of,  through 
Uterus  or  Vagina.  821. 

Intestines.  Ru])ture  of,  820. 

Intra-Pelvic  Amputation  of  Posterior 
Limbs,  653. 

Introductory,  i. 

Inversion  of  Uterus,  823. 

Involution  of  the  Uterus.  527. 

Ischium,  The.  6. 

Jaw,  Securing  of  the.  with  Cord,  638. 

Kidneys,   Ureters,   and  Bladder,  334. 
Knives,  Embryotomy,  599. 
Knives,  Finger,  596. 

Lambs,  Pustular  Eruptions  on   Lips 

of,  976. 
Laminitis,  Parturient,  907. 
Laminitis,  Puerperal,  907. 
Ligaments.  The  Broad,  21. 
Ligament,  The  Round  of  the  Uterus, 

26. 
Limbs,  Embrvologv  of,  341. 
Liver,  The,  318. 
Long  Cutting  Hooks,  602. 
Lower  Jaw,  Securing  of  by  Means  of 

Cord,  638. 
Lumbo-Sacral     Nerves,     Contusions 

of,  866. 


Index 


Lumbar  or  General   Paralysis,  Steril- 
ity from,  149. 

Lympho -Sarcoma,   Venereal,  of   the 
Dog,  104. 

Maladie  du  Coit,  73. 

Male  Animal,  Sterilit}-  of  the.  121. 

Male  Reproductive  Organs,  335. 

Malignant   Tumors   of    Genital   Pas- 
sages, 690. 

Mamnue,  Exanthema  of,  968. 

Mamuue,  The,  35. 

Mammary  Botryomycosis,  974. 

Mammary  Engorgement,  979. 

Mammary  Actinomycosis,  972. 

Mammary  Hemorrhages,  983. 

Mammary  Strangles  in  Mare,  973. 

Mammary  Toxaemia,  946. 

Mammary  Tumors,  981. 

Mammitis,  940. 

Mammitis  of  Bitch,  978. 

Mammitis  of  Cow- Pox,  968. 

Mammitis  of  Cow,  Acute,  940. 

Mammitis  of  Cows,  Infectious,  965. 

Mammitis  of  Ewe,  Infectious, 976,  977. 

Mammitis  in  the  Mare,  973. 

Mammitis  of  Swine,  978. 

Mammitis,  Tubercular.  970. 

Management  of  Normal   Parturition, 
538. 

Mastitis,  See  INIammitis. 

Mare,  Acute  Endo-Metritis  in,  874. 

Mare,  Acute  Metro-Peritonitis  in,  877. 

Mare,  Chronic  Metritis  in,  885. 

Mare,  Duration  of  Pregnancy  in.  397. 

Mares,  Infectious  Abortion  of,  477. 

Mare,  Nymphomania  in  the.  234. 

Mare.    Parturient  Eclampsia   of  the. 
914. 

Mare,  Retained  Placenta  in.  808. 

Masceration  and  Putrid  Decomposi- 
tion of  the  Fetus.  463. 

Masturbation.  Sterility  from,  143. 

Mastitis,  940. 

Maternal  Dystokia,  568,  673. 

Maturation  of  the  Graafian  Follicle, 
44. 

Maxilla,   Inferior.   Securing   of  with 
Cord.  638. 

Meatus  (Jriuarius,  34. 

Meconium.  Retention  of.  1041. 

Megalotnelus  Perissodactylus,  345. 

Membrane.  Vitelline.  46. 

Menstruation,  114. 

Menstruation,  Excessive  in  Granular 
Venereal  Disease,  1077. 

Menstruation,  Relation  of  to  Estrum, 
Ovulation  and  Fertilization,  116. 

Mesoblast,  285. 
Metritis,  Acute.  872. 

Metritis,  Acute,  in  the  Cow,  878. 


Metritis,  Acute,  in  the  Mare,  877. 

Metritis,  Acute,  in  Smaller  Animals, 
884. 

Metritis,  Chronic,  885. 

Metritis,  Chronic,  as  a  Cause  of  Ster- 
ility, 222. 

Metritis  (Chronic)  in  Cow,  894. 

Metritis  (  Chronic )  in  Mare,  885. 

Metro-Peritonitis  (Acute)  in  the  Cow, 
878. 

Metro-Peritonitis  in  the  Mare,  877. 

Metrorrhagia.  457. 

Milk  Calculi.  987. 

Milk  Disease  of  .Sheep,  937. 

Milk  Fever,  920. 

Milk  Fistuke,  985. 

Milk,  Influence  of  Castration  Upon 
the,  230. 

Milk  Stones,  987. 

Milk,  Uterine,  25. 

"  Mole  '"  289. 

Monstrosities,  367. 

Monstrosities,  Double  and  Triple,  748. 

Muco- Enteritis,  68. 

Muellerian  Ducts,  The,  19. 

Muellerian  Ducts,  The;  The  Ovi- 
ducts, Uterus,  and  Vagina,  19. 

Multiple  Pregnancy,  Diagnosis  of^ 
401. 

Multiple  Pregnancy,  Position  of  Fe- 
tuses in,  402. 

Mummification  of  the  Fetus,  461. 

Mutation,  631. 

Nares,  Posterior,  Atresia  of,  1065. 

Navel  Cord.  Rupture  of,  558. 

Navel  Hernia,  1046. 

Navel,  Purulent  Infection  of  the,  1005. 

Nerves,  Contusions  of  the  Lumbo- 
sacral, 866. 

Nervous  System,  The,  288. 

Neural  Groove,  288. 

New-Born,  Anatomical  Defects  of, 
1046. 

New-Born,  Artificial  Respiration  in 
the.  557. 

New-Born,  Asphyxia  in  the,  557. 

New-Born.  Care  of  the,  550. 

New-Born,  Diseases  of  the,  1003. 

New-Born,  Feeding  of.  564. 

New-Born,  Infections  of  the,  1003. 

New-Born,  Tetanus  of  the.  1021. 

Normal  Parturition,  509. 

Normal  Parturition,  Management  of,. 

538. 
Nose,  The.  296. 
Nostrums     and     Panacese      Against 

Sterility,  273. 
Nymphomania  as  Cause  of  Sterilitv,. 

161. 


Index 


Nyiiiphoniania,    General    Symptoms 

of,  172. 
Nymphomania  in  the  Bitch,  244. 
Nymphomania  in  the  Goat,  244. 
Nymphomania  in  the  Mare,  234. 
Nymphomania  in  the  Sow,  244. 

Obstetric  Anatomy,  3. 

Obstetric  Bands,  576. 

Obstetric  Chisels,  605. 

Obstetric  Cords,  576. 

Obstetric  Cutting  Hooks,  602. 

Obstetric  Forceps,  586. 

Obstetric  Halters,  577. 

Obstetric  Hooks.  582. 

Obstetric  Instruments,  Construction 
of,  60S. 

Obstetric  Operations,  631. 

Obstetric  Operations,  The  Prevention 
of  Infection  During,  620. 

Obstetric  Outfits,  611. 

Obstetric  Physiology,  40. 

Obstetric  Repellers,  595. 

Obstetric  vSaws,  605. 

Obstetric  Scalpels,  6cx). 

Obstetric  Shears,  604. 

Obstetric  Spatulas.  608. 

Obstetric  Work,  Equipment  For,  576. 

Obturator  Nerves,  Contusion  of,  868. 

Obturator  Paralysis,  868. 

Occlusion  of  the  Os  Uteri,  Sterility 
Due  to,  252. 

Odontomes,  1069. 

Olfactory  Organs,  The,  296. 

Omphalitis,  1005. 

Omphalocele,  1046. 

Omphalo-Phlebitis,  1005. 

Onanism,  Sterility  from,  143. 

Oophoritis,  .Sterility  Due  to,  158. 

Operations,  Obstetric,  631. 

Operations,  The  Prevention  of  Infec- 
tion During,  620. 

Operator,  Dress  of  the,  613. 

Orchitis  and  Epididymitis,  Sterility 
from,  130. 

Ossa  Innominata,  The,  5. 

Osteomalacic,  423. 

Os  Uteri,  Closure  of,  as  a  Cause  of 
Sterility,    252. 

Os  Uteri  Externutn,  27. 

Os  Uteri  Internum,  28. 

Outfits,  Obstetric,  611. 

Ova,  Permanent,  14,  45. 

Ova,  Primitive,  44. 

Ovarian  Pregnancy,  415. 

Ovaries,  Congenital  Defects  of,  as  a 
Cause  of  Sterility,  155. 

Ovaries,  Cystic,  and  Cysto-fibrous 
Degeneration  of,  as  Cause  of  Steril- 
ity, 161. 


Ovaries,  Edema  of,  as  a  Cause  of  Ste- 
rility, 160. 

Ovaries,  Inflammation  of,  as  a  Cause 
of  Sterility,  158. 

Ovaries,  Senile  Atrophy  of  the,  245. 

Ovaries,  Sterility  due  to  Defects  and 
Diseases  of,  155. 

Ovaries,  Sterilitv  from  Tuberculosis 
of,  158. 

Ovaries,  Tumors  of,  as  a  Cause  of 
Sterility.  159. 

Ovaries,  The,  11. 

Overfeeding,  Sterility  from,  138. 

Overwork,  Sterility  from,  137. 

Oviducts,  Sterility  Due  to  Diseases 
of,  247. 

Oviducts,  The,  22. 

Ovulation,  44. 

Ovulation,  The  Relation  of,  to 
Estrum,  Fertilization  and  Menstru- 
ation, 1 16. 

Palate,  Cleft,  298,  1067. 

Palate,  Fissure  of  the,  1067. 

Pancreas,  The,  318. 

Paralysis,  Gluteal,  867. 

Paralysis,  Obturator,  868. 

Paralysis  of  Penis.  Sterility  from,  145. 

Parah'sis  of  Pregnancy,  430. 

Paralysis,  vSterility  from  Lumbar  or 
General,  149. 

Paraphymosis,  Sterility  from,  149. 

Paraplegia  of  Pregnancy,  431. 

Paresis,  Parturient.  vSee  Parturient 
Paresis. 

Paresis,  Parturient,  in  Sheep,  937. 

Paresis,  Parturient,   of   the  Cow,  920, 

Parturient  Animal,  Care  of,  550. 

Parturient  Apoplexy  in  Cow,  920. 

Parturient  Eclampsia  of  the  Mare,  9 1 4. 

Parturient  Laminitis,  907. 

Parturient  Paresis  in  Goat,  937. 

Parturient  Paresis  in  the  Cow,  920. 

Parturient  Paresis  in  Sheep,  937. 

Parturient  Paresis  (False)  due  to 
Mammary  Infection,  946. 

Parturient  Paresis,  Pathologv  of  the, 
79'- 

Parturition,  Management  of  Normal, 

53«- 
Parturition,  Normal,  509. 
Parturition,  Symptoms  of,  517. 
Pathology  of  the  Parturient  State,  79 1 . 
Pathology  of  the  Placenta,  791. 
Pathology  of  the  Puerperal  State,  791. 
Pelves,    Dystokia    from    Interlocking 

of  Maternal  and  Fetal,  773. 
Pelvic  Constriction,    Dystokia   from, 

674. 
Pelvic  Fractures,  Dystokia  from,  675 
Pelvic  Girdle,  Destruction  of  the,  64  9 


Index 


1 1 23 


Pelvic  Symphysis,  Relaxation  of,  866. 

Pelvis,  The,  3. 

Pendulous  Udder,  988. 

Penis  and  Prepuce,  Bursattee  of  the, 
III. 

Penis  and  Prepuce,  Sterility  from  Ad- 
hesion of,  148. 

Penis,  "Broken,"  Sterility  from,  147. 

Penis,  Injuries  to  the,  during  Coition, 
60. 

Penis  or  Prepuce,  Tumors  of,  as  a 
Cause  of  Sterility,  145. 

Penis,  Sterility  due  to  Arrested  De- 
velopment of,  144. 

Penis,  Sterility  from  Excessive  Erec- 
tion of,  146. 

Penis,  Sterility  from  Inflammation  of 
the,  147. 

Penis,  Sterility  from  Paralysis  of,  145. 

Peromelus  Achirus   343. 

Peroinehis  Apus,  343. 

Perineum,  Rupture  of,  857. 

Peri- Vaginal  Abscesses,  901. 

Permanent  Ova,  14,  45. 

Persistent  Corpus  Luteum,  229. 

Persistent  Urachus,  1039. 

Persistent  Foramen  Ovale,  1068. 

Phymosis,  Sterility  from,  148. 

Physical  Inability  to  Copulate,  Ster- 
ility from,  144. 

Physical  Injuries  of  Coition,  50. 

Phvsiologv,  Obstetric,  40. 

"Pink  Eye,"  68. 

Placenta,  (Retained',  Granular  Vene- 
real Disease,  as  Cause  of,  1099. 

Placenta  (Retained'  in  the  Cow,  793. 

Placenta  (Retained)  in  the  Mare,  808. 

Placenta  (  Retained)  in  Smaller  Ani- 
mals, 811. 

Placenta,  Pathology  of  the,  791. 

Placenta,  The,  359. 

Pleuro-Pneumonia,  Septic,  of  Calves, 
1032. 

Polyspermia,  415. 

Posterior  Limbs,  Amputation  of,  at 
Tarsus,  651. 

Posteiior  Limbs,  Intra-Pelvic  Ampu- 
tation of,  653. 

Posterior  Nares,  Atresia  of,  1065 

Posterior  Presentation,  Dystokia  of 
780. 

Posterior  Presentation,  Embryotonn' 
in,  651. 

Post-Partum  Hemorrhage,  812. 

Position  of  Fetus,  Changes  of,  in 
Dystokia,  631. 

Positions  of  the  Fetus,  530. 

Position  of  the  Patient  in  Dvstokia, 
615. 

Pox,  Genital,  of  the  Horse,  92. 


Pregnancy,  369. 
Pregnancy,  Amaurosis  in,  435. 
Pregnancy,  Anomalies  in,  413. 
Pregnancy,  Bicornual,  716. 
Pregnancy,     Diagnosis   of    Multiple, 

401. 
Pregnancy,    Differentiation  of    from 

Various  Diseases,  393. 
Pregnancy,  Direct  Signs  of,  389. 
Pregnancy,  Duration  of,  395. 
Pregnancy,  Extra-Uterine,  415. 
Pregnancy,  Hygiene  of,  404. 
Pregnancy,  Objective   Signs  of,  387. 
Pregnancy,  Ovarian,  415. 
Pregnancy,  Paraplegia  of,  430. 
Pregnancy,  Physiologic  Signs  of,  385. 
Pregnancy,  Physical  Signs  of,  387. 
Pregnancy,    Position   of    Fetuses    in 

Multiple,  402. 
Pregnancy,  Positive  Signs  of,  389. 
Pregnancy,     Rupture    of    Prepubian 

Tendon  in,  4's6. 
Pregnancy,  Signs  of,  384. 
Pregnancy,  Subjective  Signs  of,  385. 
Pregnancy,  Tubal,  416. 
Pregnancy,  Twin,  399. 
Pregnant  Animal,    Diseases    of    the, 

421. 
Pregnant  Animal,  Hygiene  of,  404. 
Pregnant  Animal,  Infectious  Diseases 

of,  as  Cause  of  Abortion,  473. 
Pregnant  Uterus,  The  Form  of  the, 

374- 
Premature  Birth,  466. 
Prepubian    Tendon,    Rupture    of,  in 

Pregnancy,  436. 
Prepuce,    Actinomycosis  of  the,  113. 
Prepuce,  and  Penis,  Bursattee  of  the, 

I II. 
Prepuce  of  the  Clitoris,  35. 
Presentations  of  the  Fetus,  530. 
Presentations,  Transverse,  786. 
Prevention  of  (nfection  During  Obste- 
tric Operations,  620. 
Primitive  Groove,  The,  285. 
Primitive  Ova,  44. 
Primitive  Segments,  341. 
Primitive  Streak,  The,  285. 
Processus  Globularcs,  296. 
Ptocessus  Vaginalis,  336 
Prognosis  of  Sterility,  201. 
Prolapse  of  the  Bladder,  855. 
Prolapse  of  Bladder,  through  Vagina, 

822. 
Prolapse  of  Intestine  through  Uterus 

or  Vagina,  821. 
Prolapse  of  Rectum,  854. 
Prolapse  of  Uterus,  823. 
Prolapse  of  Vagina,  848. 
Prolapse  of  Vagina,  Ante-Partum,449. 


1124 


Index 


Prolapse  of  Vaginal   Portion   of   the 

Uterus,  449. 
Prolapse  of  Vaginal    Portion   of  the 

Uterus  in  Sterility,  201. 
Prolapsus  Vaginae  in  Sterility,  199. 
Pubis.  The.  7. 
Puerperal    Eclampsia   in    the     Bitch, 

938. 
Puerperal  Eclanijjsia  in  the  Sow,  936. 
Puerperal  Eclamptic  Diseases,  910. 
Puerperal  Infections,  871. 
Puerperal  Laminitis,  907. 
Puerperal  Period,  Pathology   of  the, 

791. 
Puer])eral  Septicaemia,  905. 
Puerj)cral  Tetanus.  909. 
Purulent  Infection  of  the  Navel,  1005. 
Pustular  Eruptions  on  Ijps  of  Laml)s, 

976. 
Putrid  Decomposition  of  Fetus,  463 
Pyetmic  Infection   (Puerperal),   902. 
Pyometra,  885. 

Pyometra  in  Bitch  and  Cat,  895. 
Pyometra  in  Cow    S94. 
Pyometra  in  Mare,  8S5. 
Pj'ometra  in  Sterility,  222. 
PyoSepthaemia,  1005. 

Rabbits,  Venereal  Disease  of,  no. 

Rachitis,  Dystokia  from,  674. 

Rectum,  Prolapse  of,  854. 

Relation  between  Estrum,  Ovulation, 
Fertilization  and  Menstruation,  116. 

Relaxation  of  Pelvic  Symphysis   866. 

Repellers.  595. 

Reproduction.  40. 

Reproductive  Organs,  The  Male,  335. 

Reproduction,  The  Accessory  Organs 
ofi  3- 

Repulsion  of  Fetus,  595,  632. 

Retained  Afterbirth,  791. 

Retained  Afterbirth,  Granular  Vene- 
real Disease  as  Cause  of,  1099. 

Retained  Placenta  in  the  Cow,  793. 

Retained  Placenta  in  Smaller  Ani- 
mals, 811. 

Retained  Placenta  in  the  Mare,  808. 

Retained  Placenta  in  the  Mare,  Frag- 
mentary, 810. 

Retained  Placenta  in  the  Mare,  Total, 
S08. 

Retention  of  Hind  Limbs,  Dvstokia 
of,  781. 

Retention  of  Meconium,  104 1. 

Retention  of  the  Fetal  Envelopes, 
791. 

Retro])ulsion  of  Fetus,  632. 

Rheumatic  Influenza,  68. 

Ribs,  i)ivisionofin  Embryotomy,  657. 

Ricketts,  Dystokia  from,  674. 


Rigidity  of  Cervix  I'teri,  682. 

Rotation  of  Fetus,  632. 

Round  Ligamment  of  Testis,  336. 

Round  Ligament  of  the  Uterus,  The, 
26. 

Rupture  of  Bladder,  820. 

Rupture  of  Diaphragm,  821. 

Rupture      of     the     Extensor     Pedis 
Longus  Tendons  in  New-Born,  1070. 

Rupture  of  Intestines,  820. 

Rupture  of  Navel  Cord,  558. 

Rupture  of  the  Perineum,  857. 

Rupture  of  the  Prepubian  Tendon  in 
Pregnancy,  436. 

Rupture  of  Sacro- Sciatic  Ligaments, 
821. 

Rupture  of  Umbilic  Cord,  558. 

Rupture  of  Uterus,  814. 

Rupture  of  Gravid   Uterus,   417,   447. 

Rupture  of  Uterus,  Prolapse  of  Intes- 
tine through,  821. 

Rupture  of  Vagina,  814. 

Rupture  of  Vagina  during  Coition,  56. 

Rupture  of  Vagina,  Prolapse  of  Intes- 
tine through.  82 1. 

Sacro-Sciatic  Ligaments,  Rupture  of, 
821. 

Sacrum,  The,  3. 

Saws,  Obstetric.  605. 

Scalpels.  Obstetric,  600. 

Schistocephalus  Bifidus,  297. 

Schistpcormus  Reflexus,  744. 

Scours,  White,  1022. 
Scrotal  Hernia,  1059. 
Section,  Instruments  for,  599. 
Sectors,  Obstetric,  605. 
Segmentation  of  the  Egg,  281. 
Senile  Atrophy  of  the  Ovaries,  245. 
Septicaemia.  Calf,  1033. 
Septicaemia,  Puerperal,  905. 
vSeptic   Pleuro-Pneumonia  of   Calves, 

1032. 
vShears.  Obstetric.  604. 
Sheep.  Infectious  Abortion  of.  507. 
Sheep    Infectious  Agalactia   in,  977. 
Sheep,  Milk  Disease  of,  937. 
vSheep,  Parturient  Paresis  in,  937. 
Sheep,  Venereal  Disease  of,  108. 
Sheep,  Venereal  Disease  of  in  Amer- 
ica, 1 1 14. 
Sinus  Venosus,  The,  319. 
vSomites,  341. 

Sow,  Duration  of   Pregnancy  in,  398. 
Sow,  Infectious  Abortion  of,  507. 
Sow,  Nymphomania  in,  244. 
Sow,  Puerperal  Eclampsia  in  the,  920. 
Spasm  of  Cervix  Uteri,  682. 
Spatulas,  Obstetric,  608. 
Special   Sense,    Development  of   the 
Organs  of,  296. 


Index 


1125 


Specific  Infections  of  Coition,  73. 

Spinal  Cord,  The,  294. 

Spontaneous  Degeneration  of  the 
Testicles,  Sterility  from,  135. 

Sporadic  Abortion,  467. 

Sporadic  Dysentery,  1022. 

Sterility,  119. 

Sterility,  Castration  in,  218. 

Sterility  due  to  Age  of  Male,  150. 

Sterility  due  to  Anorchidy,  125. 

Sterility  due  to  "Broken  Penis,"  147. 

Sterility  due  to  Chronic  Metritis,  222. 

Sterility  due  to  Congenital  Defects  of 
the  Ovaries,  155.  • 

Sterility  due  to  Congenital  Tumors  of 
the  Testicles,  125. 

Sterility  due  to  Cryptorchidy,  125. 

Sterility  due  to  Cystic  and  Cysto- 
Fibrous  Degeneration  of  the  Ova- 
ries, 161. 

Sterility  due  to  Defects  and  Diseases 
of  the  Ovaries,  155. 

Sterility  due  to  Defects  of  the  Ovi- 
ducts, Uterus,  Vagina  and  Vulva, 
247. 

Sterility  due  to  Diseases  of  the  Testi- 
cles and  Scrotum,  129. 

Sterility  Due  to  Edema  of  Ovaries. 
160. 

Sterility  due  to  Inflammation  of  Ova- 
ries, 158. 

Sterility  due  to  Occlusion  of  the  Os 
Uteri',  252. 

Sterility  due  to  Oophoritis,  158. 

Sterility  due  to  Tumors  of  the  Testi- 
cles, 129. 

Sterility  due  to  Tumors  or  Hernise  of 
Sheath,  145. 

Sterility,  Examination  of  the  Male 
for,  151 

Sterility  from  Adhesions  of  Penis  and 
Prepuce,  148. 

Sterility  from  Arrested  Development 
of  the  Penis,  144. 

Sterility  from  Calcareous  Degenera- 
tion of  Ovaries,  15S. 

Sterility  from  Debilitating  Diseases 
and  Overwork,  137. 

Sterility  from  Defective  Secretions  of 
the  Accessory  Genital  Glands,  144. 

Sterility  from  Excessive  Erection  of 
the  Penis,  146. 

Sterility  from  Excessive  Sexual  Use, 
142.  ■ 

Sterility,  Granular  Venereal  Disease 
as  Cause  of,  1099. 

Sterility  from  Hydrocele,  136. 

Sterility  from  Idleness  and  Overfeed- 
ing, 138. 

Sterility  from  Infectious  Diseases,  151. 


Sterility  from  Inflammation  of  the 
Penis,  147. 

Sterility  from  Lumbar  or  General 
Paralysis,  149. 

Sterility  from  Masturbation,  143. 

Sterility  from  Nymphomania,  161. 

Sterility  from  Onanism,  143. 

Sterility  from  Orchitis  and  Epididy- 
mitis, 130. 

Sterility  from  Over-Size  of  Male,  150. 

Sterility  from  Painful  diseases  of  the 
Feet  and  Limbs,  150. 

Sterility  from  Paraphymosis,  149. 

Sterility  from  Paralysis  of' Penis,  145. 

vSterility  from  Phymosis,  148. 

Sterilit)-  from  Physical  Inability  to 
Copulate,  144. 

Sterility  from  Spontaneous  Degenera- 
tion of  Testicles,  135. 

Sterility  from  Systemic  Disease,  137. 

vSterility  from  Torsion  of  the  Testi- 
cles, 137. 

Sterility  from  Tuberculosis  of  the 
Ovaries,  15S. 

vSterility  from  Tumors  of  the  Ovaries, 

159-  ' 
Sterility  from   Tumors   of    Penis   or 

Prepuce,  145. 
Sterility,  Nostrums  and  Panaceae,  for 

273. 
Sterility  of  Freemartins,  156. 
Sterility  of  Hermaphrodites,  127,157. 
Sterility  of  Hybrids,  127,  157. 
vSterility  of  the  Female,  151. 
Sterility  of  the  Male,  121. . 
Sterility,  Prognosis  of ,  201. 
Sterility,  Pyometra  in,  222. 
vSterility,  Therapeutics  of,  203. 
vStill  Birth,  466. 
Stomatodeal  Pit,  304. 
Straining,  Control  of,  619. 
Strangulated  Inguinal  Hernia  due  to 

Coition,  62. 
Stricture  of  Teats.  993. 
Superfecundation,  413. 
Superfetation,  413. 
vSupernumerary  Teats,  986. 
Swine,    Infectious   Aborti9n   of,  507. 
Swine,  Mammitis  in,  978. 
vSwine,  Venereal  Diseases  of,  1 10. 
Symptoms  of  Parturition,  517. 
Syphilis,  Equine,  73. 
vSystemic  Disease,  Sterility  from,  137. 
Teats,  Atresia  of,  993. 
Teats,  Stricture  of,  993. 
Teats,  Supernumerary,  986. 
Teats,  Warts  on  the,  992. 
Teats,  Wounds  of  the,  991. 


1 126 


Index 


Teeth,  Aberrations  in  the  Develop- 
ment of ,  313. 

Teeth,  The,  311. 

Teeth,  Tumors  of,  1069. 

Teratology,  367. 

Testicles,  Sterility  from  Spontaneous 
Degeneration  of,  135. 

Testicles,  Sterility  from  Torsion  of 
the,  137. 

Testicles,  Dermoid  Cysts  of  the,  125. 

Testicles,  Sterility  due  to  Tumors  of, 
129. 

Testicle,  The  Embryology  of,  335. 

Tetanus  Neonatorum,  102 1. 

Tetanus,  Puerperal,  909. 

Tetanus,  of  the  New-Born,  1021. 

Therapy  of  Sterility,  203. 

Tongue-tie,  1069. 

Torsion  of  the  Uterus,  693. 

Torsion  of  the  Testicles,  Sterility 
from,  137. 

Traction,  Direction  of  Application  to 
the  Fetus.  586. 

Traction  on  Fetus,  Amount  of,  588. 

Traction  on  Fetus,  Development  of 
Force  in,  591. 

Transverse  Development  of  the  F'etus, 
Dystokiafrom,  716. 

Transverse  Presentations,  786. 

Transverse  Presentation,  Dorsal,  786. 

Transverse  Presentation,  Ventral,  788. 

True  Corpus  Luteum,  16. 

Tubal  Pregnancy,  416. 

Tubercular  Mammitis,  970. 

Tuberculosis  of  Ovaries,  Sterility 
from,  158. 

Tuberculosis  of  Udder,  970. 

Tumors,  Congenital,  of  Testicles,  125. 

Tumors  of  the  Fetus,  741. 

Tumors  of  Genital  Passages,  690. 

Tumors  of  the  Mammie,  981. 

Tumors  of  Ovaries,  as  Cause  of  Ste- 
rility, 159. 

Tumors  of  Penis  or  Prepuce,  Steril- 
ity from,  145. 

Tumors  of  the  Testicles,  Sterility 
from,  129. 

Tunica  Albiiginea,  15,  44. 

Tumca  (h'anulosa,  46. 

Twins,  Dystokia  of,  752. 

Twin  Pregnancy,  399. 

Udder,  Actinomycosis  of,  972.  [ 

Udder,  Botryomycosis  of,  974. 
Udder,  Dermatitis  of  the,  988. 
Udder,  Edema  of,  979. 
Udder,  Exanthema  of,  968. 
Udder,  Furunculosis  of  the,  990. 
Udder,  Pendulous,  988. 


Udder,  The.  35. 

Udder,  Tuberculosis  of,  970. 

Udder,  Wounds  of  the,  991. 

I'mbilic  Cord,  Care  of,  558. 

Umbilic  Cord,  Rupture  of,  558. 

I'mbilic  Cord,  The,  364. 

Umbilic  Hemorrhage,  1037. 

Umbilic  Hernia,  1046. 

Urachus,  Open,  1039. 

Urachus,  Persistent,  1039. 

Ureters,  334. 

Urino-Genital  System,    Development 

of,  332- 
Uterine  Abscess,  896. 
I'terine  Cavity,  Dropsy  of  the,  430. 
Uterine  Milk,  25. 
Uterine  Prolapse,  823. 
Uterus,  Actinomycosis  of  the  Broad 

Ligaments  of  the,  1 13. 
Uterus,  Amputation  of,  844. 
Uterus,  Deviation  of  the,  692. 
Uterus,  Dropsy  of  the,  430. 
Uterus,  Dystokia  from  Displacements 

of,  692.' 
Uterus,  Eversion  of,  823. 
Uterus,  Form  of  the  Pregnant,  374. 
Uterus,  Hemorrhage  from  the  Gravid, 

457- 
Uterus,  Hernia  of,  445,  692. 
Uterus,  Inversion  of,  S23. 
Uterus,  Involution  of  the,  527. 
Uterus,  Prolapse  of,  823. 
Uterus,   Prolapse  of  Vaginal  Portion 

of,   2QI,   449. 

uterus.  Prolapse  of  Intestine  through, 

821. 
Uterus,  Position  of  the  Fetus  in, [379. 
Uterus,  Rupture  of   the   Gravid,  447. 
Uterus,  Sterility  Due  to  Diseases   o 

247. 
Uterus,  The,  24. 
Uterus,  The  Round  Ligament  of  the, 

26. 
Uterus,  Torsion  of  the,  693. 
Uterus,  Rupture  of,  814. 
Uterus,  Rvipture  of  Gravid,  417. 

Vagina,    Ante-Partum    Prolapse     of, 

449- 
Vagina,  Eversion  of,  848. 
Vagina,    Lacerations   of  the.  During 

Coition,  56. 
Vagina,  Prolapse  of  Bladder  through, 

822. 
Vagina,  Prolapse  of  Intestine  through, 

821. 
Vagina,  Prolapse  of  the,  in   Sterility, 

199. 
Vagina,  Rupture  of,  819. 


hidex 


1127 


Pro- 


of 


Va^na,  Sterility  Due  to  Diseases   of, 
247. 

Vagina,  The,  31. 

Vaginal  Catarrh,   Infectious,  of  Cat- 
tle, 97.  1075. 

Vaginal  Hysterotomy,  687. 

Vaginal  Portion  of  the    Uteru 
lapse  of,  449. 

Vaginal  Prolapse,  84S. 

Vaginitis,  898. 

Vaginitis,     Infectious     Granular 
Cows,  1075. 

Vaginitis    Verrucosa    of     Cows,    97, 
1075. 

Veins.  The,  326. 

Venereal  Disease,  Apthous,  95. 

Venereal   Disease,    Eruptive,    of   the 
Horse,  92. 

Venereal  Disease,  Granular,  of  Cattle, 
97,  1075. 

Venereal  Disease  of  the  Dog,  104. 

Venereal  Disease  of  Rabbits,  no. 

Venereal  Disease  of  Sheep,  108. 

Venereal  Diseases  of  Sheep  in   Amer- 
ica, III4- 

Venereal  Disease  of  Swine  and  Goats, 
no. 

Venereal  Diseases,  73. 

Veneral  Diseases  of  Cattle,  95. 

Venereal   Granulomata   of   the  Dog, 
104. 


Ventral  Transverse  Presentation,  788. 

Version  of  the  Fetus,  634. 

Vesicle,  Blastodermic,  284. 

Vesico-Vaginal  Fistula,  863. 

Vesicular  Exanthem,  95. 

Vitelline  Membrane,  46. 

Vitelline  Sac,  The,  347. 

Volume  of  the  Fetus,  Excess  of,  727. 

Vulva,  Hematoma  of,  864. 

Vulva,  Imperforate,  1064. 

Vulva,  Sterility    Due   to    Disease   of, 

247-    ^ 
Vulva,  The,  33. 
Vulvitis,  898. 

Wandering  of  Genital  Cells,  414. 

"  Water  Bag",  Rupture  of,  548. 

Warts  on  Teats,  992. 

White  Scours,  1022. 

Wild  Animals,  Duration  of  Pregnancy 

in,  398. 
Wolfhan  Bodies,  The,  332. 
Wolffian  Ducts,  The,  332. 
Wounds  and  Injuries  to   the   Genital 

Organs,  812. 
Wounds  of  the  Udder  and  Teats,  991. 
Wry-Neck,  746. 

Yolk  Sac,  The,  347. 

Zona  Radiata,  46. 


\ 


235  Cfl    BR 


lAi 


